Abuse of hiv/aids-relief funds in mozambique

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of such variants in vivo might aff ect sensitivity to other 4 Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus. N Engl J Med 2007; 356: 790–99.
reverse transcriptase inhibitors used at present. Although 5 Zuckerman RA, Lucchetti A, Whittington WL, et al. Herpes simplex virus the evidence for HIV-1 reverse transcriptase evolution (HSV) suppression with valacyclovir reduces rectal and blood plasma HIV-1 levels in HIV-1/HSV-2-seropositive men: a randomized, double- in people treated with aciclovir in vivo has never been blind, placebo-controlled crossover trial. J Infect Dis 2007; 196: 1500–08.
reported, this possibility should be addressed. Watson-Jones D, Weiss HA, Rusizoka M, et al. Eff ect of herpes simplex suppression on incidence of HIV among women in Tanzania. N Engl J Med We are convinced that, in view of the new data on 2008; 358: 1560–71.
aciclovir suppression of HIV reverse transcriptase, new 7 Celum C, Wald A, Hughes J, et al. Eff ect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with studies and new targeted clinical trials are needed to men: a randomised, double-blind, placebo-controlled trial. Lancet 2008;
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understand these newly discovered features of the 8 Lisco A, Vanpouille C. HSV-2 suppression and the incidence of HIV. interaction between HSV and HIV, and of the herpes- N Engl J Med 2008; 359: 535.
Cohen J. AIDS research: promising prevention interventions perform suppressive drugs in patients infected with HIV-1. Also, poorly in trials. Science 2007; 317: 440.
acknowledgment of the necessity for such trials is a 10 Hudson Eff ect of aciclovir on HIV-1 acquisition in HSV-2-positive patients. Lancet 2008; 372: 1298.
rare point upon which both of the teams engaged in 11 Lisco A, Vanpouille C, Tchesnokov EP, et al. Acyclovir is activated into a this discussion in The Lancet Infectious Diseases agree.
HIV-1 reverse transcriptase inhibitor in herpesvirus-infected human
tissues. Cell Host Microbe 2008; 4: 260–70.
12 McMahon MA, Siliciano JD, Lai J, et al. The antiherpetic drug acyclovir *Andrea Lisco, Christophe Vanpouille, Leonid Margolis inhibits HIV replication and selects the V75I reverse transcriptase
multidrug resistance mutation. J Biol Chem 2008; 283: 31289–93.
Eunice Kennedy Shriver National Institute Of Child and Human 13 Amini H, Javan M, Gazerani P, Ghaff ari A, Ahmadiani A. Lack of Development, Program in Physical Biology, National Institutes of bioequivalence between two aciclovir tablets in healthy subjects.
Clin Drug Investig 2008; 28: 47–53.
14 Weller S, Blum MR, Doucette M, et al. Pharmacokinetics of the acyclovir pro-drug valaciclovir after escalating single- and multiple-dose We declare that we have no confl icts of interest.
administration to normal volunteers. Clin Pharmacol Ther 1993;
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Van de Perre P, Segondy M, Foulongne V, et al. Herpes simplex virus and 15 Gupta R, Wald A, Krantz E, et al. Valacyclovir and acyclovir for suppression HIV-1: deciphering viral synergy. Lancet Infect Dis 2008; 8: 490–97.
of shedding of herpes simplex virus in the genital tract. J Infect Dis 2004; Cheng RG, Nixon DF. Herpes simplex virus and HIV-1: deciphering viral 190: 1374–81.
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16 Tchesnokov EP, Obikhod A, Massud I et al. Mechanisms associated with Barbour JD, Sauer MM, Sharp ER, et al. HIV-1/HSV-2 co-infected adults in early HIV-1 resistance to acyclovir by the V75I mutation in reverse HIV-1 infection have elevated CD4+ T cell counts. PLoS ONE 2007; 2: e1080.
transcriptase. J Biol Chem (in press).
Abuse of HIV/AIDS-relief funds in Mozambique
Before medical school I spent 3 years as a Peace Corps The investment of over US$2284 million into volunteer in Mozambique. A beautiful country fi lled with Mozambique in 2008 alone—by the US President’s potential, Mozambique is at present in the epicentre of Emergency Plan for AIDS Relief—increased the infl uence the AIDS epidemic. It also faces endemic AIDS-related of NGOs, the gatekeepers for much of that money. One corruption.
result has been an exponential increase in the number Mozambique was one of the last African nations of people on antiretroviral drugs and an increase in HIV- to win independence from colonialism. In 1975, prevention programmes. There is more money available the Portuguese fl ed the country, and a new socialist for HIV/AIDS than can reasonably be spent, especially government took control. Peace was brief, because given Mozambique’s poor infrastructure and large Mozambique plunged into two decades of civil war geographical area. Unfortunately, one side-eff ect has characterised by child soldiers, rape, and other human been an associated increase in corruption.
rights violations.1 During and immediately after the To give a recent example, many NGOs off er support war, there was a steadily increasing presence of aid programmes for people living with HIV/AIDS.5 By organisations in the country. These non-governmental distributing food, goods, and extra income, they help organisations (NGOs) fi lled a gap left by the young those with AIDS to live healthy, normal lives. However, government and had widespread infl uence across fi nancial and material incentives are very attractive in a the country.2 Although NGOs have worked hard to society as poor as Mozambique. One unintended result is improve lives, lack of oversight has led to substantial the identity theft of HIV-positive status. The current price opportunities for corruption.3 for a forged HIV test result is 200 meticais (about $8). www.thelancet.com/infection Vol 9 September 2009
Refl ection and Reaction
cult—government intentioned prevention programmes. However, abuse of salaries are frequently paid months late while hospital HIV/AIDS money has become widespread in Mozambique, workers struggle to make ends meet. According to a detracting from the overall public health eff ort.
report on corruption in Mozambique by the US embassy Although the detrimental eff ects of low-level in Maputo, “major corruption and mismanagement corruption are not enough to seriously derail the problems in the public health system stand as obstacles to HIV/AIDS eff ort in Mozambique, the situation is a continued improvement in health care delivery”.6 cause for concern. For example, suspect data and The price for falsifi ed health documents can be quickly subsequently inaccurate project evaluations make recouped—one programme in northern Mozambique resource allocation, as well as monitoring and off ers goats, worth $20–30 each, to HIV-positive people. evaluation, diffi The drive to fake one’s own HIV-positive status is even innocuous corruption will set the stage for large-scale stronger for government employees, who are eligible for systemic corruption is also a concern. Possible solutions a substantial salary increase for testing positive.
might include stronger monitoring and auditing by A second area of widespread corruption involves HIV donors and stricter controls on project monitoring prevention. Prevention activities necessarily occur in and evaluations. A requirement for individuals to take remote villages, where they are diffi cult to monitor. antiretroviral drugs to qualify for wage increases or A growing trend in Mozambique has been to request material incentives might help reduce the number of grants for rural education programmes (such as taking people with a falsifi ed HIV status. In the end, careful a theatre group to a rural primary school). However, and creative resource management will be needed to because of a lack of monitoring—almost a technical maximise aid effi impossibility in a country as vast and as lacking in infrastructure as Mozambique—it is common practice Paul Johnsonto pocket the money and falsify reports of having done Michigan State University College of Human Medicine, East Lansing, prevention work. Not only is aid money misspent, but the data collected I declare that I have no confl icts of interest. I would like to thank Jane Turner for on the number of people reached by prevention support during the writing of this article. programmes are inaccurate. The process of monitoring 1 Lautze S, Leaning J, Raven-Roberts A, Kent R, Mazurana D. Assistance, and evaluation is confounded by false data and protection, and governance networks in complex emergencies. Lancet 2004;
364: 2134–41.
an inaccurate picture of the progress in HIV/AIDS 2 Finnegan, CA: University of California Press, 1993.
prevention results. NGOs have outreach targets and 3 Hanlon, J. Do donors promote corruption?: the case of Mozambique. require statistics to report to donors, so there is little Third World Q 2004; 25: 747–63.
PEPFAR. FY2008 country profi le: Mozambique. http://www.pepfar.gov/press/countries/profi les/116237.htm (accessed March 6, 2009).
Money remains available because the total funds 5 PEPFAR. FY 2007 Mozambique partners. http://www.pepfar.gov/partners/103020.htm (accessed March 6, 2009).
available outpace the amount being spent. There have 6 USAID. Corruption assessment: Mozambique. Washington, DC: United States been many benefi ts from the infl ux of money for Agency for International Development, 2005. http://maputo.usembassy.gov/uploads/images/pdf/q3naBGGSYz8BsCXguSD5Pw/Final_Report-Mozambique__ HIV/AIDS into Mozambique. Over 460 0007 people that Corruption_Assessment-without_internal_rec.pdf (accessed March 6, 2009).
are HIV-positive have benefi ted from support and care, 7 PEPFAR. Mozambique FY 2007 Country Operational Plan (COP). http://www.
pepfar.gov/about/82448.htm (accessed March 6, 2009).
and many times that benefi t from well run and well The potential emergence of leptospirosis in Sri Lanka
Leptospirosis became a notifi able disease in Sri Lanka in a substantial increase in reported cases to 35·7 per 100 000 1991. The number of cases every year reported by clinicians during 2008.1 Documented increases occurred in at least to the Sri Lanka Epidemiology Unit of the Ministry nine districts (Colombo, Gampaha, Kaluthara, Kandy, Galle, of Health in the decade leading up to 2007 remained Matara, Kurunegala, Kegalle, and Matale), representing a around 1000–2000 cases, with an incidence in 2007 of large area of west, south, and central Sri Lanka (fi gure). The 11·0 per 100 000 population (fi gure). This was followed by case fatality rate for reported cases was 2·8%.
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Source: http://www.acismoz.com/docs/Lancet%20Moz.pdf