The Washington Post’s weekly “5 myths” series is nothing if not wide-ranging. Recent subjects have included drone warfare, choosing the pope, and the currently active “sequester.” Of course that’s because the series is based on the topic of the moment in the public’s mind — or in the mind of that part of the public the paper would reach. This week it picks up on the news that a neonate in Mississippi evidently had the HIV virus completely removed from her body by immediate and massive doses of drugs.
And so we have “Five Myths about AIDS.” The authors are Craig Timberg, a WaPo technology reporter, and Daniel Halperin, a professor of epidemiology at the Ponce School of Medicine and Health Sciences in Puerto Rico (whose CV reveals continuous work in this area since his 1995 PhD in anthropology from UC Berkeley), who have also written a book together on the subject. (For the general context of the 5 myths series, see the beginning of this post.)
In their introduction the authors note the Mississippi case, and caution that despite the optimism they say it inspired, “a true cure is almost certainly years away.” Then they get right to the “myths.”
1. The case of the Mississippi baby means we’re close to curing AIDS.
I don’t know who has really thought we were, but let’s assume some have so as to let the authors make their point. They first say that some are skeptical that the infant was really infected, linking to an article which is salted with phrases like “if the report [of the curing] proves true,” but which never really says why it might not.
But their main point, apparently, is that the case is too unusual to serve as any kind of model. They say that even though infected pregnant women are now routinely treated to prevent the fetus from becoming an infected neonate, there are still many, many babies born with the virus. I suppose they mean that those cases will not have access to the treatment the Mississippi baby got, although they are none too clear.
2. AIDS is the leading killer of babies worldwide.
The series usually has at least one straw man, and here it is. I’m sure that most people know that it is classic diseases like malaria that kill the most children in poor countries.
Still, Timberg and Halperin cite useful statistics from UNICEF: 7 million deaths per year of children under age five worldwide, of which AIDS accounts for about 2%. We need to work harder on those other diseases, as they correctly point out.
3. Mothers with HIV should never breast-feed.
This has indeed been a fairly prevalent belief: A professional-sounding 2007 report puts the fraction of the world’s HIV-positive children who got the virus from breast-feeding at one-third, and recommends that formula be used wherever it is available.
Not so, say our authors. Admittedly, the infant’s risk of getting the virus from an infected breast-feeding mother is about 1% per month, but in the parts of the world where AIDS is most prevalent, the water you have to use to make formula can pose worse risks. Add to that the fact that mother’s milk is just plain better for babies than formula, and you get the result that breast-feeding is to be preferred, at least in undeveloped countries.
I’m no expert but it sounds right to me.
4. Drugs are the key to preventing HIV’s spread.
Here T&H first acknowledge the “success” of the Bush 43 administration’s PEPFAR program (without mentioning either name), now ten years old, in getting antiretroviral drugs to the developing world where AIDS has been rampant, linking to a glowing WaPo editorial from last month on the subject.
Here they neglect any mention of the widespread criticism over the ten years of the way the program has actually been carried out. This began even before the measure was enacted, with Rep. Henry Waxman’s (D- CA) attacking the policy that had the effect of requiring expensive brand-name drugs rather than cheaper generics, a policy that was enacted in spite of his complaint, although it was reversed after the first two years. Then there is the fact that some of the program’s funding has been siphoned off to promote ideologically driven abstinence-until-marriage promotions (which work about as well in the Third World as in U. S. high schools), or the fact that funded organizations have been required to sign an anti-prostitution pledge (on which see Michelle Chen’s FDL post from two months ago). And on it goes.
Perhaps T&H would say that all that is irrelevant, since they are concerned to downplay drugs as a means to end the epidemic. Instead, here they tout use of condoms, reduction in the number of sexual partners per person, and male circumcision. But, leaving the first two proposals aside, do they not know that circumcision is now a controversial procedure? As one comment in the thread following their article puts it, demanding circumcision to prevent AIDS is like demanding mastectomy to prevent breast cancer.
The authors round out their argument against this “myth” by saying that
in communities with easy access to AIDS drugs, risky behavior often arises because there is less fear of the disease.
But to me that sounds like saying I should forego eating because I might lose self-control and get fat. So as I said I’m no expert, but the intelligent layperson that I hope I am must conclude that the authors have singularly failed to refute this “myth.”
Rather, it sounds like what is needed to confront the still burgeoning epidemic is a massive program to supply anti-retroviral drugs, free from interference by ideologically-based organizations, coupled to be sure with an also massive educational program in third world countries (and in depressed areas of U. S. cities) about what HIV and AIDS are and what do do about them. And BTW, that is not what we are likely to get from the Obama administration: It reduced funding for the so-called Global Fund to Fight AIDS, TB, and Malaria by 22.5% between the fiscal years of 2008 and 2011, and one hates to think of what might still come out of its management of the current sequester.
5. AIDS can’t be defeated.
Another one that I suspect few actually believe in the abstract. (A statement that it can’t be defeated by the current means of attacking it would find more supporters.) In any case, here the authors first acknowledge the current grim statistics: 34 million people are currently infected worldwide, and in 2011 there were 2.5 million new infections and 1.7 million AiDS-related deaths.
But, T&H say, we can be optimistic, especially because the infection rate has been falling. What needs to be done to make it fall further, they say, is to do more to curb infection rates and get medicines to those that are infected (in spite of downplaying this solution earlier in the article), and to follow the other measures they have suggested. They conclude with an aphorism:
In public health, curing diseases is great. Preventing them is even better.
At least to me, this updated version of “an ounce of prevention is worth a pound of cure” falls flat.
Timberg and Halperin are experts (or at least Halperin is), and I’m sure their book on this subject is worth reading. But their effort here is flawed, whether due to their own lapses or the constraints that WaPo and its “5 myths” format force on them (it’s hard to say which, although the paper’s antipathy to Bush might have played a role in the confusion as to whether or not more drugs are a good idea). The discussion of breast-feeding seems cogent, but otherwise the article contains too many non sequiturs and ignores too many elephants in the room.
In the last analysis, the AIDS epidemic is a political problem. It can only be ended when politicians are forced to recognize that 1.7 million preventable deaths per year is unacceptable. Read the rest of this entry →