I’m back! Still having issues with the laptop but have access to other computers now I found an excellent edition of the studentBMJ waiting for me when I got home – a special edition on HIV/AIDS. It is all available online for free for anyone interested: www.studentbmj.com.

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Interesting things happening in Palestine at the moment. I still find it interesting how willing Blair is to say that Hamas should be stopped, despite the fact that is has been democratically chosen by the Palestinian people.  Nothing surprising: we hardly have a history of supporting democracy…

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Great LondonFed seasonal social on Saturday: enjoyed by all I think. Well done to Noel and Neil for organizing it. I think I should be thinking up something suitable to put up for Christmas. Suggestions please!

And Finally

Last post in my quartet about HIV/AIDS.

Only in the past year have the number of heterosexual people infected with HIV in the UK outnumbered the number of gay people with HIV. Among gay men, HIV is extremelly prevalent. I believe that the reasons for this are manyfold and list a few below (not in any particular order).

1) Lack of education – the sex education curriculum in the UK does not even provide the space for sex education for gay people. It is not taught about and not spoken about. Services for gay youth arevery limited. I think the outcome of this is very similar to the outcome of abstinence only programmes in the USA: since young people will have sex if they are not equipped with knowledge about how to do it safely, when they do have sex they are more likely to do it unsafely. It is absoultely vital that some information about gay sexual health is put onto the curriculum so that every child is given the knowledge.

2) HIV as a chronic disease? - more recently, many people think of HIV as a chronic disease and ‘not a big deal’. It is great news that HIV can be treated so well, and as a result life expectancy is now much increased. Of course, it still remains a big deal. Even with the best anti-retrovirals, the side effects are huge and eventually many people’s infections become resistant to drugs. Anti-retrovirals do not reach the fluid surrounding the brain, which is part of the reason HIV cannot be eradicated from the body and also one of the reasons HIV is so problematic in the nervous system – people often die, despite all their treatment, from neurological problems: the treatment cannot prevent these.

3) The Closet – my guess is that being in the closet, feeling (due to society’s prejudices) that their sexuality is something to hide, makes many gay men ‘act out’ when they do engage in relationships.

There are many many more possible reasons for the prevalence rates but that was just a selection of thoughts.

As a final thought, I must thoroughly recommend Joseph O’Reilly’s Blog to anyone interested about this topic. It’s a well kept blog at number 51 in the top 100 Green Bloggers. A very enjoyable read on this and other Green politics issues!

(Red)?

I wonder about the (Red) initiative. While anything which increases awareness is great, I wonder if it is almost making it too simple. The soultions to the epidemic are political and such schemes encourage people to think that it is as simple as buying the right phone…

I suppose what annoys me the most is the spate of ”My Life, My Card” adverts turning up everywhere for Amex’s (Red) card. They almost seem to equate the life of a Masai with the credit card owned by Gisele (who is standing looking very carefree in the advert). So we can get a credit card from one of the least ethical banks, consume as much as we want with it and live with a clear conscience because 1p in every pound is going to pay for antiretrovirals? I think it is much more complicated than that!

Why so difficult?

If used carefully, antiretrovirals (ARVs) can prevent people from developing AIDS (severe immune deficiency caused by the HIV), yet millions are dying due to AIDS in the developing world. Only 5% of those who need ARVs in the developing world are receiving it.The reasons for this seem quite clear.

Poverty makes it difficult to access diagnostic services for many reasons. Not only is the cost of travel to a clinic prohibitive for many, the thought of being diagnosed with a chronic illness requiring long-term therapy scares many away from such services. Only be ensuring that necessary support and counselling is provided after diagnosis can more people be encouraged to use diagnostic services. In low and middle income countries, only 10% of those who require access to diagnostic services have access.
The cost of treatment is prohibitive for many. It is not just the cost of anti-retroviral drugs; even where these are provided free of charge, patients often have difficulties accessing clinics and dispensaries on a regular basis – it is often struggle enough to make ends meet without additional burdens. A recent article (registration required) in The Lancet found that providing weekly home delivery of free anti-retrovirals significantly improved patients’ adherence to treatment, which was reflected in lower viral loads. Lower viral loads mean healthier patients and lower risk of transmission. Lower risk of transmission helps avoid further increase in the size of the epidemic. It is not only important to ensure that drugs are given, but also that patients are monitored to reduce risk of resistance to ARVs developing – something that can be devestating for the patient and for those who contract HIV from him.

In addition, Intellectual Property laws make antiretroviral therapy unaffordable for most and make programmes offering free therapy much more expensive to implement. Despite a WTO waiver for drugs made before 1995 allowing the bypassing of patent regulations during epidemics like this one, many second-line medications are not available in generic forms, having been patented after 1995. It is a sign of a sick society when laws and regulation are not changed despite being the cause of hundreds of thousands of deaths. It shows that money is given more credence than anything else. This is another example of exchange values meaning more than use values in our economic system.

A good article to read about barriers to receiving ARVs here in the student BMJ, although of course the 3 by 5 initiative was never realized – despite the fact that the goal of 3 million people to be treated by 2005 was ridiculously modest!

World AIDS Day

 

A truly international tragedy. One which creates orphans, kills the young and ruins lives.

 

The tragedy that is the global HIV/AIDS epidemic is one which can only be solved by a multi-factorial strategy. It is a problem which brings together so many campaigns for reform – all must be successful in order to combat the disease. As I commented in my post “ABC?”, poverty and lack of education are central to the issue. In addition, reform of Intellectual Property law is needed – perhaps as part of a comprehensive rethink of the meaning of property and a fresh look at the ills of capitalism.

 

As well as the global perspective, on a more individual level the epidemic highlights human rights issues. The right of women to refuse sex and to be protected from rape by the state; the right to easy to access and comprehensive medical care; the right of gay men to not fear discrimination and to a decent sex education for children regardless of gender and sexuality.

 

All of this makes the HIV/AIDS epidemic an extremely political one. The solutions are societal and require a massive rethink of how society is run.

 

Over the next few days, I’ll be posting a series of thoughts on various aspects of this epidemic, I hope they’ll be interesting and worthwhile.