Tuesday, May 3, 2011

Test and Treat Strategy Guarantees a Long and Profitable HIV Epidemic

The multi-billion dollar global HIV industry continues to edge its way towards its ideal solution to HIV: allow it to spread. Genuine prevention success would cut into the industry's profits. But fake prevention strategies, such as 'test and treat' (or 'test all, treat all' or 'treatment as (or 'is') prevention'), will guarantee increasing profits every year.

This pseudo-strategy involves testing 'all' (the figure hoped for is 80%) sexually active people about once a year, or possibly more often. But only three countries in the world have more than 20% prevalence and only 9 have more than 10%. They had better be very accurate about which 80% of the population they succeed in testing, every year.

Also, the industry usually characterizes HIV as a sexually transmitted infection, although it is not always transmitted sexually and might not even be primarily sexually transmitted. But it's the party line and it's paid off very well so far. Talk about sex will get you money, talk about non-sexual transmission, especially through unsafe healthcare, will get you branded as a denialist or some kind of crank.

But even if you accept the behavioral paradigm, the view that HIV is almost always transmitted sexually (in some developing countries, but certainly not in developed countries), you might notice that the industry has always been very bad at saying exactly who is most at risk. It might seem obvious that those who have most 'unsafe' sex are most at risk, but sex worker populations often have low HIV prevalence figures.

Indee in some countries, sex workers plus their clients plus their clients' partners make up a relatively small contribution to the country's overall epidemic. The largest contribution in many mature epidemics, such as Uganda's, appears to come from people in a stable relationship who mainly engage in low risk sex.

So the industry is in the ironic position of having to target those among whom risk of sexual transmission is low, if they are really going to have any impact through their proposed strategy. In fact, the industry will have to target pretty much all sexually active people, partly because they don't know who the people most at risk are and partly because those who are not at much risk at all appear to be contributing most to some epidemics.

There's a contradiction in there somewhere. But as long as it sells drugs and sales rise every year, the industry will not be complaining. Little attempt will need to be made to figure out how HIV is being transmitted and nothing will be done to reduce transmission by actually addressing causes.

The process will simply involve finding people already infected, putting them on treatment, going through the testing process every year and claiming that a whole lot more would have been infected if the strategy hadn't been implemented.

Oh, and don't worry about evidence: the plan is "based on mathematical modelling". "The model developed assumes a population of very high prevalence which is tested once a year and those found HIV positive started on ARVs immediately; with this early antiretroviral intervention, the model shows that in three decades the new infections would be reduced sufficiently to eliminate the epidemic."

What could disprove this model? Who is discussing the fact that epidemics are the result of conditions that themselves need to be addressed, and not just treated with drugs? And who will wish to answer these questions when there is so much money to be made from ignoring them? Test and treat strategies may seem like they are doing nothing to prevent HIV transmission, but for advocates, not preventing HIV is a form of HIV prevention.


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