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Main Forums => Living With HIV => Topic started by: John2038 on May 25, 2008, 06:44:44 pm
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"We have created a monster," says health policy analyst Roger England. He's not talking about HIV itself; he's talking about the global efforts to fight it.
In a contentious article published in one of the world's top medical journals, England accuses international organizations like UNAIDS of doing too much to fight HIV, at the expense of fighting other diseases and improving health systems in poor countries.
It's time to shut down UNAIDS and start "putting HIV in its place," England writes. (Article from BMJ)
Full text: http://www.bmj.com/cgi/content/full/336/7652/1072
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While this gentleman may not be completely "right"; He's not completely wrong, either.
The largest increase in funding the global battle on HIV/AIDS began with the 2003 State of the Union speech by GW Bush, who, interestingly enough, moved the funding stream for treatment and prevention (!) of HIV infection from the "millions" to the "billions". Unfortunately, of the $15 Billion promised, only $1 Billion was devoted to HIV prevention and education, and that was with strings attached. Namely, the string was the near elimination of the "C" from the proven "ABC" campaign (Abstinence, Be faithful to your partner, and Condom use when A or B is not the chosen choice.
HIV/AIDS has had to bear the social stigma of its roots of discovery linking the initial cases to gay men and intravenous drug users. Additionally, nations have "swept under the rug" their HIV problems due to such stigma and realities of failures of blood donation programs, as well as societal concerns of "outsiders" messing in their business or cultural beliefs.
It may be that, with the effort increased beginning with that 2003 speech, the fight against HIV is perhaps overemphasized over other pressing concerns (systemic problems with sanitation and healthcare delivery). Perhaps there is an HIV/AIDS "bubble" in funding?? That question will be answered over time.
The facts are that HIV/AIDS does not have cure, and that it has decimated large segments of population in Sub-Saharan Africa (and worst in South Africa). The possible instabilities that could be created with an unchecked spread is a global threat.
Perhaps the funding increase would be better placed into EDUCATION for prevention, and then treatment/research. There is no better example of the success of education than the TASO group in Uganda. That organization had the support from the top down, with full acknowledgement of President Museveni. AND, it used ABC in an open and practical manner that related to the country's residents and general education levels.
The vaccine program has been such a disaster, with little efficacy shown in nearly all trials and approaches. I'm more a fan of KP-1461 that is in Phase II A testing by Koronis Pharmaceuticals, which promotes Viral Decay Acceleration as a possible eradication measure (proven In Vitro, but remains to be seen In Vivo).
Until THIS COUNTRY can overturn the ban for federal funding on education campaigns that address all of the ABC measures in an open and non-judgemental fashion, then neither will the rest of the world.
If GW wants to privatize it for huge cash infusion, then do it. Give it to the Gates Foundation, who is by far less judgemental than Halliburton would be, LOL.
Enough of my political view. Just wanted to state that the article likely has some merit. But definitely one-sided.
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http://www.nationalpriorities.org/costofwar_home
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Hmmmmm, not sure of what that link implies.
True, the cost of the conflict is frighteningly expensive. But, as may be with HIV/AIDS, simply "throwing $$$" to the issue may not the only answer. It may be where the money's being thrown to that counts.
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Hmmmmm, not sure of what that link implies.
Me either, considering that John is not an American taxpayer.
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Hmmmmm, not sure of what that link implies.
It implies that he's secretly in love with Dachshund. That's been embedded in Doxie's profile since goodness knows when.
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Me either, considering that John is not an American taxpayer.
In the title: HIV Getting Too Much of World's Attention and Money, Analyst Says
HIV have no border.
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simply "throwing $$$" to the issue may not the only answer. It may be where the money's being thrown to that counts.
True I guess (as with the vaccines). But we learn also from the failures.
Where ever is thrown the money, at the end, the pharmaceutical companies are making profits (good), worldwide.
And the money invested in the research is as such coming back through the tax.
HIV is a huge pandemic threatening everyone. As such, it make sense that it is having the World's attention and money.
Fortunately, the discovery made for HIV might also be beneficial for others disease.
But t is true for others diseases as well (beneficial for HIV).
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The vaccine dilemma has been rather sketchy at best, and nearly criminal at worst with so many charged personalities (Gallo, Fauci, Baltimore, Francis, Piott, etc.), lack of worldwide coordination, and competition for so many trials, etc.
Perhaps there should be better coordination between money for vaccines versus treatment/eradication.
There's still no retrovirus that has a vaccine to my knowledge, and, perhaps, it may be a futile effort. The better aspect could be advanced genetics and better study of the "reservoiir areas" in the lymphatic system and the brain where it's still difficult to deliver the cocktail.
Money is a good thing, but money well spent is another.
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The Copenhagen Convention is a meeting of the world's leading economists that get together and try and work out where to best spend a theoretical $50 billion in order to do most good, in dollar terms. It's going on now but it's worth noting that in 2004 they put HIV/AIDS at the top of the list - not only because the epidemic continues to get worse, but also because it affects large numbers of economically active adults in some countries - enough to cripple that country's economic development and send them in to a downward spiral of poverty, worse health care and yet more HIV infections.
http://reason.com/news/show/126672.html
I think HIV continues to be very important, and not just because I have it! I sometimes try to imagine what the HIV picture, and the whole of Africa, would look like if the world had gotten out in front of the epidemic from the beginning. Instead we're still arguing about the C in ABC and the sexual practices of Africans. The epidemic continues to spread, and we have singularly failed to contain it. Where will we be in 10 or 20 years without a vaccine or a cure. Or even just with a vaccine?
Personally I think a cure for HIV infection needs to be found in order to control HIV. It may be easier than a vaccine, as with Hepatitis C, which is curable in a large majority of cases but has no vaccine. It also has the benefit of taking the huge burden of medication and care off the economies of developing (and developed) countries.
Matt.
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The article's first paragraph sets the tone for the entire article, and it's pretty nasty:
The creation of UNAIDS, the joint United Nations programme on HIV and AIDS, was justified by the proposition that HIV is exceptional. The foundations of exceptionalism were laid when the "rights" arguments of gay men succeeded in making HIV a special case that demanded confidentiality and informed consent and discouraged routine testing and tracing of contacts, contrary to proved experience in public health.1 But exceptionalism grewto encompass HIV as a disease of poverty, a developmental catastrophe, and an emergency demanding special measures, requiring multisectoral interventions beyond the leadership of the World Health Organization.
He goes on to claim:
These fractures in the structure of exceptionalism are now obvious. Less obvious is the possibility that it is exceptionalism, not rural Africans, that drives stigma and discrimination
In effect, that the stigma associated with HIV is largely a product of health workers's and patient's attempt to keep treatment as private and discrete as possible!
The guy's argument is fucked up, to say the very least.
He also claims that HIV doesn't kill enough people to warrant all the fuss it's caused:
HIV exceptionalism is deadand the writing is on the wall for UNAIDS. Why a UN agency for HIV and not for pneumonia or diabetes, which both kill more people?
Worldwide the number of deaths from HIV each year is about the same as that among children aged under 5 years in India.
I find his "logic" chilling.
I'm no fan of the UN, but what other international body exists to manage and disperse money and other resources from the world's wealthiest nations to its poorest?
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There's an interesting (but long) paper from researchers at the World Health Organization that suggests a number of reasons why HIV AIDS should remain on top of the agenda at the UN. Basically, the researchers went through and projected causes of death and disability on a global basis around the world from 2002 to 2030.
Their projections show HIV increasing as a cause of death, while other communicable diseases decrease, and at a faster rate than other diseases such as diabetes.
Table 1. Projected Average Annual Rates of Change in Age-Standardized Death Rates for Selected Causes: World, 20022020
Average Annual Change (Percent) in Age-Standardized Death Rate
Cause Males Females
Tuberculosis 5.4 5.3
HIV/AIDS 3.0 2.1
Malaria 1.3 1.5
Other infectious diseases 3.4 3.3
Respiratory infections 2.7 3.4
Perinatal conditionsa 1.7 1.9
Other Group I 3.0 3.6
All causes of death in this group, which generally includes infectious diseases, are declining except HIV/AIDS
But even more importantly from a global resource allocation perspective they show HIV becoming by far the biggest source of decrease in productive life years, measured in terms of the decrease in Disability Adjusted Life Years ( the years of life lost due to premature mortality plus the years lost due to disability). The table below shows HIV as responsible for 12.1% of potential years lost to disability or early death, more than double the next highest projected cause.
Table 6. Ten Leading Causes of DALYs, by Income Group and Sex, 2030 (Baseline Scenario)
Rank Disease or Injury Percent Total DALYs
World
1 HIV/AIDS 12.1
2 Unipolar depressive disorders 5.7
3 Ischaemic heart disease 4.7
4 Road traffic accidents 4.2
5 Perinatal conditions 4.0
6 Cerebrovascular disease 3.9
7 COPD 3.1
8 Lower respiratory infections 3.0
9 Hearing loss, adult onset 2.5
10 Cataracts 2.5
This decrease occurs almost entirely in middle and low income countries -- HIV is not projected to be in the top 10 causes of lost productive years among the wealthy countries by 2030.
All of this points to a conclusion contrary to that of the article -- HIV remains the largest potential threat in terms of growth in disease and is poised to become by far the largest source of lost years of life and health in the coming decades. It remains -- very unfortunately -- an exceptional problem which calls for exceptional attention.
http://medicine.plosjournals.org/archive/1549-1676/3/11/pdf/10.1371_journal.pmed.0030442-S.pdf
Assurbanipal
(n.b. apologies for the lousy formatting of the copied in tables -- someday I need to figure out how to paste a picture correctly on here -- they often don't paste or come out huge or tiny)
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The man that wrote this is from Grenada. I'm not sure why I should pay much attention from someone from a spec of dust that holds 89,000 people.
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Isn't Grenada known for its quack mills that churn out phoney M.D.s?
I think it's a line item on their national budget.
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I'm not sure why I should pay much attention from someone from a spec of dust that holds 89,000 people.
There's only 80,000 people on the (slightly bigger) spec of dust I live on. Oh, and the latest available population count from Granada is a whopping 110,000.
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The man that wrote this is from Grenada. I'm not sure why I should pay much attention from someone from a spec of dust that holds 89,000 people.
So we must only listen to :
_Chinese
_Indian
_European
etc... (in more than you) ?
A correct interpretation of your thinking ?
And how many people are reading this publication is not important
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So we must only listen to :
_Chinese
_Indian
_European
No, John, we should heed voices from tiny islands with ramshackle higher education, but only if those voices are reasoned in what they say and in how they apply knowledge. The writer spews current statistics and factoids without deploying models to examine the future impact of unaddressed HIV and the present that could have been possible without HIV, and he takes a very narrow economic view without considering the human suffering and political instability imposed by HIV.
Worse, though, the writer's credentials and those of his "Health Systems Workshop" are uncertain. Any number of people get degreed by prestigious institutions, then noodle off to work their own bizarre thinking in relative darkness and without exposure to any thought that would challenge them. As there's no CV or list of cooperating members on the writer's HWS website, I'd tend to liken him to an epidemiological Unibomber than a great thinker. What would he have done about the quest for a polio vaccine or any number of diseases? Abandon them simply because poverty and the lack of potable water kill more people?
Namaste,
David
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post or write something controversial and you get a lot of attention
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post or write something controversial and you get a lot of attention
You mean something like: get on your knees and blow me, ya poz poof!? :o
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actually the roles would be reversed ...doh!
and namaste ;)
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So we must only listen to :
_Chinese
_Indian
_European
etc... (in more than you) ?
A correct interpretation of your thinking ?
Lately I feel like excluding individuals from Belgium. They seem to hand out science degrees to anyone there.
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post or write something controversial and you get a lot of attention
Everything is controversial.
So why you "post or write" ?
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Lately I feel like excluding individuals from Belgium. They seem to hand out science degrees to anyone there.
You have 7000+ post maybe you want to take a breath ?
Note
Re-read you, in this thread or others.
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Lately I feel like excluding individuals from Belgium. They seem to hand out science degrees to anyone there.
Philly -- please quit the constant digs at John.
Thanks,
Peter
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Everything is controversial.
So why you "post or write" ?
just making an observation