I've been working on and with HIV/AIDS since 1982, and the only thing that keeps me going is hope. The sheer crush of the epidemic, especially in sub-Saharan Africa, can be overwhelming.
It was easier to be hopeful in the early days of the epidemic. We were sure then that we could conquer HIV. The gay community made behavioral changes and new infections went way down. Researchers quickly identified the virus that caused the disease, and the antibody test came soon after. We were told a vaccine was just a few years away.
I long ago abandoned my enthusiasm that we will prevail in the short run. HIV has taught us that there are no easy solutions. HIV is strong and clever and will survive.
President Bush's Emergency Plan for AIDS Relief, the largest single global initiative on HIV/AIDS, commits $15 billion over five years to help bring anti-HIV medications to parts of the world hit the hardest. I have seen the results firsthand. Physicians in South Africa and Uganda, where I work, are suddenly enlivened, energetic and hopeful. And so are their patients.
But the lack of qualified, trained health-care workers remains a major hurdle in many low-income nations. Sub-Saharan Africa has 25 percent of the world's burden of the disease but only 1.3 percent of the world's physicians. Mozambique has one physician for every 30,000 people, compared with one for every 360 in the United States.
A recent report by the Institute of Medicine advocates addressing that need by creating a "United States Global Health Service Corps." It would consist of full-time, salaried professionals willing to commit two years or more to living and working in hard-hit countries. They would provide medical care and drug therapy while training local health-care workers and giving them clinical, technical and managerial assistance. The institute also recommends creating one-year fellowships for health-care providers and a system under which physicians and other professionals could repay their medical school loans by working in needy communities outside the United States.
A Health Service Corps, like the Peace Corps, could bring knowledge, encouragement and hope to beleaguered health workers around the world. It could give American health professionals an avenue for sharing their knowledge. It also could capture the American imagination and inspire us to do better, as the Peace Corps has done since its creation more than four decades ago. The Peace Corps experience changes its volunteers, and they come home and change the people around them.
I recently met two physicians whose actions demonstrate the goodwill that awaits endeavors such as those the institute recommends.
Perry Jansen founded Partners in Hope, with the assistance of Christian and gay communities in Los Angeles. He moved his family to Malawi, one of the world's poorest countries, where he is working with the African Bible College to build and sustain a clinic. His business model shows that the operation should become self-sustaining within three years. In addition to diagnosing and treating people with HIV, Perry and his wife created prevention programs in the villages, a home-based care program and an inpatient nutrition ward. They adopted an AIDS orphan, Olivia, who was 6 months old and weighed 6 pounds when they took her in. She is thriving.
Kim Shiner, director of the Phil Simon Clinic at Huntington Hospital in Pasadena, Calif., founded the Tanzania Project in Arusha. The clinic provides funding, training and support and has sent or carried several tons of medical supplies to Tanzania. Pasadena physicians have provided medical care to more than 400 patients there.
Many other health professionals want to do the same, if only they knew how. The Health Services Corps and the other programs the institute recommends could be their vehicle.
Thomas J. Coates is a professor of medicine in the infectious diseases division at UCLA's David Geffen School of Medicine. He also is a member of the executive committee of the UCLA AIDS Institute.