The Obama administration’s formulation of a new Aids/HIV policy in the past weeks coincided with a cluster of good news that may be pointing to another turning point in the fight to control and eradicate this epidemic worldwide. At the same time, social factors continue to represent the most serious obstacle to achieve such lofty goals.
With about 37 million people living with the infection in the world today, one million of them in the U.S., plus the over 24 million who already died of the disease since 1981, including half-million Americans, Aids has definitely not gone away, despite the appearances that the worst is over.
One of the reasons that this erroneous perception is at odds with reality is the almost 2 million children under 15 infected with Aids worldwide, most in sub-poverty living conditions and at high risk of passing the virus along to their countless sexual partners.
Once Aids stopped being considered a homosexual disease and the rate of heterosexual infections exploded, the world came to a belated but necessary realization that this epidemic is, indeed, everybody’s concern. It may’ve taken a few infected celebrities and a few outspoken children to give it an identifiable face to those who were mistakenly considering themselves safe from contagion, but once the evidence became irrefutable, another landmark was overcome.
Many would come after that and, in the process, any petty dispute over the authorship of the identification of the virus or how much money big pharmaceutical companies stood to make with the development of an effective treatment became irrelevant. At that particular juncture, it was all about saving lives. And lives were indeed saved, thank goodness.
For a brief time that couldn’t come to an end anytime too soon, obscurantism was let loose, conspiracies abounded and there was no help on sight. Did the virus jumped from some monkey species straight to humans? Has it gotten away from a chemical warfare experiment from a Philadelphian laboratory? At the end of the day, such rumors mill was of little or no help whatsoever. While they wasted time trying to pinpoint a culprit, Aids never stopped ravaging lives all around.
But we’re at a different point now. There’s still no cure or vaccine, but the currently prescribed treatment is effective to a significant majority of those infected. What’s becoming even more important than that now, though, are all the other factors that need to be addressed in order to make such effectiveness into a mechanism of change.
It’s great to have Aids medicines readily available for those who need in the U.S., Europe and all other developed societies. It’d be even better to have them on African drugstore shelves, Asian bazaars, forgotten Pacific Islands tribes and unknown small, impoverished communities that may have missed the comforts of Western civilization but haven’t escaped the fallout of its excesses.
It’s our responsibility to make sure the next step is taken, or rather, never stop to be taken, until we’re ready to tackle new challenges posed by this disgraceful virus. It’s not about pouring salt on open wounds, but to take bad and good news with a grain of the stuff. So we don’t get too depressed and hopeless and convinced there’s nothing else to do. Or too ready to pat ourselves in the back and congratulate us all on our good fortune. In the meantime, let’s check those good news.
A FEW GOOD NOTES
A South African study, for example, found that a vaginal gel can block the Aids virus, cutting in half a woman’s chances of getting HIV from an infected partner. The gel would need to be more effective to be approved in countries such as the U.S., but it can make a huge difference in South Africa, where one in three girls is infected with HIV by age 20. It can also cut in half the chances of getting the HSV-2 virus that causes genital herpes, which is important since any sexually spread diseases raise the risk of catching HIV.
- “This is the first time that there’s been a tool that women can use to protect themselves from becoming infected.” Harvard Medical School Professor Dr. Bruce Walker.
Another study published in the journal Lancet and presented at the International Aids Conference in Vienna, has proven that a stronger version of the already widespread used cocktail of antiretroviral drugs has dramatically reduced HIV infections among injection drug abusers. The fact confirms that, in the absence of an Aids vaccine, the cocktail is still highly effective and should remain part of any public policy designed to control the spread of the disease.
- “These findings are especially important since new HIV cases have remained stubbornly steady in the United States at a rate of about 56,000 per year for the past 10 years.” U.S. National Institute on Drug Abuse Director Dr. Nora D. Volkow.
At the same conference, the International AIDS Society-USA Antiretroviral Therapy Guidelines Panel, which makes non-binding recommendations on the treatment of the disease, is now recommending that therapy should start earlier than previously decided, following the level of the HIV viral load or the number of CD4 cells, which are the immune system cells target by the virus.
- “Advances in (antiretroviral therapy) have shown that Aids, as traditionally defined, can be prevented.” Guidelines Panel report.
Talking about an Aids vaccine, two other studies published in the past year have greatly raised hopes in its development. In one, a combination of two older vaccines lowered the infection rate by about a third after three years among 16,000 Thai volunteers. In the other, published earlier this month, researchers discovered human antibodies that can protect against a wide range of AIDS viruses.
“I am more optimistic about an AIDS vaccine at this point in time than I have been probably in the last 10 years.” U.S. National Institute of Allergy and Infectious Diseases Dr. Gary Nabel.
Going back to Africa with yet another piece of progress against Aids, a Malawi study sponsored by the World Bank found that if poor schoolgirls and their families received small monthly cash payments, the girls had sex later, less often and with fewer partners. A year and a half after the program started, girls were less than half as likely to be infected with the Aids or herpes viruses than girls whose families got no payments, underlining the central role of extreme poverty in sexual choices.
- “Maybe we can combine these behavioral and biomedical interventions.” WHO’s Dr. Tim Farley.
And finally, billionaire Bill Gates agrees with those who believe that prevention is the most effective way of fighting Aids. Among the efforts the Bill & Melinda Gates Foundation, which has reportedly dedicated about $287 million to 16 global Aids/HIV research teams, is focusing on are the promotion of male circumcision, monitoring of mother-to-child transmission, drug use and secret male sex practices, and research on understanding the virus itself, among others.
-“ Vaccines, new diagnostics and antiretroviral-based prevention (pills, injections and gels) are some of the new tools I’m really excited about. We don’t have the money to treat our way out of this epidemic.” Bill Gates.
THE NEW U.S. POLICY
The new directives announced by President Obama were equally received with praise and indifference from the part of Aids activists and researchers. It correctly identifies the need to improve the U.S. response to the disease’s growing impact domestically, but the lack of new funding is also seen as its main vulnerability.
To be fair, the Health and Human Services did allocate $30 million to develop better prevention methods. It directs government agencies to work more closely together, focus spending where it is most needed and identify where it’d be more necessary – for instance, black and Hispanic communities, drug users and gay and bisexual men.
It urges the FDA to make review of new HIV tests a priority and highlights the fact that patients need housing and other support in addition to medical care.
More than 56,000 new infections are reported in the U.S. every year, according to the Centers for Disease Control and Prevention.
- “We need to ensure every HIV-positive American gets the care they need. We need to make sure all our efforts are coordinated within the federal government and across state and local governments.” President Obama.
Finally, to illustrate how even the approach from law enforcement agencies and the U.S. judicial system has evolved in the matter, a New York State Supreme Justice ruled recently that a man, who infected at least 13 women with the Aids virus, can be locked up beyond his original prison sentence. The ruling is an acknowledgement of the seriousness of this disease and potential to be used as a lethal weapon, and how it can liable to be considered as such.
A long way since the days that people infected had to deal, besides the physical devastation caused by the disease, also with the insensitivity and public scorn of their condition from the part of those entrusted to protect them.
The outbreak of the Aids epidemic is commonly traced back to 1981, when increased reports of a rare form of “gay cancer” began to be discussed within the medical community in the U.S. and some European countries. Two aggressive forms of Kaposi Sarcoma and Pneumocystis carinii pneumonia, previously very rarely diagnosed in young patients, gave the red alert that something serious was apace, and the rest is unfortunate history.
The good news coming out in these past few weeks are stark contrast to the despair and hopelessness that surrounded the first years of the epidemic. People were dying because of their lifestyle choices but also unwittingly, infected by unavoidable blood transfusions and the like. Until the virus was identified and an effective test was developed, the mostly urban population who were getting infected was in no better position than sitting ducks.
So the news do show encouraging signs in the Aids treatment, but also show that comprehensive steps need to be taken to address the social environment of people affected by the disease. If social conditions do not improve, even if the treatment is more available than it has ever been, it may not be effective, for the discipline it requires depends a lot on the educational level of the community to which it’s destined.
THE MANDATE OF THE LIVING
It’s also great to see that in Western countries, there’s now an understanding that Aids is a lethal disease and can be liable to criminal responsibility if used on purpose to infect other people. But if such understanding is starting only now in the U.S., what about what happens in poor, war ravaged countries, where rape is commonly used as a weapon of domination?
In other words, a lot still remains to be accomplished. We owe to the thousands of people Aids took on its wake, and the thousands more of their loved ones left to collect the pieces of their broken lives and dreams. We owe to those who, even today, will die infected with HIV, without access to treatment or hope. And we owe to those who’re left behind to fend for themselves, a great majority of them, will also die from the same disease.
The fight to eradicate Aids in the world is much more than to cure a lethal disease. It’s the fight to save the future of so many, who need to live to help us build our own. Who need to survive to help us all live. Who must win so we can also prevail over poverty, social inequality, war and injustice.
Once again, a New York City public awareness campaign clashes with activists and community groups whose cause is supposed to support. This out-of-step ritual was on display recently over the amount of salt and sugar New Yorkers should be consuming (much less) and whether smoking is a public issue or a freewill lifestyle decision (it’s both).
And it’s all been played out in graphic advertisements shown mostly on YouTube and other straight-to-consumer media outlets, but hardly on the mainstream media. The effect though has been the same: advocates split over their efficiency and the city usually has to retreat, once it all becomes another arm wrestling and the message gets lost in the finger pointing.
The latest battle is being fought over a campaign about the risks of HIV, the virus that causes Aids. A still lethal disease with a gruesome regime of pill taking and rigorous controlled behavior, it’s been dangerously perceived as of lately as a minor discomfort by a demographics particularly vulnerable to it, under-20 youth.
But whether negative ads will propel a change of personal behavior or aggravate it is not what’s the most important at stake here. For instance, veteran Aids advocates see the need to first de-stigmatize it and its past association with a no longer truthful gay lifestyle, for any campaign to be effective.
On the other hand, proponents of a direct approach want to bring to the fore the devastation the disease is still capable of inflicting, and the limits of currently available therapies, compared to prevention and education.
In the end, a balanced mix of both approaches should be part of any renewed effort at tackling a public health issue that cuts such a swath through lower and uneducated classes, with increasingly rarer exceptions.
But in African and Middle Eastern countries, for example, Aids is still perceived as nothing short of a plague, as it’s proactively used against woman and minority rights. It’s often part of the brutal political subjugation arsenal that warring factions won’t hesitate to use against enemies, along with mass rape and dismemberment.
So, taking in perspective, the fight over methods to catch people’s attention toward this or that disease is really parochial and beside the point. Much harder is to use whatever means are available to address Aids’s underlining currents of poverty, addiction, political oppression, critical illiteracy and so on. In other words, it’s still time to act it up just like they used to say it in New York 30 years ago.
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