Misspent Aid Money

Photo: A lot of money is spent on this sort of material, which is all very well. But much of the HIV prevention, treatment and care work is done by volunteers.

Since HIV/Aids has been identified, tens, perhaps hundreds of millions, have been spent on advertising, marketing and publicity. Great, the more people know, the better. However, people who are 'experts' in advertising, marketing and publicity do not seem to know much about public health, nor do they seem to care. So campaigns have received a lot of attention for a short time.

Well, that's what advertising, marketing and publicity are all about. But it's not what public health is all about. People have human rights that relate to health, as well as other basic benefits. Human rights are not a matter of a quick (and extremely expensive) campaign. People need to be aware of their rights and those who are in a position to do so, should object when people are denied their rights.

There are many examples of the excesses of advertising, marketing and publicity campaigns but one featured on the BBC website yesterday certainly takes the biscuit. An Adolf Hitler lookalike is shown having sex and represents HIV, so to speak. For any viewer, Adolf Hitler could just as easily represent a HIV positive person. If the viewer is HIV positive they will experience the sort of stigmatizing attitude that they and other campaigners have spent years fighting against.

So well done to the advertising, marketing and publicity industries. They always know how to make a bad situation worse. Let's hope that their lack of success at achieving anything permanent results in this campaign having as short term an effect as all their other travesties. The worrying thing is, who insists on continuing to give millions of dollars of aid money to these idiots? Sphere: Related Content

Congratulations to the Clinton Foundation

The Clinton Foundation has negotiated a significant reduction in the cost of several second line antiretroviral (ARV) drugs. Out of the 3 million or so people who are presently on first line drugs, many have developed resistance and need second line drugs, but these are far too expensive for most people. This is great news because over the course of treatment, many people will develop resistance. So the availability of cheaper drugs will save a lot of lives.

May the Clinton Foundation go on to negotiate more such deals. While they are at it, they could advocate for more widespread production and use of generic versions of ARVs. Developing countries should be able to produce these themselves and thus increase their self reliance and the overall sustainability of treatment programmes. Also, perhaps they could advocate for more money to be spent on preventing HIV transmission so all these billions of dollars of aid money don't need to go straight into the pockets of rich and greedy pharmaceutical companies. But this is a very good start, so congratulations to the Foundation. Sphere: Related Content

HIV Treatment Must Be Accompanied by HIV Prevention

In most high HIV prevalence African countries, rates are currently flatlining or changing very slowly. The rate of new infections is high, the death rate is high and about one third of those needing treatment are receiving antiretroviral drugs.

Ideally, HIV programming should aim to reduce the number of new infections while treating as many people as possible. Unfortunately, prevention programmes have not been too successful. Therefore, the number of people living with HIV continues to increase and is only held down by a high death rate.

Continuing to treat those receiving drugs right now is becoming a problem because of funding shortfalls, so it is unlikely that the number of new recipients of treatment is going to increase in the foreseeable future. If people needing drugs are unable to get them, even temporarily, death rates will rapidly increase.

Ironically, this could result in the death rate exceeding the rate of new infections and HIV prevalence would then decrease. This may make it appear as if we are winning the fight against HIV because the prevalence figure tends to be used as a measure of epidemic severity.

Funding for HIV programming needs to increase because, in addition to getting as many people on treatment as possible, the rate of new infections also needs to be reduced. Otherwise the epidemic will continue to grow and, if treatment programming is not presently unsustainable, it soon will be.

Judging the state of a HIV epidemic using prevalence figures is futile because prevalence goes down when death rates exceed new infections; and prevalence goes up when those needing treatment are receiving it because more HIV positive people are living longer.

Instead of being blasted with prevalence rates all the time, we need some indication of the rate of new infections (incidence), death rates, treatment rates and possibly some other figures. Otherwise we have no way of judging the status of an epidemic. Sphere: Related Content

De Facto Subsidies for Big Pharma

It sounds like this article, about a HIV prevention trial of gel and tablets, is actually about pre-exposure prophylaxis (PrEP).

PrEP is the use of antiretroviral (ARV) drugs to prevent HIV infection. At present, ARVs are used to treat people who are at an advanced stage of HIV. They are also used to prevent mother to child transmission of HIV.

One of the reasons that HIV programmes, especially treatment programmes, are so expensive is because the price of ARVs are kept artificially high by drug companies and this phenomenon is supported by donor funding, which is a de facto subsidy to the pharmaceutical industry.

If PrEP gets the go ahead, HIV prevention could also become dominated by capital intensive pharmaceutical technologies. There are an estimated 33 million people living with HIV at the moment. The number of people who could be targeted with PrEP would run in to the hundreds of millions.

It seems odd that the article never mentions PrEP but perhaps it's just an oversight. Sphere: Related Content