Unequally Yoked
My time at AAAS has come to an end, and today, I just want to feature one session. (The post on the Dialogue on Science Ethics and Religion panel will be up later this week).
Julio Montaner: Toward the Control of HIV and AIDS: Comprehensive Treatment as Prevention
We think of the mark of success for a new medical treatment as scoring a significant result when all the data are in. That’s pretty good, but there’s an even better prize: having your study called off part-way through because your new treatment is so good that it would be immoral to keep people in the control group.
That’s what’s happened in almost every study of using antiretroviral drug therapy to lower the chance of HIV transmission. According to these studies, here are some ways you will almost certainly not contract HIV if the HIV+ person you’re exposed to is using highly active antiretroviral therapy (HAART):
- Having unprotected sex
- Sharing needles
- Being born
We have all the medical tools we need for eradication now. Unfortunately, as you might remember from discussion of contraception (99% effective when used correctly, but, with typical use it fails 8.7% of the time) the problem is compliance and logistics.
British Columbia has made ART available for free to every HIV+ person in the province. This intervention got them to an estimated 60% coverage of all eligible infected people. In the US, which doesn’t make this kind of commitment, we’re only at around 30% coverage.
This is why I like the coercive power of the government to be linked to healthcare. People in the early stages of HIV/AIDS are asymptomatic, so they need to be screened. Even once they’re identified, they may not want to pay for treatment, since, subjectively, they don’t feel sick. You need a major actor to change the incentives. In developing countries, you can add in all the problems of outreach, education, and follow-up (which also exist in the developed world when you consider transient or illegal populations).
I asked the speaker where he recommended donating, since this is one of the biggest opportunities to over the next decade to make medical research pay enormous dividends. He recommended the Global Fund to Fight AIDS, TB, and Malaria. But he cautioned that no private charity will ever be able to build up an entire parallel health care network to solve this problem. It needs the government to universalize it.
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