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Posts Tagged ‘African American’

Covid-19: Can the initial response to HIV teach us anything?

Many of us who participated in the early response to HIV/AIDS have been asked if any useful lessons were learned that might help us in dealing with Covid 19.  Implicit in the way that question was sometimes asked was the assumption that the medical response to AIDS was exemplary, a contention I most certainly do not agree with.  Instead and more to the point, the question might have been: Can we avoid repeating the mistakes made in the medical response to HIV/AIDS?

The mistakes that were then made, both with respect to steps that were taken and those that were not taken were numerous and easily documented. As examples, they include the failure to make recommendations and pursue studies on the prevention and treatment of opportunistic infections, most strikingly the failure to provide guidance on the prevention of pneumocystis pneumonia until 1989, when the means to do this had been known even before 1981;  the very inappropriate use of interferon to treat people with AIDS when it was already present in patients and in large quantities, and when evidence already existed that interferon could play a role in pathogenesis; the failure to respond to the movement of the epidemic into African American communities, that was happening in plain sight as early as the late 1980s.  There are many more examples.

It’s difficult to see where responsibility for this dismal response lies.  Medical scientists who could see these failings also remained largely silent, or perhaps were not successful in advancing their criticisms.

Should we not try to understand how the indifferent federal medical response to AIDS was able to continue?

How is a medical leadership established in times of crisis?  How should it be established, keeping in mind the wellbeing of the public as its goal, safe as possible from political influence?

Sadly, it’s unlikely that this question will ever be addressed let alone answered. With the increasing privatisation of public services over the past 40-50 years there is now almost nothing left to defend the public interest.

 

Whatever goes into the establishment of a medical leadership in times of crisis, in the case of HIV/AIDS, it failed miserably.  Can we trust that it will not fail us today?

 

Unlike the mediocre medical response to HIV/AIDS, the scientific response was spectacularly successful, resulting in major advances in virology and molecular cell biology with implications well beyond HIV/AIDS. The same appears to be true of the scientific response to Covid 19.  Maybe virologists, immunologists and molecular cell biologists have performed so much better than the doctors partly because they are to a greater extent, shielded from political influence.

 

There has been much recent publicity reassuring us that we are in good hands with Dr Fauci leading the medical response. Maybe this is indeed a good thing, but in extoling his virtues, one can’t help but note that the less than lustrous performance of the medical response to HIV/AIDS under his leadership has somehow been transformed into a triumph.   We should not be taken in by this attempt to obscure a less than exemplary past.

We have to admit to what went wrong as a first step to getting it right.

 

 

 

 

 

 

AIDS and MINORITIES

February 25, 2009 2 comments

February 24th 2009

AIDS and Minorities

In the US, African Americans constitute 12% of the population, yet almost half of the total number of AIDS cases in the country occurs among them. This disaster is only now being generally recognized, with the leadership of the Federal AIDS response finally turning their attention to this tragedy, at least publicly.

This is a tragedy that has been developing in full view for more than twenty years. One only has to look at statistics provided by the Centers for Disease Control (CDC) since the epidemic started to know, as early as 1987 that without intervention a preventable disease was inexorably moving into African American communities.

Firstly, take a look at the situation in 2006 (data from the Kaiser family Foundation).

2006c3

Now take a look at this picture that clearly tells a horrible story that words cannot match.

usepidemic3

In the light of this devastating evidence how is one to understand the comments of Dr Fauci, who can be regarded as the head of the Federal scientific and medical response to AIDS?

He noted that these “shocking statistics would be tragic anywhere but are particularly inexcusable in a wealthy country such as the United States.”

His complete statement can be seen here: http://www3.niaid.nih.gov/about/directors/news/BAAID_09.htm

Look at the above picture again. Cases in African Americans started to exceed those in white Americans in 1994, but the trends were quite evident long before this. We knew in 1988-1989 what was coming. So, one must wonder why it took all of twenty years to announce only in 2009, that these statistics are shocking.

A preventable tragedy was taking shape in full view of the Federal AIDS leadership, who rather than fund a vigorous prevention education campaign directed towards those most in danger, instead chose to support a wasteful, vacuous untargeted prevention education program in the form of “America Responds to AIDS”.

It is not only the federal AIDS leadership that failed to respond to warning signals flashing brightly right in front of them. In the early days of the epidemic there was a vigorous and exemplary community activist response. This was a terrific example of people dealing with a deadly disease taking action on their own behalf, fighting for the best medical and scientific response and against the all too frequent shameful stigmatization of HIV infected individuals.

The flowering of AIDS activism in the late 1980s and early 1990s achieved a great deal. All people dealing with serious illness have benefitted from the precedent that was set. Yet, in recognizing this achievement, we must also wonder why many of these experienced advocates, who no doubt were aware of the demographic trends shown above, seemed generally less willing to at least try to avert the disaster threatening their fellow citizens? Of course some tried, and maybe were overwhelmed by massive indifference.

Whatever the reasons, the advocacy of US activists abroad, particularly in Southern Africa, proved to be more effective than anything they were able to achieve in their own country for their fellow African American citizens. There are also other groups where AIDS has been, and continues to be a growing problem, but have been relatively neglected.

Not for profit organizations, that raise funds to help and advocate for people with AIDS were also aware of what was developing, but if there were any efforts devoted to preventing a calamity visibly descending on the largest community at greatest risk, these clearly were of little benefit.

What is almost, but not quite, as shocking as the neglect of a disaster developing in front of our eyes, is the complete absence of any sense of contrition, let alone a simple acknowledgment of failure, on the part of those who might have helped to prevent it.

If justice includes the notion of equity then prevention resources should be distributed in proportion to the needs of different communities. This clearly has not happened and it might be helpful to give some thought as to why this has been the case.

We need to know and admit what it is that we did unsuccessfully, or failed to do, to stop a preventable disaster, so that we can get it right in the future.

Instead we have a wringing of hands by those who could have done something, but did nothing, to stop this.

A similar article was posted on a health related web site in December of last year. There was no response to the issue I raised.

This post can be seen here.

http://Aidsperspective.net/articles/AIDS_AND_MINORITIES.pdf

Take yet another look at the picture showing the changes in the proportion of AIDS cases according to racial/ethnic group over the past 20 years. It tells the whole story; no comment is really needed.