Saturday, July 21, 2012

English Guardian Issues Press Release On Behalf of HIV Industry

It's not rocket science and there's probably even a name for it, I just don't know what it is. But when a company wants to charge a ridiculous price for their product, they have to start with something astronomical. Suppose the ridiculous price was $100, the seller needs to put the word around that they will be charging $1000. Everyone will gasp, but they will praise the seller when the price is very publicly dropped to $800 and, over a period of years, goes down to $200, double the price the seller originally wanted.

Of course, sales of antiretrovirals are now very much higher than they were years ago, when the cost of the drugs was in the thousands of dollars per year. Numbers of people on treatment was in the tens and hundreds of thousands at first. But once the market expanded to millions of people the drug companies could afford to drop their prices by what looked like substantial amounts. Bills Gates and Clinton and anyone else jumping on the bandwaggon could happily boast about how 'cheap' treatment was, as long as no one looked beyond the drug costs. Generic versions of the drugs could be made for a fraction of the cost but this was exactly what the philanthropic foundations did not want, non-patented drugs undercutting Big Pharma.

Now Bill Clinton's organization, which specializes in lobbying for higher quantities of (patented) antiretroviral drugs to be sold to developing countries and paid for by 'aid' money, is claiming that the entire costs of treatment, not just the drugs, is much lower than anyone realized before. The 'game-changing' work by Clinton's Foundation just happens to be ready for the forthcoming International Aids Conference in Washington, which is a very expensive forum for the HIV industry to move its latest products and strategies up the agenda (and will doubtless host a number of 'game-changers' over the course of the event).

In the five countries the Foundation researched, the entire costs for treatment came to an average of $200, which says a lot about how badly health professionals are paid and what exactly 'treatment' includes in developing countries. But the argument was never really about cost alone. The argument was about how much money certain multinationals could make and how quickly they could make it. Instead of advocating for the development of health systems, building new hospitals, training more health professionals, increasing the amount of money spent on health and other social programs and the like, the HIV industry agenda has always been about cherry-picking the most profitable strategies.

Thirty years into the pandemic an estimated 2.5 million people will be newly infected with HIV in the next 12 months and nearly two million will die. And yet the big conferences are all about commerce and politics. But why are so many people still being infected with HIV every year and why are so many still dying? The industry, for political reasons, can just point to sexual behavior. But why do we still not know what kind of sexual behavior could give rise to such high transmission rates or how such high levels of 'unsafe' sexual behavior could occur, or if they even do occur?

In Western countries, HIV transmission has been primarily a problem among men who have sex with men and people who inject drugs. But rates of male to male sex are no higher in high HIV prevalence countries in Africa than they are in the West and intravenous drug use is generally a lot lower. And the vast majority of people infected are neither men who have sex with men nor intravenous drug users. In fact, the majority are people who face very low sexual risks and there are far more heterosexual women than men infected. 'Women are more susceptible' says one of the mantras of the HIV industry; but they are not more susceptible in Western countries. In the West, few women are infected through heterosexual sex and almost no men are.

Clinton's Foundation, naturally, latches on to the 'treatment is prevention' reflex that the HIV industry currently pins its hopes on. After all, this could eventually take numbers on treatment from mere millions to tens of millions. Almost anyone who is HIV positive could be 'put on treatment' (and in developing countries, the idea of choice does seem to be absent), as if they are a risk to the public unless they are 'adhering' to a drug regime that is claimed to prolong their lives and ensure the health of those around them. (The SERO Project puts forward a similar line of reasoning about treatment as prevention, but entirely from the point of view of the US and similar contexts.)

The 'sexual behavior of Africans' is to blame, according to the HIV industry, ably fronted by an entire UN institution, UNAIDS. Article after article attests to the entire lack of sexual continence throughout the whole of sub-Saharan Africa. The more restrained factions tend to blame feckless men and bemoan the lot of their female 'victims', who tend to outnumber the men when it comes to being infected with HIV. But the fact that levels of sexual behavior do not generally correlate with HIV transmission rates, despite this being well established, is rarely alluded to by a hungry industry.

The HIV industry continues to claim that 80 to 90% of HIV transmission is through heterosexual sex in African countries, even though heterosexual transmission is the exception in Western countries. The industry also claims that almost no transmission occurs through unsafe health care practices, such as reuse of single use needles, improper use of gloves and various other lapses in infection control procedures. Not only are HIV and other diseases transmitted through unsafe healthcare, but such isolated outbreaks can result in hundreds and even thousand infections in a short space of time, something even eye-watering levels of 'unsafe' sexual behavior could not do.

But while nosocomial outbreaks of HIV and other diseases are regularly and publicly investigated in Western countries, this has never happened in sub-Saharan Africa. I mean that investigations have never been carried out, not that such outbreaks have never occurred. They may never occur, but looking at the low figures for treatment that Clinton's Foundation cites, it sounds like health services get by on a shoestring. And if HIV, one of the most hyped viruses in history, gets by on a shoestring, it's hard to imagine how badly funded less media (and industry) friendly health issues get by.

The Guardian article cited above is a dolled-up press release for the Clinton Foundation and the pharmaceutical and HIV industry it represents (and the Gates Foundation, which funds the Guardian's Development section). It is not a 'breakthrough' or a 'game changer', which terms readers should recognize as clear signals that what they are reading is hype, and not genuine research findings. HIV treatment is treatment; it's what HIV positive people need when they have reached an appropriate clinical stage; it is not prevention. HIV prevention will only be achieved when serious outbreaks, which are very common in some African countries, have been investigated without prejudice, commercial interest or anything else skewing the findings.

[Note: the "average of $880" the Clinton Foundation estimates for treatment seems high compared to the "between $450 and $800" in another study, published in a peer reviewed journal. This could take quite a lot of the wind out of the Clinton sails, especially considering that publicity is just wind. I wonder how much scrutiny some of the other Clinton Foundation claims could bear.]


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