David Bangsberg stands with an outreach worker and recipient of HIV drugs.
Infectious diseases epidemiologist David Bangsberg has led an effort to save the lives of HIV-positive men and women in Uganda with the help of a cadre of committed colleagues and concerned citizens.
An associate professor of medicine at UCSF and director of the UCSF Epidemiology and Prevention Interventions Center at San Francisco General Hospital Medical Center, Bangsberg has brought hope to those whose lives would otherwise be cut short or whose families would be torn apart by HIV/AIDS.
In 2003, Bangsberg and his colleagues established the
Family Treatment Fund, a program which raises money through the UCSF Foundation to provide lifesaving antiretroviral treatment to Ugandans, most of whom cannot afford to buy the medications.
The introduction of low-cost generic AIDS drug therapy in 2001 has led to dramatic reductions in the cost of therapy - now $17 per month - but that price still remains out of reach for most Ugandans, whose median income is $300 per year.
"We find that extended families will pool their money together and are frequently forced to choose only one of several HIV-positive family members to receive treatment," Bangsberg says. "It's an extremely difficult, excruciating decision for families to make."
Often the decision for treatment considers how a family can maximize its future income potential. And sometimes paying for treatment can mean that a family can no longer afford to send their children to school.
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| Bangsberg and daughter pose with a family in Uganda. |
"The news about AIDS in Africa is astounding, and many people become numb to the fact that thousands of people are dying every day," Bangsberg notes. "But it's amazing to think that $1 a day will provide one person with therapy not only to save their life, but keep their family together."
A Big Impact
Located in eastern Africa west of Kenya, Uganda is a country slightly smaller than the size of Oregon with fertile, well-watered land featuring many lakes and rivers. Agriculture is the most important business, employing more than 80 percent of the workforce. Coffee is its biggest export and revenue source.
Uganda is widely viewed as offering the most effective and comprehensive national response to the pandemic in sub-Saharan Africa. Ugandans have employed a variety of approaches to AIDS education and prevention, ranging from promoting condom use to abstinence-only programs.
Yet the effects of HIV/AIDS in Uganda still result in thousands of deaths each year and contribute to lower life expectancy, higher infant mortality, and lower population and growth rates. For example, the life expectancy of Ugandan men is 50.74 years and that of women is 52.46 years, according to 2005 estimates.
Bangsberg first visited Uganda in 2000 to conduct a pilot study on patient adherence to antiretroviral treatment in an impoverished country. This research was important, as some feared that incomplete pill-taking would speed the mutation of drug-resistant strains that could spread around the world. Bangsberg's research found that Ugandan patients, on average, took more than 90 percent of their medications, compared with Americans, who took about 70 percent. It soon became clear to Bangsberg that Ugandans had the medical expertise, infrastructure and the motivation to counter the deadly disease. "The only thing missing was the medications," he says.
"We came up with the concept of the Family Treatment Fund to address this disparity by closing the treatment gap, and thereby bridge low-income Ugandan families to a time when HIV antiretroviral treatment will be more widely accessible," Bangsberg says. "We realized that if we just spent a little bit of time and energy, a small group could raise money and make a big impact to keep individual parents alive and families together in Uganda."
He credits his Division Administrator Laurae Pearson for being the "heart, soul and engine of the program" and his entire staff for going above and beyond their regular duties to promote the program, building a network of supporters that now numbers more than 200. The vast majority of these supporters, who learn about the program through word of mouth, are families and friends who contribute to the cause.
To date, the Family Treatment Fund has raised more than $100,000 and has provided about 60 people with lifesaving AIDS drug therapy. When the Family Treatment Fund first began paying for the much-needed drugs, organizers hoped to provide individuals with at least five years of therapy until they could receive government assistance. The organizers focused their initial intervention efforts on assisting widowed parents who took care of several children, including their nieces and nephews after their brothers or sisters had already succumbed to the virus.
International Support
Since then, international humanitarian aid in sub-Saharan Africa has soared, pumping cash donations into the Uganda Ministry of Health and elsewhere to help battle HIV/AIDS. Today, some 67,000 people in Uganda receive antiretroviral therapy. But access to medications can vary as the health care system experiences gaps and glitches in supplies and delivery.
Today, it may take a person as long as three to four months on a waiting list before getting treatment from national and international programs, Bangsberg says.
"We know that 20 percent to 30 percent of people will die while on the waiting list," he says. "Now we target our funds toward the sickest people on the waiting list. We're able to save a life for under $50 (or three months at $17 a month), then transfer them for long-term treatment on government-run programs. We've renewed our efforts even more."
For Bangsberg, 42, who moved to San Francisco with his family in 1994 to work as an infectious diseases fellow at UCSF, participating in the project has been exceptionally gratifying. Several times a year, he makes the 40-hour trek (36 hours by airplane and four hours by car) to southwestern Uganda, where he usually spends about a week working in Mbarara University HIV clinic, a small but vibrant program led by former NASA flight surgeon Larry Pepper.
"Every time I go, I get homesick," Bangsberg says. "But as soon as I come home, I look forward to returning."
Source: Lisa Cisneros
Links:
Family Treatment Fund
