Friday, May 11, 2012

Status Quo is Good For All, Not Just HIV Industry

A frequent theme of HIV related articles is the question of whether disproportionate levels of HIV funding in high prevalence countries has diverted attention from other health issues. These issues include water borne diseases, intestinal parasites, malnutrition and acute respiratory infections. After all, the latter conditions affect billions of people and are preventable and treatable. But the HIV industry, unanimously, answers the question in the negative.

So they will be welcoming a piece of self-serving research purporting to show that the industry has been right all along, that it is OK to continue spending more on one disease that grabs a lot of attention than on all the others put together, which don't grab so many headlines. Health facilities are in abysmal condition, with low levels of staff, many of whom are badly trained; there are chronic shortages of equipment and supplies, etc. There is a lot of evidence that health facilities are quite dangerous places to go to when you are sick, as you may leave with something worse than you had when you arrived.

But this research didn't seem to look into such mundane matters. How often do hospital transmitted HIV infections ever grab headlines, anyhow? A significant proportion of HIV infections might be averted if conditions in health facilities were improved. This would also cut the number of infections with various other diseases that are most efficiently transmitted in modern healthcare settings, especially where safety and infection control have been almost entirely ignored.

The article seems to concentrate on treatment and care, with very little mention of prevention of HIV or other diseases. But the bulk of HIV money goes into drugs and other technologies. That's one of the things that makes it such an expensive disease. Not that producing the drugs is expensive, just that pharmaceutical and other companies make inordinately high profits from them. The fact that the majority of people with HIV live in poor countries is not a problem now that intensive lobbying has ensured that what may look like foreign aid is no more than a de facto subsidy for the pharmaceutical and other industries.

I haven't got access to the research on which this article was based but even the language used by the lead author is very cautious. It is unclear if the health facilities providing HIV services were already superior to those not providing the services, used for comparison. It is concluded that "the experience in Rwanda adds to a growing body of evidence from several countries that AIDS-related funding is not adversely affecting non-AIDS services". But some AIDS related programs such as mass male circumcision, which will provide little or no benefit, may even result in HIV infections that wouldn't otherwise have occurred.

Well done to the researchers for finding new ways of coming to the conclusion the HIV industry wants, this will ensure future funding. But how does this research contribute to a reduction in HIV transmission, or even transmission of other diseases? It's clear that billions can be made available when the right interests are involved, so why do people with a difficult to transmit disease receive lots of money if they are infected, but next to none to protect them from being infected in the first place? If the fight against other diseases is not undermined by HIV funding, even if the fight is strengthened, how much more could be done if funding were to be distributed in a reasonable and balanced way?

[For more about non-sexual HIV transmission and male circumcision, see the Don't Get Stuck With HIV site.]


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