Re: Re: HIV in Canada and elsewhere 20 September 2004
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Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY

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Re: Re: Re: HIV in Canada and elsewhere

I found Mark Bartlett's post interesting, because aside from his views regarding AIDS as an infectious disease he raises some extremely important issues. While not perhaps a good foundation on which to question the whole paradigm, they are perhaps a good foundation to raise ruckus in other ways. I think there may have been rushes in the field, maybe in causation but also in treatments, but I have to say that in my opinion the subsequent evidence has more than confirmed the original theses.

HIV and AIDS does indeed attract a lot of money, which is peculiar for a disease that largely affects the developing world. The political spectre of a sexually transmitted lethal infection is tall... The drugs are expensive, the research is extensive. The advantage is that people like myself were able to get funding to investigate minutae of the virus for purely academic interest. The disadvantage is that other fields perhaps don't get the money. Even "at home" in the UK prostate cancer affects 27,000 men every year (kills around 9,500). The annual AIDS incidence has been around 800 for the past few years. Such is the disparity in funding (around 4 million per annum for government-funded prostate cancer research versus around 20 million for HIV and AIDS) that the Daily Mail has started their own campaign to promote awareness of the situation. There is a very very real argument that money spent in developing countries on basic sanitation and medications would go very far indeed.

Sadly the threat from HIV there isn't immediate, and one must balance the future damage to the next generation (who will lack a great deal of teachers, workers and parents) with the immediate damage to the current. The dichotomy is perhaps best illustrated at the level of breastfeeding: how does an HIV+ mother balance the increased risk of giving HIV to her child against the decreased risk of acquiring immediate life-threatening infections due to using formula feeds?

I would also add that those countries in Africa which have managed to slow or even reverse the epidemic are those which started education and protective measures fastest. Those that refused to even acknowledge the disease existed, much less do anything about it (and for once, we're back on topic!) of course suffered the most. While one cannot of course say that these measures resulted in the observed improvements (correlation/causation once again) the logic seems pretty sound.

I feel that the next 30 years will be an awful turning point for the world, the developing world mostly, as the long-term effects of HIV infection rates of 10%-30% begin to bite. Even if they are "upper end estimates" or "only in a subpopulation", by God that's going to hurt.

Competing interests: None declared