Tuesday, July 20, 2010

Whose Rights, Which Rights and Where?

The punchline for the Vienna Aids Conference that's taking place at the moment is 'Rights Here, Right Now'. But it is only recently that the HIV industry has been making it clear whose rights they are demanding. They are demanding that HIV positive people, all of them, receive treatment. HIV positive people have a right to treatment but the conference rally cry seems to ignore the right that HIV negative people have to stay negative, indeed, the same right that HIV positive people have already been denied. Of course sick people have a right to treatment. But what the industry is claiming is that treatment for HIV positive people will ensure that HIV negative people stay that way; not healthy (not by a long shot), just HIV negative.

Well, in an ideal world, HIV positive people on successful antiretroviral treatment (ART) are less likely to transmit the virus to other people. We actually live in a world where most HIV positive people are not on ART, for a variety of reasons, and that will probably remain the case for the foreseeable future. But UNAIDS and the rest of the HIV industry don't live in this world. They live in a better carpeted world, better paid, where a disaster is having to drink a coffee with full fat milk when they ordered skinny. They themselves have a right to health. Others have a right to (HIV) treatment, and let's be clear, we are talking about people in developing countries here.

The Alma-Ata Declaration defines health as follows:
health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and [...] the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.
Notice, it is not about treatment, which is for sick people. Telling healthy people who are hoping to stay healthy that treating the sick will also be good for them is not promoting their health. Treatment is not prevention, it is just treatment. But putting as many people as possible on treatment will not have the effect of eradicating HIV. Mass treatment may slow transmission down a bit, but refusing to do anything to reduce transmission aside from treating those known to be HIV positive and willing to be treated with ART, is denying the majority of people their right to health.

There are several manifestations of the industry's desire to see treatment as prevention. In some places, where circumcision rates are low, there are plans to circumcise millions of men. This may or may not protect those circumcised, the evidence is slim. But it is unlikely to protect those with whom they have sex. The difference here is that millions of people, most of whom are not sick, are being told to have an operation that will keep them healthy. It is further implied that their being healthy will ensure the health of others. And this is in countries that have few health facilities, doctors or nurses and chronic shortages of equipment and medication.

Another manifestation is called pre-exposure prophylaxis or PrEP. This involves people who are HIV negative taking ART drugs on the grounds that they will be less likely to become infected. So treatment is not only being offered to those who are HIV positive, it is also being offered to those who 'may' become infected, in the opinion of a bunch of 'experts' who think that HIV treatment is a substitute for health. HIV industry spokespeople like to talk about 'science' and 'evidence', but what about rights, logic and common sense? Is a healthy person just a potential customer to them?

The industry has long insisted (it's a bit tenuous to call it a belief) that HIV is almost always transmitted through heterosexual sex in developing countries. There are two problems with this 'behavioral paradigm': firstly, given that those in developing countries don't engage in more sex, safe or unsafe, than those in rich countries, why do some developing countries have unbelievably high rates of HIV transmission, far beyond what could be reasonably explained by sexual behavior? Secondly, it is clear that a lot of HIV transmission must occur through non-sexual routes, but what exactly are these routes and how much transmission do they account for?

The first problem is vexing because there has never been any evidence for the rampant levels of unsafe sex that would be required for 20 or 30% of any population to become infected with a virus that is difficult to transmit through sexual intercourse. The industry has reacted by insisting that some people really do have the time, the opportunity and the inclination to lead a life that, previously, only existed in porn films. The second problem, the industry simply ignores. Almost everything about the industry assumes the truth of the behavioral paradigm. You could say that they view everybody (in developing countries, of course) as already sick and that they see the treatment as being preemptive (without being preventive).

Until we know why people in developing countries are becoming infected with HIV in such large numbers, it is senseless to keep droning on about sexual behavior. If there is something about sexual behavior in developing countries that results in a difficult to transmit virus being transmitted with ease, we don't know what it is yet. But we do know that there is a lot more non-sexual HIV transmission than the HIV industry are prepared to admit. HIV treatment is for HIV positive people, and I hope everybody who needs it receives it, regardless of their race, religion, sexual status or anything else. But everyone has a right to health; everyone has a right to live free of HIV. Avoidable HIV transmission needs to be prevented.

There is still a need for genuine HIV prevention and if UNAIDS can't come up with anything better than slogans, the agency should be abolished. They have shown a complete unwillingness to drop the behavioral paradigm despite there being no evidence for it and a lot against it. Their calls for rights are just humbug and they seem to be more interested in self-preservation than anything else. As more and more people become infected unnecessarily and many die every day, UNAIDS and the rest of the industry do little but spread stigma and lies about HIV. Those who are HIV positive, many as a result of the industry's failures, have a right to treatment. Others have a right to health, the same right that so many HIV positive people have been denied by this industry.

The Vienna Aids Conference is being used as a platform to make desperate pleas for yet more donor money to be ploughed into an industry that has failed to reduce HIV transmission and will continue to fail, given their present trajectory. They do not have any new ideas; they have just dressed up their old prejudices in new terminology. People have a right to health. Those who are sick have a right to treatment, a right to live lives that are as close to healthy as possible. But enough money has been wasted on political and commercial interests. We know enough about HIV to do things much better.

(For further discussion of PrEP, see my other blog, pre-exposureprophylaxis.blogspot.com)


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