Q & A ON AIDS: Think Global, Write Local

In recent months, several major drug makers have agreed to sell AIDS drugs to Africa at significantly reduced rates. Sobering press reports from Africa, where an estimated 25 million people are HIV-positive, created the sense of urgency that helped bring about the change. Mark Schoofs, who won a Pulitzer last year for his coverage in The Village Voice of the AIDS crisis in Africa, now covers it for The Wall Street Journal. Mary Ellen Schoonmaker, an editorial writer at the Record, in northern New Jersey, caught up with Schoofs, via e-mail, in Uganda, to talk about where the story goes next:

Q: Now that the drug companies are beginning to lower prices, where does the coverage of this issue go?

A: Even at the new prices, the drugs are still expensive. The lowest price offered so far for the commonly used regimen has been $347 per patient per year. That sounds cheap, until you put yourself in, say, Malawi. In that country, the per-capita GNP -- the value of all goods and services produced in that country per person -- is just $190. So clearly, the world community -- the G8, the World Bank, large companies doing business in Africa, and so forth -- will have to pony up. The Harvard economist Jeffrey Sachs estimates that treatment and prevention in developing countries would cost rich countries only about $10 per person.

That said, if the world puts up serious money, how will these complicated regimens be delivered? AIDS is highlighting problems that have existed for ages -- in this case, the lack of basic public health in most of the world. I've met people with AIDS who were subsisting on one meal a day. For them, treatment didn't mean drugs, it meant a second meal. I've visited hospitals where surgical gloves were so scarce that doctors washed them for reuse and hung them out to dry like laundry. How will such places get AIDS drugs when they can't even get other basics?

And what about the patients? American activists scream racism when anyone suggests that African patients might be less likely than their American or European counterparts to take the AIDS regimens as directed. There may be an element of racism in some of those suggestions, but it's not racist to face up to the myriad ways in which extreme poverty can undermine AIDS treatment.

So actually delivering the drugs poses tremendous problems -- and, for journalists, superb opportunities for stories.

Finally, AIDS raises the question of other diseases. Will AIDS be remembered as an exception, or will the world change the way it does business to make sure that, while drug companies get rewarded for innovation, new medicines for malaria, TB, and other killer diseases also are made available to poor countries quickly? There, too, lie stories galore.

Q: Is this an issue that papers other than the Journal and The New York Times, etc., can cover? Is there some aspect of the crisis that a paper in Indiana, for example, might pursue?

A: Well, if the weekly Village Voice can send a journalist to Africa -- for six months, no less! -- then just about any paper can make a contribution. If you travel on a shoestring, you will get a much more interesting, worm's-eye view of the problems.

But for reporters doing domestic work, there are extremely urgent questions. If you read most AIDS coverage -- my own work included -- you would think that AIDS happened only in Africa. But 30 percent of American black, gay men -- 30 percent! -- get infected with HIV before they turn thirty. This is a scandal.

The double stigma of racism and homophobia renders these men tragically vulnerable to disease. Hardly anyone is reporting on this, even though such fundamental social issues make the most compelling public-health journalism.

Q: Isn't this a case where journalism can rightfully claim some of the credit for helping alert the world to this crisis and bringing pressure on the drug companies to start to lower prices -- a moral victory of sorts?

A: Absolutely. The fact is that journalism is a moral enterprise. Thirty-six million people and counting have a disease for which treatment exists, yet currently less than a tenth have any hope of getting that treatment. There is something profoundly wrong with this.

There is a tendency to think that just exposing a problem is enough, but it's not. AIDS has generated an astonishing amount of rhetoric, but I keep thinking about a nurse I met in remote northern Uganda. She had adopted three children from three of her AIDS patients who died. For her, all our stories have not made a difference, and I keep wondering how many more orphans she will have to take in.