10/06/08

Life after AIDS? Not quite yet

A couple of weeks ago I wrote an article in Prospect about HIV prevention among gay men now that near-universal access to treatment is making AIDS virtually invisible in rich countries. This excited a fair bit of comment over at Metafilter, not all of it pretty. But in any case, I was premature in declaring the end of AIDS.

Neither my article nor the comments focused on the really important issue raised by New York Magazine. In an excellent article, the magazine asks Who still dies of AIDS, and Why?. In countries where treatment is easily available, the answer is: people who don’t get tested and diagnosed until it’s way too late. And that is still far too many people. In the UK, one in five gay men diagnosed in 2006 didn’t find out he was infected until after the point when he should have started treatment (and they were 14 times more likely to die within a year than men diagnosed earlier). In New York City, it was one in four. As the (always sensible) Joe urges on Joe.My.God.: “Test, test, test. There is no excuse not to do so.”

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This post was published on 10/06/08 in Good sex and bad, Science.

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  1. Comment by Jim Pickett, 11/06/08, 02:01:

    Hey there, as I posted on the Joe.My.God post you mention above – yes, it is good to test, and I am all for informed, voluntary testing with some form of counseling, but without access to care and treatment, it is criminal to push it on people who, in fact, will not have access. In the US, we do a lot around testing, testing, testing – but still, here, in the richest country on the planet, around half of people living with HIV/AIDS do not have regular access to quality care and treatment. So, testing as a containment strategy (we also like to withhold prevention until someone comes up positive) – is a bad, bad deal.

  2. Comment by Roger, 12/06/08, 06:03:

    I am having problem undertanding why without access to care and treatment, it is criminal to push for testing on people who, in fact, will not have access to treatment.

    Is that also true for something like cancer? Diabetes? Obesity? or is it true only because it is a contagious disease?

    Isn’t it criminal to allow people kill other?

    ~r

  3. Comment by Jim Pickett, 16/06/08, 03:15:

    So, R, you think that unprotected (consensual) sex among two people is equitable to murder if one of those people is HIV positive?

    I believe it is criminal to alert people to their HIV status and then have nothing for them in terms of care and treatment. It is not ethical, or humane. Of course, much of our healthcare system is not ethical or humane.

    A testing strategy must include access to care and treatment. Why would anyone want to find out such difficult news if they knew there was going to be zero support for their health and well-being?

  4. Comment by Roger Tatoud, 16/06/08, 09:12:

    Jim,

    Because I believe that there is a chance for people being tested positive to change their behaviour and therefore save the lives of those they care about (and other they have sex with or share needles with).

    I have met more than one HIV+ people in my life. For some, the news was devastating and even if their sexual behaviour had all the ingredients leading to increase chances of getting infected, it still came as a surprise.

    Some, knowing they were positive decided to continue with unprotected sex either to take revenge or because they were in situations where they could not change their behaviour. In some case, the guys would not even take treatment even if they could get it (and they could) because it would be admitting being sick.

    Other decided not to have sex at all anymore and more decided to simply be more careful.

    I remember meeting a young guy and and his brother at the Thai Red Cross In Bangkok. He was HIV positive and he had convinced his brother to come and have a test too. The result was positive but he could not understand the lab results. They did not know much about treatment but they were still optimistic about the future.

    The problem is that because it is HIV, it should be different. Women regularly get breast cancer screening though there is still a risk that treatment fails. Older men get screened for prostate cancer though there is no treatment for this cancer. Some genetic disease can and are diagnosed before birth but parents still choose to have a child they know will suffer of an incurable disease. Few finds that unethical.

    Receiving such a bad news as being HIV does not makes people dumb or irresponsible. If it does, it is because of the stigma still attached to HIV. Keeping it secret or not offering people the possibility to know does not help getting ride of the stigma.

    See page 171 of Elizabeth book for a discussion on ethics and responsability.

    This does not mean I disagree with you when you say that A testing strategy must include access to care and treatment but HIV testing should not be ignored on the basis that it is more ethical to keep people ignorant than knowledgeable, especially when life and death are at stake.

    Warm regards.

    ~r

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