Re: Re: Re: Horizontal Transmission ? Reply to Perth 28 March 2004
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Mark Bartlett,
Communicable Disease Investigato
Toronto, Canada

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Re: Re: Re: Re: Horizontal Transmission ? Reply to Perth

James Parker said: "Despite it's African adventures Cuba contained AIDS by the application of orthodox public health measures which come closer to 'test and removal' than other situatons. These also point toward an infectious aetiology."

One would have to do a proper case-control study to determine if this is in fact the case. In removing these individuals, they may, in fact, be removing a cohort of individuals who practice risk behaviours that are not practiced in the general population. In doing so, it could appear that "test and remove" was successful because an "infectious agent" had been removed from the population at large, when in fact that was not the case at all.

If we rounded up all those who smoke and "removed" them from the population at large, I'd bet that lung cancer rates would fall in the overall population too. Would it be reasonable to conclude this was because we had removed an infectious agent -- hardly.

One needs to know far more about what "test and remove" means, in terms of how this practice impacts other risk behaviours -- without knowing and controlling for these other risk behaviours, "test and remove" is interesting but far from conclusive.

I would suggest that here in Canada (and in the US), where we do not have "test and remove" we have been very successful in controlling AIDS at the same time STD rates are going up -- which, interestingly is a proxy for unprotected sex.

Still, our numbers of AIDS cases is very small and still very much part of the original risk groups. All the predictions made a decade ago by the experts, in terms of anticipated numbers and spread into the hetrosexual population, have proven to be very wrong.

Competing interests: None declared