One of the long-standing arguments against the use of anti-retrovirals to treat the AIDS crisis in Africa goes like this: African countries like the health infrastructure to ensure that patients will consistently take anti-HIV drugs (which, of course, have a number of side effects). This will create a situation, the theory goes, where few patients take the full set of drugs and likely give rise to more virulent, drug-resistant forms of HIV.
But a survey of African patients in Botswana, Senegal, South Africa and Uganda found that, in fact, HIV patients in those countries were more likely to stick to their regimen of AIDS drugs than were Americans.
On average, the survey reported that AIDS patients in those four countries take about 90 percent of the prescribed drugs. That ranks favorably with American AIDS patients who, in similar surveys, reported taking about 70 percent of their anti-HIV drugs.
Interestingly, there is also evidence that African patients are more truthful in reporting their compliance with the anti-HIV regimen than American patients. According to the New York Times’ report of the survey results,
Moreover, doctors say, most African patients are zealous about their regimens. They are also more truthful when estimating their adherence, said Dr. David Bangsberg, a professor of medicine at the University of California in San Francisco who has studied compliance patterns here and abroad.
On average, he said, American patients tell their doctors that they are doing 20 percentage points better than they really are Â— that is, a patient who says he takes 90 percent of his pills will, when tested with unannounced home pill counts or electronic pill-bottle caps, turn out to be taking 70 percent.
A study of 29 Ugandan patients found that, on average, they estimated that they were taking 93 percent of pills and proved to be taking 91 percent.
There are a number of possible reason for the difference, including that in African nations a number of people in the AIDS patient’s extended family may be contributing to help pay for the relatively expensive drugs, and that AIDS patients in Africa have a more immediate experience with numerous fatalities from the disease given the relatively high death rate from AIDS in Africa compared to the United States.
Africans Outdo Americans in Following AIDS Therapy. Donald G. McNeil Jr., New York Times, September 3, 2003.