Moving Mountains: The Race to Treat Global AIDS (New Afterword) [Paperback]

Anne-Christine d'Adesky (Author)

Book Description

Publication Date: July 17, 2006 | ISBN-10: 1844675432 | ISBN-13: 978-1844675432

In dispatches written from villages and cities around the world, Anne-christine d'Adesky reports on the greatest challenge facing us today: the global effort to provide life-saving medicines and care to millions living with HIV and AIDS in resource-poor countries. With a new afterword.

In dispatches written from around the world, Anne-christine d’Adesky reports on the greatest challenge facing us today: the global effort to provide life-saving medicines and care to 40 million people living with HIV and AIDS in resource-poor countries, the great majority in sub-Saharan Africa. She analyzes the obstacles to providing universal access to antiretroviral drugs whose cost has been out of reach to millions until now, and she exposes the underlying and often competing agendas of donor and recipient governments, funders, activists and individuals with HIV who are struggling to survive.

In lively, in-depth field reports from countries including Cuba, Brazil, Russia, Haiti, Mexico, Uganda, South Africa, China and India, she reveals how pilot and national treatment programs are serving as models. They provide a litmus test of the feasibility of HIV and AIDS treatment in settings of abject poverty, underdevelopment and economic and political instability. Looking ahead, Moving Mountains discusses the potential of AIDS treatment programs to bolster prevention efforts and help rebuild shattered nations and economies. It also warns of the consequences that could face individuals, nations and the world if we fail to achieve this monumental task.

Editorial Reviews

From The New England Journal of Medicine

The term "paradigm shift" became something of a cliche in the late 20th century, but there are few who would argue with its use to describe the revolution in global thinking that occurred less than five years ago, when the world community decided that it was actually not all right for people to die from a treatable disease just because they could not afford the drugs they needed. In reality, few people probably ever thought that it was acceptable, but the world seemed to be constructed in a way that said it was. That was the paradigm. If you had diabetes, cancer, hypertension, the human immunodeficiency virus (HIV), or AIDS and happened to be a poor person in a poor country, you simply could not expect that most of the known effective treatments were going to be made available to you. Although the world community had previously united against epidemic diseases and their causes, with the smallpox campaign held up as the greatest victory, there was always a sense that any health strategies being considered for global implementation had to wait until there was a realistic (read, "cheap") solution at hand. With AIDS treatment, many people seemed to take a different view. Once antiretroviral drugs were seen as having the potential to transform HIV infection from a disease of guaranteed lethality into a manageable chronic infection, the call, led by an informal coalition of nongovernmental advocates, academics, and others, went out to make these drugs available to the 90 percent or more of people with HIV infection who live in poor countries. The precise moment of this paradigm shift is often considered to have been in 2000 at the International AIDS Conference, which for the first time was staged not only in a developing country (in Durban, South Africa) but right in the heart of one of the most affected areas in the world. From that time on, it became a matter of when, rather than whether, poor people would have access to antiretroviral drugs. Since then, "when" has become "how many," since a mutually reinforcing cascade of initiatives -- including large-scale private donations, the distribution of low-cost copies of antiretroviral drugs, and massive public-sector programs, such as the Global Fund -- have combined to send the message that effective treatment is essentially a basic human right. In Moving Mountains, journalist d'Adesky tells the story of this revolution in global thinking. Using a series of case studies from various countries, she covers a vast territory, both geographic and conceptual, and reports on her engagement with many of the key people and organizations that have been at the forefront of HIV treatment. D'Adesky clearly knows her way around this world, and she provides convincing testimony about the social and political challenges that this epidemic has exposed so starkly in many countries, including the overwhelming discrimination experienced by people with HIV infection, the risk that women face when they are not in a position to negotiate their sexual safety, and the thinly stretched fabric of infrastructure for primary health care that must now become the front line for HIV treatment. The author's country-by-country approach provides the reader with vivid images of local circumstances, but it also leads to a degree of fragmentation in the thematic aspects of her story. She sometimes reports an aspect of an issue as if it were unique to the place from which she is reporting, such as the fact that people in Mexico with HIV infection present late in the course of disease, whereas late presentation is common in most developing countries. On the other hand, the approach also produces some repetition that can serve to emphasize the power of her message. Despite containing a wealth of valuable detail (including eight appendixes and more than 75 pages of footnotes), the book could have benefited from some further technical editing. Protease inhibitors were not widely available in the early 1990s, Uganda is part of sub-Saharan Africa, it is the World Trade Organization (not the World Health Organization) that would have been the recipient of the U.S. government's complaint against Brazil in February 2001, and Bill Clinton was no longer in charge at that point. These quibbles about structural and editorial matters are secondary to the main problem with d'Adesky's book, which is that it is ultimately an extended polemic that divides the world into heroes and villains, whose roles are determined as much by their affiliation as by their actions: Pharma (Big) vs. Farmer (Paul), to extend the caricature. D'Adesky's account fails to acknowledge that the new global thinking about HIV treatment not only represents a paradigm shift for the AIDS epidemic but also challenges many of the comfortable and long-held assumptions on which the world economic and political order is based. Toward the end of the book, d'Adesky allows that the revolution in HIV treatment could well have implications for the funding and distribution of other drugs, but she does not make the links beyond health initiatives that can be put into small bottles and does not try to understand what it was about the AIDS epidemic that forced the world to respond in a way that it never had before. It is hard to resist the almost missionary fervor that d'Adesky conveys so well in her book, but the world remains a complicated place. Drug companies will still expect to protect their investments and intellectual property, international agencies will still have too few resources and too many demands to meet, and donors will still be driven by geopolitical imperatives and self-interest as much as by altruism. To be sure, some sobering lessons have come from the early chapters of the AIDS epidemic, when the international community spoke of confronting the epidemic with a change in behavior. Treatments have indeed made remarkable progress during the past decade, and we must keep extending their availability in every corner of the world, but it is important to remember that they do not provide anything approaching a cure, and there is not even a hint on the horizon that they will be capable of doing so. So although the situation for patients with HIV in poor countries may start to look more like that of patients in rich countries, we are still on a very long journey -- with many more mountains to cross, go around, or even move -- toward the control of the global pandemic, whether it is achieved through prevention or treatment. John M. Kaldor, Ph.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.

Review

D’Adesky clearly knows her way around this world, and she provides convincing testimony about the social and political challenges that this epidemic has exposed so starkly in many countries. (New England Journal of Medicine )

Indespensable for anyone trying to stop the global AIDS epidemic—or who wants to learn its searing lessons. (Mark Schoofs )

Moving Mountains should be required reading for anyone who wants to know how history's largest infectious killer of young adults could spread untrammeled across five continents. (Paul Farmer )

See all Editorial Reviews

Product Details

• Paperback: 496 pages
• Publisher: Verso (July 17, 2006)
• Language: English
• ISBN-10: 1844675432
• ISBN-13: 978-1844675432
• Product Dimensions: 7.9 x 6 x 1.2 inches
• Shipping Weight: 1.6 pounds (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #1,336,359 in Books (See Top 100 in Books)

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6 of 6 people found the following review helpful:

5.0 out of 5 stars Read this one, July 15, 2004

By A Customer

This review is from: Moving Mountains: The Race to Treat Global AIDS (Hardcover)

Moving Mountains is a thorough and moving account of the overwhelming worldwide threat of AIDs and the struggle to provide preventive medicines to those communities devastated by the virus yet lacking the resources necessary to contain it. Although I approached this book possessing very little knowledge about the AIDs virus and quite ignorant of its treatment methods, I found D'Adesky's study not only clear and informative, but involving and compassionate. Her relentlessly complete account of the immeasurable repercussions of AIDs, and the mind-numbing statistics she presents, are balanced by powerful personal accounts of AIDs victims and activists. Yet most important I think is D'Adesky discussion of the direction AIDs prevention is going and the disastrous results of failing to provide treatment. Although controlling the spread of the virus is an enormous task, as D'Adesky urgently informs us, the epidemic cannot continue to be ignored, and treatment cannot continue to be out of reach to the impoverished communities that need it most. I strongly recommend D'Adesky's book; it is a passionate and necessary addition to AIDS literature that should be read by all those actively interested in AIDs research - which should be every one of us.