Left Field by Patricia Nell Warren
Who will pay for the “AIDS-Free generation” in a world facing financial crisis?
Secretary of State Clinton’s now-famous November 8 speech at the NIH has promoted the “new” idea of an “AIDS-Free Generation.” The State Department swears this can happen as a result of their new three-point program. The program keys (1) global ART for HIV-positive mothers and babies, (2) global ART for everybody else who is poz, and (3) global male circumcision. In my last “Left Field,” I analyzed Points 1 and 2.
In reality, the program offers little that is new—it simply looks for new reasons to push existing AIDS policy. And not surprisingly, little serious analysis of Hillary’s plan has hit the media so far. Indeed, media stories often simply parroted the government policy advocates. For example—regarding the studies cited as proof that Hillary’s program will work, they misquote statistics, or oversimplify results to the point where critical parameters are omitted. For instance, with the much-quoted HPTN 052 study, some media stated merely that early ART can prevent infection ninety-six percent of the time. Sounds good, right? The media didn’t mention that, in the studies, effective treatment had to happen during a narrow window when the infected person’s CD4 count was still between 350 and 550.
The studies themselves, if scrutinized, show us that progress towards this “AIDS-free generation” will travel a bumpy road.
For instance, the #3 point, male circumcision. The U.S. is one of the world’s leading practitioners of male circumcision, thanks to heavy Protestant missionizing for this ancient religious practice during the Victorian era. In recent years, its advocates made huge efforts to legitimize their claims that it protects against HIV. And they’ve succeeded—policy to go global with circumcision is now on a roll. In her speech, Clinton enthused about the 35,000 male circumcisions a month being done by PEPFAR, and she aims for millions more foreskins to be snipped around the world. The U.S. media have given a lot of high-drama coverage to male circumcision, which now has its own mantra of belief about how effective against HIV infection it supposedly is.
Cost-wise, male circumcision may be “simple and inexpensive.” But the science alleging it to be an effective barrier to HIV looks a bit shaky. All three African studies being cited as “proof” that circumcision prevents infection were, in fact, run by scientists who had already taken a strong ideological position in favor of circumcision. We might as well ask a cigarette lobbyist to run a study on whether or not smoking is harmful. So the three studies may have been biased from the start.
Hillary quoted a generalized sixty-percent protection rate for circumcision—and some media upped this to “over sixty percent.” Only hetero couples were studied. But in fact the three studies reported a range, with the highest prevention reduction at sixty-one percent in South Africa, and the two others much lower, at around fifty percent in Uganda and Kenya. In short—if you have sex with a circumcised man whose status you don’t know, you’d better pray that you’re lucky, because your odds of coming out of the encounter with HIV infection are around fifty percent. People who do sports betting would not view these as attractive odds.
Overall—where Hillary’s three-point plan goes off the cliff is on costs. All it takes is some fifth-grade arithmetic to raise scary post-grad questions about whether this AIDS-free Eden will be bankable—especially during our era of global financial apocalypse.
Clinton quoted the PEPFAR average of $335 a year to treat one patient with ARVs in a developing country. At that rate, treatment of the estimated global cohort of 33.3 million HIV-positive people would require around $11.2 billion a year, for the rest of their lives. If all of them live for just six years, total treatment will cost $67 billion dollars, which is slightly more than the State Department spent to date on the reconstruction of Iraq. In sub-Saharan Africa, where the greatest burden of AIDS cases weighs, there are an estimated 15.2 million HIV-positive adults and children; these alone would require $7.6 billion a year for the rest of their lives. The estimated world total of women living with HIV would require over $5 billion a year in ART.
Worse yet, the PEPFAR average evidently is for cost of ARVs alone. It doesn’t include the cost of treating side effects and opportunistic infections. Meanwhile, according to PEPFAR, their global funding has helped to treat just 11 million people in fifteen countries last year. So PEPFAR has been going since 2003, and it is still less than halfway to Hillary’s global goal.
Hillary’s program will also be undermined by the growing influence of extremist pentecostal and evangelical churchism, especially in Africa. These church leaders—both Africans and U.S. missionaries—go around teaching that AIDS should be cured by prayer, not pharma products. A Culture, Health and Sexuality article on Nigeria tells how young HIV-positive African Christians are actually discouraged from seeking ARV treatment and urged to rely on faith healing instead. Hillary attends the National Prayer Breakfast every year, where (as a Bible believer herself) she chums with some of the American extremist figureheads who drive that international movement. I suggest that she have a chat with those people about how their ideology gets in the way of her “AIDS-free generation.”
Yet another threat to Hillary’s program is a simple law of nature—what inevitably happens when living viruses mutate in response to years of bombardment by pharma drugs. Even if PEPFAR could provide enough cheap second-line drugs to PWAs whose growing resistance has nixed the first-line drugs, sooner or later the second-line drugs will fail as well. Result: Her program will result in tens of millions of individuals becoming walking reservoirs of drug-resistant HIV strains. Already well over 3,000 of these strains are on record with the government’s Los Alamos HIV clinical database.
Recognizing this threat, the World Health Organization says: “The consequences of drug resistance include treatment failure, increased direct and indirect health costs associated with the need to start more costly second-line treatment for patients, the spread of resistant strains of HIV and the need to develop new anti-HIV drugs. The extent of HIV drug resistance resulting from recent ART scale up in resource-limited countries has not systematically been quantified due to the lack of reliable data and information.” Translation of WHO’s low-key cautionary statement: there are major questions about whether a global backlash of drug-resistant strains could appear.
In the closing tropes of her speech, Hillary did make it clear that the U.S. would not shoulder the gargantuan cost of this “AIDS-free” Eden. We can’t even afford to treat our own PWAs now! She insisted that governments of other countries should shoulder their just financial share of the “AIDS-free generation.” Great idea. And where are they going to find the money?
In the next Left Field, Warren will explore some further ramifications of Hillary’s speech.
Text of Hillary’s speech:
Huffington Post piece by Goosby/Dybul:
NIAID report on HPTN 052 study:
African Christians go for faith healing:
“Youth, Sin and Sex in Nigeria,” by Daniel Jordan Smith (Culture, Health and Sexuality, September–October 2004)
Copyright © 2012 by Patricia Nell Warren. All rights reserved.