Pre-Exposure Prophylaxis or PrEP

Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. This blog looks at some of the pros and cons of PrEP.

Tuesday, January 4, 2011

Science Awards: Virtuous Circle or Spooky Cabal?

There are few things that make me think 'collusion of interested parties' than prominent awards, with the exception of peer reviewers, who always me think of Freemasons for some reason. For all I know, though, they could all be completely innocent and/or unrelated.

Anyhow, Science Magazine has awarded two of their ten prizes to the highly controversial and unconvincing Tenofovir vaginal gel (the CAPRISA 004 trial) and the almost equally unconvincing pre-exposure prophylaxis drug (the iPrEx trial). There is a lot of USAID and PEPFAR funding behind both of these, so the poor trial results may not matter too much.

The ongoing concentration on capital hungry technologies and technical expertise tends to mask one of the biggest problems that poor countries face: shortage of skilled health personnel. Here in Tanzania there is one doctor for approximately every 50,000 people (compared to about one for every 170 people in Cuba). What are people going to do with all these drugs and other technologies, assuming they can ever afford them?

This problem, like many of the other real problems developing countries face, is ignored by the cabals of industrialists, megaphilanthropists, technologists, politicians, religious fanatics and other jackals of the HIV industry. But it is not going to just go away.

Of course, it's of little interest to the same interested parties, who wish to establish markets, not undercut the very source of their current and future wealth. In addition, HIV related technologies need to be put through rigorous trials in countries with high HIV prevalence to prove their worth. So even if 'aid' money will not be diverted to subsidize these markets, contacts with developing countries need to be maintained. After all, that's what 'aid' is, a tool of foreign policy.

Botswana has announced that it is going to concentrate on prevention, and not before time. The country has one of the worst epidemics in the world. But perhaps now they will reject the self-serving arguments about treatment 'being' prevention and about HIV funding 'strengthening health systems' or about it  not diverting funding from other health issues. If only other high prevalence countries, and even low and medium prevalence countries, would follow suit and stand up to the moneyed interests.

Botswana simply can't afford antiretroviral drugs at current levels of usage, never mind the annual increases in incidence adding to the costs, along with resistance and other factors ensuring that costs will rise exponentially, not linearly, in the future. All high prevalence countries with large numbers of people on antiretroviral drugs are experiencing the same problems as Botswana.

But Botswana also seems to have realized that much of the money spent on behavioral interventions has been wasted. Perhaps they'll take another step and realize that this failure of behavioral interventions may be because HIV transmission is not all about sexual transmission?

Using mere technologies to solve deeply rooted development problems is as likely to work as planting seeds on the moon (in its present state). And if I thought the HIV industry really wanted to solve development problems, health and HIV related problems in particular, I would think they are behaving like fools.

But I don't think anyone seriously believes such naive claptrap. They are business people, involved in protecting their markets and ensuring that they make as much money as possible, regardless of the consequences for people in developing countries.


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