Interview with Dr. Paul Farmer, MD, PhD

This interview is published in the IAEN (International AIDS Economics Network) Global Dialogue Series. Paul Farmer, MD, PhD, is the Medical Director of the Clinique Bon Sauveur in Cange, Haiti, and Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women's Hospital in Boston, Massachusetts, USA.

According to the IAEN, Haiti was the first country to receive Global Fund support, reflecting in part the respect of the work undertaken in Haiti by Dr. Farmer and colleagues. He is also the subject of a recent best-selling book "Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World."

In this interview, Dr. Farmer talks about the AIDS epidemic in Haiti, the interlinking of treatment and prevention, steps that countries should take that currently have low prevalence of HIV, funding issues, and what he would like to see as the principal messages or results coming out of the 2004 International AIDS Conference in Bangkok.

Dr. Farmer states that although the AIDS epidemic is high in Haiti, that "two decades of innovative AIDS prevention, which have included close attention to other STDs and to tuberculosis and women's health, have started to pay dividends: Haiti's AIDS epidemic is contracting, with sentinel surveillance showing unmistakable declines in prevalence."

He also believes that "it's becoming increasingly obvious that one of the best ways to improve HIV prevention is to improve care for those living with HIV disease.... There's no question that interest in VCT (Voluntary Counseling & Testing) has skyrocketed with the introduction of comprehensive HIV care, including access to ARVs (Anti-Retroviral (ARV) Treatments) for those who need them. The numbers are telling. We're moving from offering VCT to a few thousand people a year in the pre-GFATM era to having between 20,000 to 30,000 people accepting VCT each year. Second, the great majority of women in prenatal clinics here now see VCT as part of routine care. Third, we spend a lot of time thinking about "secondary prevention" by working closely with people living with HIV, incorporating them into prevention efforts and delivery of care. Fourth, patients who have undetectable viral loads are not only in close contact with providers, and hearing and sharing prevention messages, they are also "less infectious." Better care improves HIV prevention in many ways."

In conclusion, Dr. Farmer advocates for more funding and for HIV prevention and care to be fully integrated to address the HIV/AIDS epidemic. "It would be great if there were no more skirmishes between the prevention and care camps -- HIV prevention and care need to be integrated fully. I think that we should demand that more resources be invested in the biggest epidemic ever recorded. Is it really impossible to develop a vaccine? I think not. I also believe that promoting the notion of HIV prevention and care as "public goods"-- that is, taking a rights-based approach to AIDS-- is a key desideratum. And I think that community-based care for HIV disease should be seen as the standard of care. I also believe that all countries, especially the rich ones, should invest more in the Global Fund for AIDS, TB, and Malaria."

Click here for the full interview online.