Sorry for not posting for a while but to make up for it here here’s a quick post about an article written by Pisani, in which she provides anyone wanting an excuse for not funding ARVs in Africa. Brilliant.
In this article, as ever, Pisani seeks media attention by making a point in an inflammatory and simplistic way.
This is in response to another story, in which some researchers have suggested that screening and in some cases blanket prescription of ARVs could prove effective.
In this case her argument runs like this:
1.) The AIDS mafia want treatment to replace prevention in Africa because they think that people on ARVs are less infectious, therefore reducing the spread of HIV.
2.) What the fools don’t realise is that people are most infectious soon after having contracted HIV so the screening is unlikely to help identify people in time
3.) Availability of treatment makes people less worried about HIV and so indulge in more risky behaviours
4.) Treatment is bad and people who think it is a good idea are optimistic simpletons
This ignores several important factors. Firstly the scientific argument, obviously there will be a decrease in inflections if everyone who needs drugs gets them as viral load is reduced, but this effect will not help those infections that take place before people have received treatment. Clearly then, the balance between effectiveness and screening interval needs to be considered. Annual screening could reduce all infections which aren’t caused by newly HIV+ people. No doubt this is still a significant chunk, though this is not the most risky time. It will also catch a good amount, though by no means all, people while they are at their most infectious. Assuming people are at their most infectious for several months you will find 8.3% (100/12months) of people in their first month and 25% of people within their first three months. This is still a big reduction. To increase this rate further you could increase screening intervals, perhaps of ‘at risk’ groups to achieve greater success.
As the true effectiveness of the idea will depend on loads of diverse factors, the only way to really know how well this will work is to do a trial. This is actually what is being proposed, so the whole thing sounds very sensible to me.
Secondly, the moral argument. You really can’t just go letting people die preventable deaths. If it costs money to bring the new infections and deaths under control in a way that rich counties have, then that is money well spent.
Once we acknowledge that it is morally right to reduce the spread of HIV the interesting question, and the one the researchers will set out to answer is “is screening and increased access to ARVs more effective, cost effective and practical than other forms of prevention?” That question won’t be answered by misrepresenting the augment as if the researchers have made a basic error in understanding the virus.