The Real Tragedy of AIDS

[bhk]

http://www.techcentralstation.com/081905E.html

By James K. Glassman Published 08/19/2005

The press these days is obsessed with avian flu. "Officials are preparing as though the virus is the heir apparent to the 1918 international flu pandemic, which killed more than 40 million," says the Baltimore Sun.

Precautions are encouraging, but remember that the ability of scientists - not to mention the media - to predict the course of diseases is extremely limited.

In 1986, Newsweek forecast that by 1991, HIV, the virus that causes AIDS, "will have spread to between 5 million and 10 million Americans." Never happened. Infections peaked at about 1.5 million, and, since 1995, the disease has been sharply on the decline.

I am not minimizing the horror of AIDS, but the disease has largely been checked in the United States and Europe by education on prevention, through high-quality professional care, and, after a multi-billion-dollar effort by American and European and drug companies plus basic research by academic institutions, with anti-retroviral (ARV) drugs, which stop HIV from developing into full-blown AIDS.

In the 24 years since it first appeared, AIDS has mutated from a middle-class disease mainly afflicting male homosexuals in the United States to a disease of poverty, mainly afflicting heterosexuals in Africa. Last year, 2.3 million people in sub-Saharan Africa died of AIDS compared with 20,000 in Europe and the U.S. combined.

What to do?

The best antidote for AIDS, or any other disease, is prosperity. Wealth makes health. It is no accident that Africa is home to the other two global epidemics, tuberculosis and malaria. Even if deaths from the three were erased tomorrow, another scourge would flourish in Africa, where the infrastructure of prevention and cure - communications, education, roads, clean water, clinics, good health workers, and a diligent bureaucracy - is pitifully lacking.

Ending poverty is the most pressing problem in the world. While the solution is clear (free and democratic political and economic systems, guided by the rule of law and purged of corruption), the process will take decades.

In the meantime, Africans need emergency help, and they are getting it, primarily from the United States. But, unfortunately, publicity-seekers, thieves, and ideologues abound in the world of AIDS relief, and they are damaging the overall effort. For example:

-- The World Health Organization now admits it will not come close to meeting its ballyhooed "3 x 5" target, getting three million AIDS patients into therapy by 2005. Worse, 18 Indian-made ARVs on the WHO's approved list were either de-certified or withdrawn by their manufacturers for not being "bioequivalent" to the patented U.S. and European drugs from which they were copied.

Some of the medicines have been lately reinstated, but WHO policies encourage the use of such copycat drugs, even though there is no evidence that they are less expensive, on average, than the originals and serious worry that they will promote resistance and the advent of more virulent strains of HIV, which cost 10 times as much to treat.

-- With great fanfare, the Clinton Foundation last year announced that it had negotiated a price of $140 a year for ARV treatment, about half the typical price in Africa. But that figure is a cruel hoax, as a transcript of a meeting in Mumbai between AIDS activists and officials of Indian drug companies confirms. Hardly anyone pays it.

The representative of Cipla, one of the largest Indian firms, said that the $140 offer had rigid unpublicized conditions, including "large, confirmed irrevocable orders," which were never met. Clinton promised 200,000 patients by 2005, but another Indian drug official said that the foundation had not produced even 40,000.

An activist from Cameroon then said, "The Clinton deal is not working…. I'm surprised that you believed what Clinton told you."

Said Cipla: "He is a very good talker."


-- Brazil, the 11th largest economy in the world, has been threatening to seize the patents of drug companies that make ARVs. The results of such policies are already emerging. As my colleague Roger Bate has found, fewer companies are making anti-AIDS drugs. Why would you if your investment will be stolen?

The tragedy of AIDS in Africa is that, even absent prosperity, the disease could be controlled - with honesty, integrity and faith in sound science and economic incentives. But with Clinton and the WHO, with Brazilian and African kleptocrats in the mix, I despair of a solution any time soon

[Red Dog]

The tragedy of AIDS in Africa is that, even absent prosperity, the disease could be controlled - with honesty, integrity and faith in sound science and economic incentives. But with Clinton and the WHO, with Brazilian and African kleptocrats in the mix, I despair of a solution any time soon


I don't necessarily disagree with the author (I know very little about the subject), but I'd tend to give him the benefit of the doubt if a 'such as.....' came after the bolded part above. Instead, it seems he would rather bash Clinton and others.

[Pistol Pete]

With great fanfare, the Clinton Foundation last year announced that it had negotiated a price of $140 a year for ARV treatment, about half the typical price in Africa.
The tragedy is that AIDs drugs cost ~$30k/year in the US.

[bhk]

The tragedy is that AIDs drugs cost ~$30k/year in the US.

And yet, hardly anyone dies of AIDS here now.

[wendersfan]

My understanding is that the AIDS epidemic in sub-Saharan Africa is largely promulgated through ignorance, that infected men think they can cure themselves by having sex with virgins, etc. Now of course, poverty and ignorance go hand in hand, but I don't think you can blame centuries-old cultural myths and attitudes on President Clinton. There's an enormous amount of responsibility to go around on this subject, by I would contend that another former world leader, recently deceased, bears a larger weight of it than Clinton.

And I'm not talking about President Reagan, either.

[Rockmjd23]

There's an enormous amount of responsibility to go around on this subject, by I would contend that another former world leader, recently deceased, bears a larger weight of it than Clinton.
And I'm not talking about President Reagan, either.

No, you're talking about JPII, of course.-rolleyes-

[wendersfan]

No, you're talking about JPII, of course.-rolleyes-
Why the rolled eyes, if you don't mind me asking?

[Rockmjd23]

Why the rolled eyes, if you don't mind me asking?
Because, being a personal hero of mine that he is, I never understood how anyone could blame him for aids in africa. Unless of course he held a gun to every HIV+ person in the continent and told them to have promiscuous sex with everyone.

[al_bundy]

The tragedy is that AIDs drugs cost ~$30k/year in the US.


that's because our prices subsidize the low cost third world drugs

[Groucho]

In keeping with the spirit of this forum, I think a better title for this thread would be Genocide? Clinton order the deaths of millions in Africa

[Rockmjd23]

In keeping with the spirit of this forum, I think a better title for this thread would be Genocide? Clinton order the deaths of millions in Africa
No kidding. It's completely ridiculous to blame such a thing on any one person.

[VinVega]

No kidding. It's completely ridiculous to blame such a thing on any one person.
Don't ruin a perfectly good Clinton bashing thread! :grunt:

[Mordred]

Good article bhk! I just wish there was someway to stop Clinton from raping all those poor Africans and giving them AIDS. I blame the liberal media for not bringing this to light earlier.

[Breakfast with Girls]

The real tragedy of AIDS is that it gets more research funding than cancer or heart disease.

[Myster X]

Bush Jr. has done more for Africa than any other prez.

[wendersfan]

Bush Jr. has done more for Africa than any other prez.Is it <i>non sequitur</i> week here in the politics forum?

[Groucho]

Is it <i>non sequitur</i> week here in the politics forum?Concealed permit laws actually serve as a deterrent to violent crime.

[Ranger]

Ironically, I think the best cure for Africa's AIDS problem is have the rest of the African countries become Islamic countries. Don't Islamic countries have some of the lowest AIDS rates in the world? Only downsides would be all the human rights violations and increased pro-Al Qaeda sentiments.

But of course, is the AIDS problem in Africa "our" problem?

No. It is not.

[mikehunt]

they stop raping infants and kids as a "cure" and maybe I'll give 2 shits

[grundle]

The tragedy is that AIDs drugs cost ~$30k/year in the US.
Before the AIDS drugs were invented, the cost of hospitilization was $100,000 a year.

[grundle]

My understanding is that the AIDS epidemic in sub-Saharan Africa is largely promulgated through ignorance, that infected men think they can cure themselves by having sex with virgins, etc.
That's ridiculous that anyone would think such a thing.

We need to teach them the real truth - that AIDS is caused by lack of government funding.

[Mordred]

Before the AIDS drugs were invented, the cost of hospitilization was $100,000 a year.Yeah, but you died really quick. You have to pay $30k/yr for life! Hospitilization followed by quick death pays for itself pretty fast.

[grundle]

that's because our prices subsidize the low cost third world drugs
Actually, AIDS is a very tricky disease, and the HIV virus is not very well understood. It is extraordinarily expensive to invent new AIDS drugs. That's why they are so expensive.

We could do what Canada did and set price controls on drugs. But then just like Canada, there would be a huge decline in private investment to invent new drugs. A lot of liberals like that idea. But imagine if we had done that 30 years ago - there would be no AIDS drugs today. And yet, I still sense that liberals like this idea. Apparently, having no AIDS drugs is better than having expensive AIDS drugs.

[grundle]

In keeping with the spirit of this forum, I think a better title for this thread would be Genocide? Clinton order the deaths of millions in Africa
But I wasn't the one who started this thread.

[grundle]

Don't Islamic countries have some of the lowest AIDS rates in the world?
Yes.

And some of those countries are in Africa.

[grundle]

There is no accurate statistic on how many people in Africa have AIDS.

Africa is the only place in the world where a person can be "diagnosed" with AIDS without ever actually having a blood test.

[grundle]

Yeah, but you died really quick. You have to pay $30k/yr for life! Hospitilization followed by quick death pays for itself pretty fast.
Say now...... that's a good point.

How dare those drug companies keep people alive for so long!

[nemein]

Ironically, I think the best cure for Africa's AIDS problem is have the rest of the African countries become Islamic countries. Don't Islamic countries have some of the lowest AIDS rates in the world?


Might that in part be because of the very strict legal system which has the death penalty for a wide range of "offenses" (maybe I'm wrong but don't some of them stone a woman who is raped?)? I agree education is the key, I'm not sure I agree this form of "education" is the best solution.

[Mordred]

There is no accurate statistic on how many people in Africa have AIDS.

Africa is the only place in the world where a person can be "diagnosed" with AIDS without ever actually having a blood test.Well I've never heard that. I'm sure the statistics aren't completely accurate, but I've seen documentaries on the problem. When you watch a group of 20 people in Uganda go to a clinic for an AIDS test, and 4 of them come up positive and the Nurse administering the tests says that 4 of 20 is a good result because the number of positives is usually closer to 50%... you start to realize the enormity of the problem. It's one thing for some guy to get AIDS from sleeping with anything that moves (and I don't feel much pity for him), it's another to be a girl who's raped or a faithful wife who gets it from her philandering husband. And please don't get me started on the numbers of children born with AIDS or who get it from breastfeeding as they are staggering.

Acting like it's all hype just makes you look ignorant of what's really going on.

[Ranger]

Might that in part be because of the very strict legal system which has the death penalty for a wide range of "offenses" (maybe I'm wrong but don't some of them stone a woman who is raped?)? I agree education is the key, I'm not sure I agree this form of "education" is the best solution.
Like I said, the human rights violations would be one downside.

[Mark_vdH]

We could do what Canada did and set price controls on drugs. But then just like Canada, there would be a huge decline in private investment to invent new drugs. A lot of liberals like that idea. But imagine if we had done that 30 years ago - there would be no AIDS drugs today. And yet, I still sense that liberals like this idea. Apparently, having no AIDS drugs is better than having expensive AIDS drugs.
Just asking: Isn't allowing for patents really against libertarian principles?
I mean, what's the libertarian rationale behind that?

[Ranger]

I think patent rights are supposed to promote property rights, so I'd guess libertarians would be for that. But I guess some of them have a problem with how some patent laws are applied.

[wendersfan]

Just asking: Isn't allowing for patents really against libertarian principles?
I mean, what's the libertarian rationale behind that?If you create something, even if it's just an idea, it should be <i>yours</i>.

[grundle]

Just asking: Isn't allowing for patents really against libertarian principles?
I mean, what's the libertarian rationale behind that?
That is an excellent question.

Libertarians are divided on this issue.

I am in favor of patents and copyrights, because from a pragmatic viewpoint, it creates incentives to invent things. But I believe these patents should be temporary.

The first patent laws in the U.S. allowed an initial patent of 14 years, with the option to renew it for anohter 14 years. And that was it.

I am against Disney's policy of lobbying the government to keep renewing its copyrights again and again. This violates the idea of rule of law. It's not fair to change the rules after the game has already begun.

[BigPete]

Looking at the treatment of AIDS as a game theory model -

Even if a pharmaceutical company knew exactly how to cure AIDS and could execute flawlessly with only $XXmil in R&D there is, unfortunately, almost no incentive for them to do so. The second they announced a cure, they would be under instant pressure (if not extortion) to immediately provide the cure to the world at virtually no cost. This may not be true of other diseases, but due to the sensitive nature of AIDS it's almost guaranteed.

So you have to ask yourself - as a business - why on earth would you even want to try to develop a cure for AIDS? I'm not saying you'd subvert a cure - a rational business would never even address the issue.

[Tracer Bullet]

Well I've never heard that. I'm sure the statistics aren't completely accurate, but I've seen documentaries on the problem. When you watch a group of 20 people in Uganda go to a clinic for an AIDS test, and 4 of them come up positive and the Nurse administering the tests says that 4 of 20 is a good result because the number of positives is usually closer to 50%... you start to realize the enormity of the problem. It's one thing for some guy to get AIDS from sleeping with anything that moves (and I don't feel much pity for him), it's another to be a girl who's raped or a faithful wife who gets it from her philandering husband. And please don't get me started on the numbers of children born with AIDS or who get it from breastfeeding as they are staggering.

Acting like it's all hype just makes you look ignorant of what's really going on.

There is a different, "African" definition of AIDS. It does not require an HIV test to diagnose. There are no hard statistics on how many African AIDS patients have even had an HIV test.

[grundle]

Looking at the treatment of AIDS as a game theory model -

Even if a pharmaceutical company knew exactly how to cure AIDS and could execute flawlessly with only $XXmil in R&D there is, unfortunately, almost no incentive for them to do so. The second they announced a cure, they would be under instant pressure (if not extortion) to immediately provide the cure to the world at virtually no cost. This may not be true of other diseases, but due to the sensitive nature of AIDS it's almost guaranteed.

So you have to ask yourself - as a business - why on earth would you even want to try to develop a cure for AIDS? I'm not saying you'd subvert a cure - a rational business would never even address the issue.
That is very interesting.

[grundle]

There is a different, "African" definition of AIDS. It does not require an HIV test to diagnose. There are no hard statistics on how many African AIDS patients have even had an HIV test.
Thank you.

[Mark_vdH]

If you create something, even if it's just an idea, it should be <i>yours</i>.

When I steal your car, you can no longer drive in it. When I use your idea, it's still 100% yours. Basically, patent laws promise you more time to accumulate property than the free market will grant you when you've invented something new.

I'm sure most of you have already read this, but Thomas Jefferson once explained it (http://odur.let.rug.nl/~usa/P/tj3/writings/brf/jefl220.htm) better than I ever could:

"Stable ownership is the gift of social law, and is given late in the progress of society. It would be curious then, if an idea, the fugitive fermentation of an individual brain, could, of natural right, be claimed in exclusive and stable property. If nature has made any one thing less susceptible than all others of exclusive property, it is the action of the thinking power called an idea, which an individual may exclusively possess as long as he keeps it to himself; but the moment it is divulged, it forces itself into the possession of every one, and the receiver cannot dispossess himself of it. Its peculiar character, too, is that no one possesses the less, because every other possesses the whole of it. He who receives an idea from me, receives instruction himself without lessening mine; as he who lights his taper at mine, receives light without darkening me. That ideas should freely spread from one to another over the globe, for the moral and mutual instruction of man, and improvement of his condition, seems to have been peculiarly and benevolently designed by nature, when she made them, like fire, expansible over all space, without lessening their density in any point, and like the air in which we breathe, move, and have our physical being, incapable of confinement or exclusive appropriation. Inventions then cannot, in nature, be a subject of property. Society may give an exclusive right to the profits arising from them, as an encouragement to men to pursue ideas which may produce utility, but this may or may not be done, according to the will and convenience of the society, without claim or complaint from any body."


Oh, and thanks grundle, for the explanation. I fully understand what you're saying. The problem I have with the line of thought is that it argues that government interference is okay as long there is a clear advantage to society (and I believe patent laws clearly are). Which is basically the idea behind all government interference so loathed by libertarians.... :)

[Giantrobo]

There is a different, "African" definition of AIDS. It does not require an HIV test to diagnose. There are no hard statistics on how many African AIDS patients have even had an HIV test.

Doesn't the "theory" on African AIDS/HIV suggest it's a different strain from the one here in U.S.? A strain that can make it through the squamas(sp?) cells of the vagina? Apparently the strain here has harder time getting past those cells.

has anyone else heard this?

[bhk]

No kidding. It's completely ridiculous to blame such a thing on any one person.
I don't see it as blaming one person. I see it as typical Clinton that if you just talk about a problem and make symbolic gestures that are meaningless that is as good as solving the problem.

Originally Posted by Groucho
In keeping with the spirit of this forum, I think a better title for this thread would be Genocide? Clinton order the deaths of millions in Africa
Can we have funny groucho back?

The other reason that I posted this article is below:
-- The World Health Organization now admits it will not come close to meeting its ballyhooed "3 x 5" target, getting three million AIDS patients into therapy by 2005. Worse, 18 Indian-made ARVs on the WHO's approved list were either de-certified or withdrawn by their manufacturers for not being "bioequivalent" to the patented U.S. and European drugs from which they were copied.
Some of the medicines have been lately reinstated, but WHO policies encourage the use of such copycat drugs, even though there is no evidence that they are less expensive, on average, than the originals and serious worry that they will promote resistance and the advent of more virulent strains of HIV, which cost 10 times as much to treat.

So what if that Lipitor tablet imported from a 3rd world country costs 5 cents each? If it isn't bioequivalent, it is useless.

[Jason]

I stopped reading at the first sentence. Where exactly is the media obsession with avian flu?

Glad to see AIDS is all Clinton's fault though.

[Mark_vdH]

Actually I think it's both Clinton and the Pope!

The Pope taught them not to use condoms, and Clinton showed them it's okay to screw around (and, of course, that oral sex is not real sex).

http://www.telegraph.co.uk/news/graphics/2005/02/02/pope/clinton_1999.jpg
Sieg Heil!

[Tracer Bullet]

Doesn't the "theory" on African AIDS/HIV suggest it's a different strain from the one here in U.S.? A strain that can make it through the squamas(sp?) cells of the vagina? Apparently the strain here has harder time getting past those cells.

has anyone else heard this?

Do a search for "Bangui definition"... it basically says that anyone in Africa that has prolonged fever, weight loss, and prolonged diarrhea has AIDS. No HIV test required.

Of course, those symptoms are not exactly rare in countries rife with poverty and starvation.

[Mordred]

Do a search for "Bangui definition"... it basically says that anyone in Africa that has prolonged fever, weight loss, and prolonged diarrhea has AIDS. No HIV test required.

Of course, those symptoms are not exactly rare in countries rife with poverty and starvation.Interesting... except for the fact that the Bangui definition has been highly discredited and is no longer used.

A good modeling method they have is to test all pregnant mothers when they visit their doctor.
http://www.unaids.org/wad2004/EPIupdate2004_html_en/Epi04_08_en.gif
It's probably safe to assume that the infection rates among men are at least as high as the women they're getting pregnant. 35% at the 25-29 level is pretty sobering.

Here's a chart of African Life expectancy from the World Bank World Development Indicators 2004:
http://upload.wikimedia.org/wikipedia/en/d/d6/Aids_in_africa_graph.gif
You can see Uganda's AIDS education programs are starting to work... but still that is a very scary chart.

[Tracer Bullet]

Interesting... except for the fact that the Bangui definition has been highly discredited and is no longer used.

Right. They also use the 1994 WHO definition, which also doesn't require an HIV test to diagnose AIDS.

Also, the Bangui definition is certainly still used.

[hahn]

There is a different, "African" definition of AIDS. It does not require an HIV test to diagnose. There are no hard statistics on how many African AIDS patients have even had an HIV test.

I think what Mordred is saying is that these people going to the clinic ARE being HIV tested and the fact that anything less than 50% is considered good, indicates that the problem IS severe no matter how you want to spin the statistics.

I also believe he is saying that just because the definition of someone who has HIV may not always be via HIV test, does not mean you can say that they got HIV through promiscuous or 'sinful' means and somehow suggest that they deserve it. That is what I'm saying anyhow.

BTW, the REAL tragedy of AIDS is that some people would use it as a political tool. I'm no huge fan of Clinton, but this is an absolutely ridiculous thread. Can't say I'm surprised though.

[Tracer Bullet]

I think what Mordred is saying is that these people going to the clinic ARE being HIV tested and the fact that anything less than 50% is considered good, indicates that the problem IS severe no matter how you want to spin the statistics.

What documentaries are these? Where are these clinics? Who is being tested?

I also believe he is saying that just because the definition of someone who has HIV may not always be via HIV test, does not mean you can say that they got HIV through promiscuous or 'sinful' means and somehow suggest that they deserve it. That is what I'm saying anyhow.

If there is no proof (HIV test) that they have HIV, yet you diagnose them as being infected with HIV, isn't that a bit disingenious? I don't know about you, but if my doctor suspects I have, say, strep throat, he does a culture before prescribing medicine or declaring I have strep throat.

[Canadian Bacon]

[quote=I see it as typical Clinton that if you just talk about a problem and make symbolic gestures that are meaningless that is as good as solving the problem.[/quote]

rotfl yeah it's Clinton fault, I guess you blame him for 9-11 and the high gas prices, take off the blinders your right wing bias is obvious

[Mordred]

What documentaries are these? Where are these clinics? Who is being tested?I cannot remember the name of the documentary, but I do know it was on HBO about a week and a half ago. I was also partly wrong. I talked to my wife (who remembers some things better) and it was actually 2 of 20 tested who were positive and she thinks it was Botswana and not Uganda where the tests were being done. However we both remember VERY clearly the clinic worker who administered the blood tests saying it was a very good result because 50% of the people she tests are positive. I'll try and find it on their schedule so you can take a look at a copy.
If there is no proof (HIV test) that they have HIV, yet you diagnose them as being infected with HIV, isn't that a bit disingenious? I don't know about you, but if my doctor suspects I have, say, strep throat, he does a culture before prescribing medicine or declaring I have strep throat.Yes I would agree with that. What you refuse to acknowledge is that they are doing HIV tests. Those pregnant women going into the clinics for neonatal care are getting HIV tests and 35% of them between 20-25 are testing positive. Life expectancies have dropped 20years across a lot of Africa in the past 15 years. You don't need to test every Africaner to realize that the problem is enormous. Feel free to stick your head in the sand if you want and blame erroneous statistics as the real problem. Some of us realize the enormity of the situation.

Also you seem to be implying that people are being giving expensive ARV drugs to treat imaginary AIDS when a $.50 blood test would confirm whether they are needed. That seems highly implausible to me.

[Tracer Bullet]

Also you seem to be implying that people are being giving expensive ARV drugs to treat imaginary AIDS when a $.50 blood test would confirm whether they are needed. That seems highly implausible to me.

No, no, no. The drugs should be given to people who test positive for HIV... but it seems to me that the AIDS statistics in Africa are inaccurate at best at wildly exaggerated at worst. That is my point.

[hahn]

If there is no proof (HIV test) that they have HIV, yet you diagnose them as being infected with HIV, isn't that a bit disingenious? I don't know about you, but if my doctor suspects I have, say, strep throat, he does a culture before prescribing medicine or declaring I have strep throat.

First of all: no, not at all. I suspect you have never worked in the medical field. There are many many MANY times when diagnoses are made on clinical impressions alone. Sometimes for reasons of practicality, and sometimes because the diagnosis cannot be made any other way (depends on the disease). Yes, even strep throat. You are right in that a definitive diagnosis cannot be made without the throat culture. However, in medicine, as a physician, you have to play the odds sometimes (oftentimes). With clinical impression, you can make a pretty good guess and be right more often than you are wrong. I should also add that based on clinical signs and symptoms, you can also wrongly give a NEGATIVE diagnosis. The fact that clinical diagnosis is not definitive does not indicate anything about the "positive or negative predictive value" (PPV/NPV) of your diagnosis. You have to know that before you can say whether your clinical diagnosis is over or under reporting.

Second of all: I don't know where you're getting your information. There are huge numbers of independent studies coming out of Africa that look at seroprevalence. That is the prevalence of HIV types. These are definitive diagnoses. Also, if you had read the WHO AIDS Surveillance reports, you'd also know that their AIDS case reporting is based on the Bangui clinical case definition PLUS a positive HIV antibody test (ELISA test). How much more definitive would you like it to be? Viral counts? Studies have looked at that too. HIV subtyping? That's covered as well.

Third of all: I don't follow the logic of your attempted argument. You are saying that if a diagnosis is not definitive, then the actual number is overestimated? What is the basis of that logic? It the diagnosis were not definitive (and it is), then it could just as easily be underestimated. Speaking of which, the surveillance reports state that in many regions of Africa, the cases are likely to be underestimated because many do not even come into the clinics to get checked.

Fourth of all: The original argument was that none of this says anything about HOW a person got HIV to begin with. The presumption of a few people on this board seems to be that if the HIV rates are high in Africa, that it's because they deserve it.

[Thor Simpson]

While assigning "blame" to Clinton in any way for this is pretty rediculous, you have to admit that the life expectancy chart didn't fair so well during his administration. ;)

There are a lot of things causing this problem, and I'll have to agree with most of the article that poverty is the biggest factor. I'll also agree with some posts here that funding for AIDS compared to some other health issues seems rather disproportionate. The issue of having to provide a cure at a low cost is also an angle I had never considered. The best way to fight AIDS in Africa is not to cure the people to have it... it's in prevention. And that's no simple task under their living circumstances.

But if we're going to fight a global battle against AIDS, it would seem that much of the money spent on AIDS research could be better spent on education and curing "poverty" first. But that's a tough view, and not one I'm 100% confident in. I do think we should target a cure for AIDS. It will not be fully erraticated through education and safe sex. Prioritizing funding in that way isn't an easy thing to do... but perhaps it's <B>the American people</B> who donate so much to AIDS reseach <B>who are also lacking some education on the issue</B>?

We see similar things in donations towards different kinds of cancer. The most research money isn't necessarily being put into the most lethal forms of cancer. But what are you gonna do? Have the government manage people's private donations? Just make a donation to "something good," get your deduction, and let Uncle Sam decide what to do with it. Brilliant! ;)

[Tracer Bullet]

First of all: no, not at all. I suspect you have never worked in the medical field. There are many many MANY times when diagnoses are made on clinical impressions alone. Sometimes for reasons of practicality, and sometimes because the diagnosis cannot be made any other way (depends on the disease). Yes, even strep throat. You are right in that a definitive diagnosis cannot be made without the throat culture. However, in medicine, as a physician, you have to play the odds sometimes (oftentimes).

Okay, sure. But would you start someone on chemotherapy before finding out if they have advanced cancer?

And with a disease like AIDS, which needs a positive HIV confirmation, can you really diagnose it without a test? I'm not a doctor, but that just seems stupid to me.

Second of all: I don't know where you're getting your information. There are huge numbers of independent studies coming out of Africa that look at seroprevalence. That is the prevalence of HIV types. These are definitive diagnoses. Also, if you had read the WHO AIDS Surveillance reports, you'd also know that their AIDS case reporting is based on the Bangui clinical case definition PLUS a positive HIV antibody test (ELISA test). How much more definitive would you like it to be? Viral counts? Studies have looked at that too. HIV subtyping? That's covered as well

I'll have to look into this. Any links?

Third of all: I don't follow the logic of your attempted argument. You are saying that if a diagnosis is not definitive, then the actual number is overestimated? What is the basis of that logic? It the diagnosis were not definitive (and it is), then it could just as easily be underestimated.

I say overestimated because without an HIV test, many Africans were and continue to be diagnosed with HIV infection or AIDS because of the prevalence of symptoms that could have entirely different causes. Sure, it could be underestimated, but I don't find that likely.

Fourth of all: The original argument was that none of this says anything about HOW a person got HIV to begin with. The presumption of a few people on this board seems to be that if the HIV rates are high in Africa, that it's because they deserve it.

I agree with you and that was never part of my argument. Hell, I'm gay! :lol:

[hahn]

I'll have to look into this. Any links?


http://www.who.int/hiv/strategic/pubafr_rep00/en/

It's a long report. Enjoy reading! :)

[grundle]

Glad to see AIDS is all Clinton's fault though.
He sure was popular with the ladies!

[grundle]

Here's a chart of African Life expectancy from the World Bank World Development Indicators 2004:
http://upload.wikimedia.org/wikipedia/en/d/d6/Aids_in_africa_graph.gif

Wow! The sharp drop in life expetancy from the AIDS crises coincides exactly with Clinton's time in the White House. He really was popular with the ladies!

[Thor Simpson]

Wow! The sharp drop in life expetancy from the AIDS crises coincides exactly with Clinton's time in the White House. He really was popular with the ladies!
grundle has me on ignore. :(

[Mark_vdH]

Wow! The sharp drop in life expetancy from the AIDS crises coincides exactly with Clinton's time in the White House. He really was popular with the ladies!Good one grundle! :lol: :thumbsup:

[grundle]

grundle has me on ignore. :(
No I don't.

I was reading through the posts and responding to them one by one.

I read your comment about Clinton and AIDS after I had already said the same thing.

[grundle]

Good one grundle! :lol: :thumbsup:
Thanks!

[Pharoh]

Ironically, I think the best cure for Africa's AIDS problem is have the rest of the African countries become Islamic countries. Don't Islamic countries have some of the lowest AIDS rates in the world? Only downsides would be all the human rights violations and increased pro-Al Qaeda sentiments.

But of course, is the AIDS problem in Africa "our" problem?

No. It is not.



Not the lowest rates in the world, and it will likely get worse in many Islamic countries. Here is a recent article on this very topic.


AIDS does not discriminate by religion or citizenship. Yet, for years, leaders of Muslim countries have denied the pandemic’s threat to their societies. While they looked the other way, HIV quietly crept into the most vulnerable populations in the most volatile parts of the world. Muslim leaders must now address the threat—or risk losing their community of believers to a global plague.


On a cold December evening in the southern Iranian city of Kerman, the stars blazed overhead as a father took his son’s life. Enraged, and with an ax in hand, the head of a prominent Iranian family chopped his child to pieces for bringing shame upon his relatives. The son’s crime? Contracting HIV, the virus that causes AIDS. In a country where, in some parts, nearly 60 percent of HIV–positive citizens take their own lives within the first year of their diagnosis, the 23–year–old son faced little chance of acceptance, even from his family.

That tragic story is just one of the many being told as the deadly contagion unfolds across the massive Islamic expanse, from Morocco to the Philippines. In the years immediately ahead, the AIDS pandemic will exact a grim toll on a number of vulnerable populations with volatile polities—places unlikely to cope with the significant social stresses and economic burdens that AIDS can cause.

Officially, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates the total HIV population of North Africa, the Middle East, and predominantly Muslim Asia at nearly 1 million people today. At the end of 2003, UNAIDS estimated that up to 420,000 people in Mali, 180,000 in Indonesia, 150,000 in Pakistan, and 61,000 in Iran had HIV/AIDS. Those numbers, however, are severely understated. UNAIDS figures depend upon surveillance data; thus a lack of information can be taken as a lack of infection. UNAIDS data on the number of people living with HIV/AIDS are completely missing for Afghanistan, Turkey, and Somalia, all countries with large at–risk populations. Moreover, UNAIDS’ HIV estimates are determined by conferring with local governments, and politicians who do not wish to allocate domestic resources to HIV/AIDS programs (or to deter foreign investors) can downplay its reach or simply refuse to admit its presence. Although the prevalence rates of Muslim infections may seem small when compared with the tragedy that is unfolding in southern Africa, they stand in sharp contrast to official estimates that suggest no disease at all.

An instructive tale for the Muslim world lies in the differing responses to HIV/AIDS in Thailand and South Africa. In the early 1990s, both countries had an official national prevalence of between 2 and 3 percent. Thailand embarked on an aggressive anti–HIV campaign that reached all sectors of society. AIDS education programs were delivered in schools as well as in brothels, and senior political leaders delivered AIDS–prevention messages as a part of almost every public address. As a result of this campaign, HIV rates remained low throughout the 1990s. By comparison, South Africa did little to halt the spread of HIV until the dawn of this millennium and now has the nightmarish task of controlling a disease that already infects nearly a quarter of its adult population. The Muslim world now must decide if it will replicate Thailand’s relative success, or follow South Africa’s deadly path.


It Couldn’t Happen Here
The first cases of HIV in the region were officially recorded in Bahrain, Qatar, Iran, and several other Muslim states in the mid–1980s. Despite identifying the disease early on, many countries still have not launched treatment or public health education programs to prevent its further spread. One major reason for this lack of action has been assumptions that premarital sex, adultery, prostitution, homosexuality, and intravenous drug use do not occur in the Muslim world, or happen so infrequently that the risk of the disease gaining a foothold in these countries is low.

In 1995, for example, Indonesia’s Council of Ulemas urged that condoms only be sold to married couples with prescriptions from general practitioners. It was felt that strong religious convictions would prevent people from having extramarital sex. Members of the international public health community, for their part, have not only seemed to accept the presumptions behind those arguments but on occasion have also espoused them. As recently as February, an official in Pakistan’s National AIDS Control Programme asserted that HIV prevalence was lower in Pakistan than in other countries thanks largely to “better social and Islamic values.”

Islamic culture and Muslim beliefs, unfortunately, are not sufficient to inoculate populations against the spread of HIV. The trajectory of the virus in predominantly Muslim regions of the sub–Sahara proves this point. In Nigeria, 6 to 10 percent of adults are infected, and between 10 to 18 percent of adults in Ethiopia are HIV–positive. Both are countries in which fully half of the people practice some form of Islam. Although the HIV epidemic in Muslim Africa should have sounded a wake–up call to other Islamic communities, few Islamic authorities north of the Sahara seem to have heard the alarm.

For all the diversity within the more than 1 billion–strong Muslim world—from Albania and Turkey in Europe, across Northern Africa and through the Persian Gulf, and to Malaysia and Indonesia in South Asia—a couple of common features have kept its efforts to combat the disease frozen in time. One is that there is no prescribed separation of faith and state in many Islamic countries today: The Koran is consulted not only as a religious text but also as a source of law, a guide to statecraft, and an arbiter of social behavior. Although such reliance on the Koran may help leaders envision an ideal human society (one with low rates of drug abuse, prostitution, and other types of crime), it also often keeps them from providing civic assistance to counter real social problems. Another common factor that contributes to a slow response to HIV/AIDS is the relative absence of firmly rooted or functional democratic systems in many Muslim countries. Citizens of these countries simply do not expect their governments to provide social services to mitigate the impact of HIV/AIDS. Taken together, these two tendencies—political primacy of the Koran and weak or absent democracy—have cost Muslim leaders valuable time in the fight against the epidemic.


Tackling the Taboo
Although many Muslim leaders have done little to control HIV/AIDS other than deport the foreigners that they blame for the disease, a handful of leaders have acknowledged their epidemics and are working diligently to find ways to control infections. One of the Muslim governments that does seem to be responding to its gathering HIV problem is, surprisingly, “axis of evil” member Iran. Although the social stigma associated with the disease remains quite severe—until 2001, workers could be fired from their jobs for being HIV–positive, and throughout 2002, doctors and hospitals could refuse to treat AIDS patients—recent government actions paint a more promising picture. Iran’s President Mohammad Khatami and his administration have been very forthcoming about the extent of the epidemic and the urgent need to control the further spread of the disease. HIV education is now offered as a standard part of the health curriculum in many Iranian public schools, and lectures about how to prevent the disease are also given to couples who apply for marriage licenses. Perhaps surprising, given the Iranian regime’s strict conservative reputation, needle–exchange programs also have been offered in high drug–use areas of Tehran, and syringes are now sold over the counter in many pharmacies. Hopefully, the incoming administration will continue HIV education and prevention efforts.

Yet, spread of the disease among prostitutes and their clients remains a challenge for Iran. Officials are not even sure how many commercial sex workers there are, and estimates range from 30,000 to more than 300,000. Creating social welfare programs and communicating alternative, safer behaviors for poor or troubled women and girls could reduce the number of prostitutes and levels of transmission in this difficult–to–reach group, thus preventing the further spread into the general population.

Another Muslim society has seen considerable progress in HIV education and prevention efforts within gay and bisexual networks and commercial sex circles. In Bangladesh, recent surveys have found that knowledge of HIV and its transmission is low among both male and female sex workers, and efforts to increase condom use are under way around the country. Since 1997, the Bandhu Social Welfare Society has provided safer–sex promotion activities for more than 76,000 homosexual and bisexual men. Some officials hope to expand this successful nongovernmental organization from six cities where anti–HIV and anti–STD education and prevention are offered to a national program. The Bangladeshis have also successfully experimented with awareness programs in the social and religious center of each community: the mosque. Because imams play an important role in shaping values, training them to educate people to the dangers of HIV seems natural. With assistance from the Islamic Foundation, the Islamic Medical Mission, and the United Nations Development Programme, thousands of religious leaders—including some women—are now trained to deliver anti–HIV and anti–STD educational and prevention messages. Unfortunately, the efforts of Iran and Bangladesh far outpace those of other Muslim countries. Little or no surveillance data are available on the disease in many countries with significant higher–risk populations of intravenous drug users—Afghanistan and Iraq among them. Saudi Arabia and other states in the Persian Gulf have only recently begun to admit that they have a small but persistent domestic locus of infection after decades of blaming foreigners for the disease.


Guarding the Faithful
A look at the latest UNAIDS update for Muslim nation statistics is telling for its lack of information: a handful of cases here, empty columns there. But all these blank pages cannot mask the toll AIDS is taking, and will take, on the Muslim world. If Muslim societies are to respond effectively to their own still–gathering domestic HIV epidemics, they must begin mounting aggressive HIV/AIDS surveillance programs. To control the epidemic, sweeping legislative and social changes are also required. Following the example of Iran, conservative and fundamentalist regimes must harness their religious piety to deal with this urgent social need. In addition to teaching safer behaviors to higher–risk groups, social messages can be crafted to teach people that they can still be good Muslims and care for those infected with this disease. Counselors for an Egyptian hotline encourage callers to accept acquaintances and family members with AIDS by reminding them of the relationships they shared before the diagnosis. By stressing similarities between the infected and the non–infected, the counselors encourage greater social acceptance of the disease.

In the Muslim world, as everywhere else, battling HIV/AIDS is in part a women’s issue. Islamic women must refuse to be infected and die in silence. They must embrace the fight against this disease at all levels of society. Married women must talk to their husbands who work as remittance laborers overseas and urge them to avoid extramarital sexual contact (or use condoms if they do stray).

HIV/AIDS education and control efforts could also become part of each citizen’s zakat, or charity giving. In nations that use taxes as part of their zakat, some portion of the contributions could establish AIDS awareness and treatment programs. Helping Muslim societies confront their own HIV/AIDS problem might actually become an avenue of positive engagement for the United States—in regions where America could stand to improve its image.

Domestic or international, anti–AIDS action for the Muslim world must be planned and implemented soon. Unchecked, HIV/AIDS will continue to spread through Muslim countries—destroying families and deepening poverty—until it has ruined the very fabric of these societies. Muslim countries must acknowledge that contemporary societal ills are serious domestic issues, but also that modern public health and scientific measures can help them conquer this disease. And those of us in the West must respect the fundamental fact that socially conservative societies will adapt to some issues but will not necessarily buy what we mean by “modernity” wholesale.

Islamic countries are at a crossroads. They can choose to act slowly and mount only superficial education and prevention programs. Or they can choose to confront this killer virus that threatens their community of believers. After a shaky start, the formidable powers of national religious leaders can be harnessed to educate people to protect themselves. Most important, these countries have to reach out to their most vulnerable—to the people who are most at risk—to stop the continued spread of the disease. If they don’t, AIDS will exact an even greater toll among the faithful.



Laura M. Kelley is the principal author of the U.S. National Intelligence Council's 2002 study, The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China.
Nicholas Eberstadt is the Henry Wendt chair in political economy at the American Enterprise Institute, senior advisor to the National Bureau for Asian Research, and is working on a book on the global impact of the AIDS pandemic.

[Ranger]

Thanks for the article. I saved it and will read the rest of it later. My statement was based on an AIDS rates graph I saw a couple years ago. This is a similar graph.
http://www.nationmaster.com/graph-T/hea_hiv_aid_adu_pre_rat

The ranks are about the same from what I can remember. I realize that the numbers may be understated and not all the Muslim countries have the lowest ranks though the majority of them still have very low rates. I think the stigma point is still a bigger factor to consider since AIDS-infected individuals in some Muslim countries are probably more likely to die from suicide or murder than from the actual virus itself. So that leads me to believe that the AIDS rates must be pretty low there.
ex:
In a country [Iran] where, in some parts, nearly 60 percent of HIV–positive citizens take their own lives within the first year of their diagnosis, the 23–year–old son faced little chance of acceptance, even from his family.