July 22, 2003
Feeling Like a Challenge?... Let's take five with Moira Gunn. This is "Five Minutes".
HIV isn't just HIV. HIV-positive Americans are almost exclusively infected
with what is called Subtype B, a subtype also representative of some 60% of
HIV-positive Europeans. And the rest of world? A complement of Subtypes A, B, C
and others abound.
Since the United States and Europe have had the most access to drug
therapies, it's not surprising that the most drug resistant strains of HIV are showing
up for Subtype B. But make no mistake - it's not the success of the AIDS drugs
which creates drug resistance; it's their misuse.
People use HIV drug therapies to attack the virus in their bodies 24 hours a
day, and should they choose to go off their medications - on what is described
as a "drug holiday" - they must do so strategically. Just like the boost
bacteria gets when we cut short a course of antibiotics, HIV has a field day when AIDS medications are taken haphazardly.
--
Besides the medical advances present here in the United States are public
awareness campaigns with two basic messages: Protect yourself from HIV infection, and if you are infected, take care not to spread the virus. What's missing from these campaigns, however, is another essential point: once positive, do not participate in the virus' mutation.
The consequences of infecting someone with a new drug-resistant strain are
palpable. The mindset that says a person can control HIV with a life-long, but
effective, regimen of daily medication transforms itself into one big,
frightening question mark.
The study which confirmed the Subtype B drug resistance was presented
recently at the International AIDS Society conference in Paris, and what has emerged
from that conference is an intricate picture of the world and AIDS, one in
which it is clear there is no one-stop global fix to the HIV problem.
During President Bush's recent tour of Africa, he consistently repeated his
promise of $15 billion for AIDS drugs, and on the face of it, it appeared to be
very good news. Millions of Africans are infected, while only tens of
thousands receive drug therapy.
With so few receiving drugs, the medical community believes that few, if any,
drug-resistant strains have developed in Africa, but what about when drug
therapies are widely introduced?
--
In our worst nightmares, mass-delivering AIDS drugs to an ill-prepared
populace could develop drug-resistant strains beyond our comprehension, while adding
the cost of continual testing for drug resistance would substantially reduce
how many could receive treatment.
This is exactly where social policy gets stymied by technology.
Can we in all good conscience send Africa drugs without bringing the entire
medical establishment needed to trace the emergence of drug resistance? Or do
we outright deny life-saving medical treatment in order to cautiously avoid the
potential for unchecked drug resistant strains?
It seems to me that our hopes to "conquer" HIV harken back to the 1950's,
when we believed that antibiotics had conquered bacteria. To believe that sending
AIDS drugs to third world countries is an outright solution is also very
1950's thinking.
The "fight" to conquer HIV is really a perpetual engagement, where technology
both contains - and, when misused, fuels - HIV's mutations.
The only real global answer to HIV is to commit ourselves to an unremitting
dance of containment, recognizing the limits of technology, the relentless
drive of the virus to survive and the frailties of human nature.
I'm Moira Gunn. This is Five Minutes.
