HIV - somewhat long

We've been watching the recent documentary by Stephen Fry, HIV and me. I've raved about the intelligent, sensitive and aware doco that was Fry's discussion on manic-depression (bi-polar). The HIV doco was far more moving, indepth and ultimately, depressing.

Fry, as I've mentioned, is one of the most articulate and interesting hosts out there, and as such god only knows when it will be played on NZ TV.
He looked at the historical death sentence that HIV was in the early 80s, and the development of drugs (around 24 now) to treat, suppress but not cure, HIV infection. Of far more interest was the current behaviour of both straight and homosexual youth in the face of the horrendous number of HIV infections in Britain (it's thought that around 20-40%? of people in the UK with HIV have yet to be diagnosed). They were, to put it politely, cavaliar about sexual behaviour. Unprotected sex, rampant numbers of partners. Dumb fucks. I've got nothing against rampant sexuality, but unprotected sex? yeah think I'll pass on that one. It's been awhile since we've seen full blown AIDS victims dying, that's how good the drugs have become. As such it was a shock to see them. I think that was the point Fry was trying to get across. Those of us who followed HIV in the 80s can remember Rock Hudson (vaguely), other images on the news of the death sentence, and of course Freddie. Admittedly he said that he had AIDS one day and dead the next, so not the most useful for HIV protection campaigning.

In addition to the stupidity of the youth, the social stigma associated with HIV has, apparently, got worse. As such the people who did front up to the camera to discuss HIV were in the minority. But hells bells they scared me. Kids with HIV who were infected in utero, living with HIV, getting yelled at by parents of their boyfriends. Ahhh ignorance.Bless it.

But the big one for me is a pet peeve of mine. Actually two pet peeves. Sub-saharan Africa has the biggest. and the fastest growing, rate of HIV infection. I've read that in various countries it is impossible to find a family who hasn't lost someone to the virus. First up is the gross stupidity of the South African government who deny the link between HIV and AIDS. Now this used to be questioned by Western scientists, but that was the early-mid 80s. I don't think, or at least I haven't read, anyone who disagrees that HIV infection causes AIDS recently. Apparently this hasn't reached SA. But this is a culture where STDs cannot be spread by having sex with virgins. there was some good news, but the implication was strongly that individuals, definitely not the government, were trying to educate people.

Uganda was also mentioned. A country where education in the 90s was helping control the rates of infection. But then early 2000 something happened in a land far far away that fucked that up. And no, there isn't a better way of phrasing that. The man who proudly asserted today that there will be peace between Israel and the Palestine curtailed funding to countries and organisations that did not live up to his 'faith based requirements'. And gosh gee darn whiz apparently condoms don't quite fit with George's requirements. I wonder if we level charges of genocide against him? Manslaughter by omission? Although given his inability to help various waterlogged regions of his own country, maybe we shouldn't complain too much... *I'll curtail the rant a bit*.

This, more than anything else in the doco, provoked heated discussion. S felt that treatment should be provided to those who are infected with the virus. My view is that yeah that's great and noble, but:
- inherent corruption in governments inhibits either purchase or distribution of the drugs
- costs of the drugs are prohibitive and if the first point isn't an issue, then the victims only have access to a limited supply of older style drugs. the efficacy of which is low and resistant is quite frequently built up
- getting to the hospital or drug distribution centre is prohibitive. One family Fry talked to took 3 hours to get to the nearest hospital - and I think we can assume the roads aren't as good as ours.
So S's point that everyone should have the right to treatment is, although noble and inherently good, I think misplaced. And that's what lead to our arguments.

My point is that putting money into providing drugs, and this is ignoring the George Bush problem (which exacerbated the problem immensely) had too many issues.
Firstly getting a consistent supply to the people who need them.
Second making sure the people take them.
Thirdly what to do when they develop resistance?

Obviously the drug companies are unlikely to give away their product for free. And given the amount of money involved in getting drugs through the FDA approval process, and requirement to their shareholders, nor should they. If nothing else, if they don't make a profit for investors there's going to be nothing available for R and D for the next generation of drugs. I realise that's over simplifying things, and that an argument could be advanced for subsided or lower profit margins, after the West has made their money. But I'm not going there today.

The distribution, corruption and ensuring the drug regime is followed are immense problems. If one of those issues occurs, then the viral load increases again and potentially causing resistance to develop.

My position, which caused the argument, was to largely ignore those already with the virus. The "what-ifs" are too likely to occur meaning money invested in the drug treatment is likely to be wasted. What strikes me as a more meaningful way of dealing with the problem is to focus on education. And focus on women. Most of the African societies are patrilineal - with women as chattels (as mentioned on the doco).Various aid organisations have found by funding women initiatives the return on the investments is better. Therefore if you can get the message to them to start wearing condoms it will begin to slow the virus infections. Education should also encourage women to pass this onto the children, in addition to education of the children. This could lead to more of a paradigm change than throwing money at corrupt governments.
Idealistic? yeah probably, but if the education system is emphasised with 'hey how many people do you know have died from HIV' and 'did they look good?' and 'do you want your children to die like that?' I imagine the pickup rate might be ok. From the doco, one of the most moving scenes was Fry talking to African women with HIV who were making 'Memory Books' for their children. Akin to planning your own funeral.
Now most of you will realise my leanings are left, which I think is why my suggestion of 'why waste money/resources on people who are drying anyway' caused such an argument. I think Western society has tried too many other options, which haven't worked, and as the drugs are not available all that is being achieved by giving the victims old school drugs is prolonging their ability to spread the disease. What really needs to happen is a shift of perception.
So by letting people die and focussing on women by saying 'hey, wanna end up like that?, no? wear a condom'. Might be the only way of achieving it. By allowing males to continue to have unprotected sex with HIV and giving them drugs - all you are doing is letting them live longer and infect more people.

And I think that leads to another problem that Stephen identified, the 'eh we can live for years with drugs' issue in the UK population. Why should they care when the new regime of drugs keeps people alive for years, and new drugs are continually being developed. But that's more a Western issue at the moment, the epidemic in Africa is at the point where HIV was in the 80s for Western society, except that the information isn't getting out there on how to have safe sex.

So who should be doing this? Obviously in a democracy with a rational leader you'd expect the government to take charge. But as the South African example shows, that ain't going to happen, and in the countries who don't have a democracy you've got even less chance due to higher levels of corruption. So it's going to fall to international aid agencies. And there's the crunch. The nice people who give donations to these organisations are going to get all upset if it comes out that the agencies are focussing on education to the detriment of victims. Sure it makes sense to stop the infection by telling people how it's transmitted and that contraception will stop it, but the lag time before improvement is seen (i'd guess 5-10 years) and the dramatic pictures of end-stage AIDS death ain't going to look good.

One other aspect that has crossed my mind is compulsory testing. Should everyone having sex get tested? Personally I'd suggest yes. I'd also suggest that it should be compulsory for pregnant women to get tested. Is this likely to happen? Very unlikely I'd say. But there is a comparable example, organ donation. I noticed this morning that the British government is considering making it an 'opt-out' rather than 'opt-in' issue in order to turn around the horrendously low donation rate. Now this is a topic I've thought about a lot. I'm fully in favour of it. Before the usual cliches are trotted out, bear in mind that one of the world's most Roman Catholic countries, Spain, has the 'opt-out' clause. The rate of donation is most Western countries is appallingly low, and sadly most families when placed in the position of making their recently deceased member's organs available, are too stressed to say yes. I would suggest presumed consent is a better way to go. Even if you do believe in a supernatural being, or soul, or whatever insecurity takes your fancy, then having a lung, heart, kidney, eye missing isn't going to affect that. In an ironic way donation might up the deceased's karma!

From a biological perspective, HIV is particularly efficient virus. It's spread by the one thing we all do, has long latency before symptoms show up - allowing plenty of time to spread the virus, and is able to mutate quickly to evade drugs being thrown at it. The one criticism I have of HIV is the low infection rate. Only exchange of bodily fluids transmits it, and even then it's still betting odds if you get infected or not. The upside to this inefficiency is that it gives us a method of control. Cut it off at the early stage - copulation. Notice how I'm avoiding abstinence as a solution? That's never worked - case in point, faith based "no sex til marriage" twats in the USA (sigh) have a higher pregnancy rate that the general populace. Apparently god is a horny wee beaver, or should that be buck?

Oh dear, now that kinda went on a bit longer than I thought it would. Those of you who would like to view this doco, give me a yell. And yep, this is a topic that depresses me.

Editorial at Nature:
Focus on Uganda:
South Africa and their 'lunatic fringe' view:
The Doco:
Muhammad Yunus : small funding bank founder and Nobel Prize winner

B.