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This post was published on 24/02/10 in Pisani's picks, Science.

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  1. Comment by peripheries, 24/02/10, 11:16:

    I got an even better figure than yours, but a different explanation as why it could not work, even if I think it is the future!

  2. Comment by Conor, 25/02/10, 12:15:

    I completely agree with what you have said there. As a gay man I know that a lot less people are using condoms due to an apparent decrease in the risk of HIV killing you. I have spent countless hours (including many last night) explaining some side effects of drugs and how 1 pill a day is possible but its still 1 pill every day for the rest of your life which will sill probably be considerably shorter than if no HIv transmission had taken place. As I do HIV research myself I see how the drugs are improving quality and length of life and fighting the disease, I still think that if people didnt get it at all in the first place we wouldnt need better drugs, we wouldnt need drugs at all.

  3. Comment by Pheasant, 25/02/10, 02:43:

    Pisani always looks at facts and arguments. I think she looks at them from many points of view. The people who whine and complain about her seem more concerned about appearances and maybe, accidentally offending someone. People are going to be pissed by her findings, but get over and start working toward some solutions.. this is HIV we are talking about people.

  4. Comment by Sahil, 25/02/10, 04:57:

    [this comment is on thebathhouse as well]

    I think the original article helps raise anthropologists’ favourite issue – practice. Is it more fruitful to think of ‘development ‘as policy statements – such as blanket testing and treatment for all – or practice.

    The development industry has to be more concerned with policy statements that mobilise funding and the support of a diverse set of interest groups – NGOs, Governments, Electorate, WTO etc – than about how policy unfolds when it’s implemented.

    What the article help’s articulate is that policy is undermined by all sorts of mundane human factors. To maintain ARV treatment you need to eat etc, you need to make it to the clinics regularly etc. This doesn’t, in itself, undermine the policy prescriptions, but I think the gap between policy and practice is not thought about enough when considering development intervention.

    From my perspective development is, like everything, a case of competing interest groups. Policy is a tool to align some interest groups, which by definition, marginalises others. I don’t know enough about the development health industry, but I guess a policy of blanket testing and treatment will be fantastic news for Big Pharma and other health-delivering organisations, alongside having plenty of other consequences.

    This is all very obvious and it doesn’t undermine the policy, but 50 years of evolving policy statements have had pretty unsatisfactory development outcomes, so how else can we think about it all?

  5. Comment by Miriam in Vancouver, 26/02/10, 12:20:

    Thank you for sharing Elizabeth. Our media in BC has been so biased in favour of Seek & Treat (treatment as prevention) that we were thrilled to have some concise and concrete arguments about the challenges. Funny when we talk about education, behaviour change, and getting condoms where they are needed, we are called utopian. And here, we are supposed to believe that somebody is going to (pay to) test every person (in Africa? In the world? …) and then (pay to) treat everybody who tests positive? There are two arguments that convince me we should not put all our eggs in this basket:
    1) there is evidence that treatment might NOT actually reduce transmission in anal sex, and no convincing evidence that it reduces transmission in IDUs. Let’s not forget that anal sex (gay or not) and IDU are still the main ways this virus travels rapidly through populations; and
    2) when somebody is most likely to transmit the virus (right after infection), they are likely to be in the window period and test negative. By the time they test positive and receive ARVs, they may already have infected many people.
    Yes, we need increased testing!
    Yes, we need increased treatment!
    But this does not replace the need for increased prevention education, access to condoms, etc.

  6. Comment by Kees, 02/03/10, 01:39:

    You wrote:
    “We DO, however, need to face the fact that until now, more treatment has been associated with more new infections.”

    What about the recent neuws from British Columbia and San Francisco?
    It looks like an association between more treatment and less infections.

  7. Comment by rogerq, 03/03/10, 11:52:

    The SF data in gay men are not statistically significant. Community viral load was not associated with a reduction in HIV incidence.

  8. Comment by Rupert Gude, 30/04/10, 12:01:

    Dear Elizabeth,
    I have just read the responses to your excellent article in the Guardian. I was appalled at the rudeness, the poor counter arguements and the ignorance of many of the respondents.
    I have just spent 15 months working in an HIV outptients in Tanzania. Your article is spot on. Even with high prevalence rates and open access to testing it is extremely difficult to persuade people to come to be tested. The men were particularly resistant until ill. Even if tested positive a third dissappear without trace becauce of stigma. In our antenatal clinic only a quarter would qualify for ART due to CD4 below 350 and half of these defaulted as they felt well. ART adherence was extremely good in our patients especially the women but there did seem to be a trend to default if initial symptoms were mild.
    As you have described before many AIDs experts grow fat on their AIDS work which has little revalence to those working at the coalface.
    Keep up the good work

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