July 07, 2002
From the desk of Jane Galt:Aziz Poonwalla has a good
Aziz Poonwalla has a good post on the possibility of treatment, but it suffers from a major flaw: it assumes that the two populations are similar.
It assumes that the drugs we use will work the same way in Africa, even though the major AIDS strain there is different from the one here.
It assumes that education will have the same effect there as it did here (although given that AIDS education is only apparently about 50% effective here, and unsafe behavior seems to be -- anecdotally -- on the rise again with the advent of the "cocktails", that may not be enough of a goal to shoot for)
It assumes that a disease vectored primarily through heterosexual sex will respond to education and/or treatment the same way as one vectored primarily through homosexual sex and blood-to-blood contact. This is actually pretty likely to be wrong, in my estimation. Media reports to the contrary, heterosexuals, unless they are the partners of bisexual men or drug users, are at a very low risk for contracting AIDS. The most successful public health efforts here have been extremely targeted: needle exchange, addict counseling, gay groups that made a fetish out of condom use. (I mean that in a good way, like Lister made a fetish out of cleanliness). It wasn't the campaign to get every heterosexual in America using condoms that slowed the epidemic; it was the flood of resources into the high-risk communities.
Most of all, it assumes that the drugs we send can be administered in Africa the same way they are here. I'm sorry, I just don't see it. Roads. Clinics. Electricity. Health care workers. Education, to believe that little bugs you can't see can really make you sick. (Don't snicker. It took your ancestors a hundred years to believe it.) Population density. Attitudes about sex. Look at where AIDS campaigns are working -- Southeast Asia and America/Western Europe, both with relatively shame-free attitudes about most sorts of sex, both with high levels of population density and a functioning health care infrastructure, both with compact high-risk populations that could be targeted and identified.
Vaccines? I'm all for 'em. But I'm not going to talk about an AIDS policy that relies on vaccines, any more than I'm going to talk about an environmental policy that relies on cheap renewable energy -- I'll be the first one waving the flag if it happens, but it hasn't yet, so let's stick to realities.
Now, I'm not saying that it can't be done. But I've had a couple of friends who were on the cocktails, and it strikes me as unlikely. Some of their meds had to be refrigerated (though I don't know that they were anti-AIDS drugs, as they were pretty sick when they went on). Others required careful monitoring of side effects. Everything had to be timed and regimented like a Busby Berkley musical number. They went to the doctor all the time. Now, maybe they didn't need to do all this. And maybe you could train people in Africa as AIDS workers. I don't know what's vital and what's not, but I do know that we'll have one shot to get it right -- because if we get it wrong, we'll be creating drug resistant viruses that won't give us a second shot.
Posted by Jane Galt at July 7, 2002 09:43 PM | TrackBack | Technorati inbound links