I wanted to post this as a reply to this thread, but I think that one has been hijacked a bit, and I’d like some serious discussion on this. In that thread, Brutus said:
Now, I don’t know the exact validity of this statement, but basically agree with it. I also have a friend who spent a great deal of time in Kenya, who reported that the root of the problem is that there are cultural behaviours that are ultimately self-destructive as far as contracting HIV (when I go home from work I can ask for more specifics if you all would like). Apparently it is next to impossible to get many people there to change behaviour; they refuse to believe that what they are doing is causing the problem, and also refuse to believe that changing behaviour will do anything about it. (I realise that this is all very wishy-washy without any specifics. I’ll get some when I get home tonight).
That being understood (or not, feel free to argue with the premise), which would be a more beneficial (and effective per cost) expenditure of resources; one geared towards education and some degree of cultural reprogramming to alter dangerous behaviour, or one focused on developing a vaccine?
Does anyone seriously believe that even if we develop an effective AIDS vaccine it will be made available to poor African nations?
There already exist relatively low cost options to deal with other causes of death in extremely poor nations (oral rehydration salts and general vaccinations against a wide range of childhood diseases spring to mind); if the deaths caused by those conditions are not “important” enough for us to make relatively low cost health care options available, I can’t see anyway that an HIV vaccine is going to be made available (and you can count on any HIV vaccine being expensive for quite a long time after its development).
Education has to remain our major way of combatting the spread of HIV for the foreseeable future, but we also need to recognise that in cultures where there are so many other causes of morbidity and mortality, HIV is not going to be seen as the kind of “exceptional” threat to well-being that it is in the Western World.
I just don’t see where the money is going to come from for poor African nations to manufacture their own vaccine, let alone the infrastructure needed to distribute it.
We in the West have been controlling and preventing malaria for years, yet it remains a major health problem world wide. The political and economic priorities of Third World nations are very different to those in the West, and preventing ONE disease among many equally lethal (in those cultures) diseases is not likely to be seen as cost-effective.
Social change we can do now. Vaccines and cures may nor may not be possible, and are far off. Why not spend some of those billions going to AIDS research and spend it on something that can work today, not a decade from now, if ever.
Brutus, I curious about what specific social changes you think we can bring about in the developing nations in the relatively short-term (say, the next 5 years) which would impact on HIV transmission rates.
Brutus, we are all rather painfully aware that there is no vaccine; in fact, if I may be so bold, that is the very impetus for the discussion(s) at hand. But the question here is what is a more worthwhile use of resources available.
AIDS is a set of symptoms of the known HIV virus. We have combatted virii(? correct pluralization) before using medicine. We have not been successful, AFAICT, in altering behavior significantly. Any evidence to the contrary is welcomed (and, for reprise, requested).
Do you brush your teeth every day? Do you shower daily? Wipe after you do your duty? Scrape the mold off of bread and eat it? Wash your hands? What is the last time we had the good, lard-fried french fries at McD’s? Why aren’t there ads in magazines extolling the medicinal benefits of smoking?
How many other things do we do in the name of health and hygiene now, that we did not do 100 years ago? Add to the list: Stop being a fuck-monkey and always use a latex condom.
Only people’s own stupidity stops them from changing behavior when it comes to health and hygiene. I fail to see why it is so hard for people to accept that, but have no problem spending my tax money to bail these people out.
If people changed their stupid behavior now, then the cost of treatment will be however much lower.
We will continue to search for an HIV/AIDS vaccine not out of altruism but because whichever company develops an effective vaccine stands to make a lot of money in the Western world - just as those companies which developed antibody tests and existing treatments have made an enormous amount of money.
In Australia, at least, there was a dramatic alteration of risk taking behaviour by gay men in the early days of AIDS, and to a lesser extent among injecting drug users. It’s hard to recall a time during the mid-1980s when HIV/AIDS wasn’t constantly being talked about in both mainstream and gay media.
Education campaigns were very much taken to the target client groups. Workers were visiting gay bars, saunas, beats, brothels, known drug dealing venues etc.
What has changed in the last 15 years is the perception of the seriousness of HIV/AIDS in the target groups - and much of this is a response to better treatments. HIV/AIDS is both less dramatic and less visible within the community than it was 15 years ago when the time between diagnosis (which often only came about because an apparently healthy person presented with a devastating and uncommon opportunistic infection) and death was apparently (and often actually) quite short.
There are many difficulties in developing effective education programmes for the developing countries, not the least of which is that populations are often extremely mobile and that HIV/AIDS is only one among a long list of many other causes of morbidity and mortality. Your average Sub-Saharan can’t exactly pop into the local pharmacy to buy condoms, even if they could be persuaded of the need to use them (and in the absence of mass media and identifiable venues through which to distribute information, delivering an effective campaign on such a vast scale would be a logistical nightmare).
So do we simply accept that those currently infected will continue to transmit the virus until the time of their own, inevitable, deaths? We already accept appalling death rates from other preventable diseases in the same regions.
It’s easy to say “change your stupid behavior.” It’s not so easy to do.
Anyway, I don’t understand why we don’t just do both. We could educate the people AND give them a vaccine/medicine. The two are not mutually exclusive. People can get AIDS despite protection. The vaccine can prevent that, and the drugs can treat it.
Also, if we gave these people some hope of a cure, they might–just might–be willing to be tested. From what I’ve heard, a lot of people there view it as a death sentance, and there’s a huge social stigma against those who are HIV-positive as well. Under those conditions–you’re basically going to die anyway if you’re positive, and if everyone knows your postive, you’re going to be abandoned–why would people get tested?
…I’m not making much sense right now. Coherent response coming soon.
I will beat this dead horse until it is nice and tender:
There is no medical vaccine or cure for HIV. There may never be, regardless of how much money we spend on it. Just because a bunch of people want others to research a cure (and pay for it), does not mean it will neccesarily ever happen. There are how many diseases that we have been researching Nor does it mean that it will happen anytime soon. Nice thoughts about getting a vaccine or cure will not make one magically appear. That is why we can’t do both now.
There is behavior which acts as a vaccine. That can be taught right now. This instant. Is it 100% effective? No, but it is close. And behavior is free. The only cost would be telling everyone to keep it zipped and covered.
Can anyone explain to me why they don’t think that we can convince them to change their behaviours, but do think that we can convince them to take a vaccine?
We all know this, no one is claiming otherwise, and it is not furthering the argument. It was useless the first time you said it, and it only becomes more painful to hear you repeat it.
We have not figured out how to change behavior en masses: people still smoke, murders still happen (with some frequency, at least in the uSA), teen pregnancy, drug use (millions of people in jail for that), lying, stealing… I mean, do you watch the news?? If we could control behavior with any success we wouldn’t have half the problems we do.
I’m going to ask this again: why do you find it reasonable for every person to have no more than one sexual partner for their entire life?
While I appreciate the point erislover is trying to make about health education campaigns not being a total solution to public health issues, they very often do influence behaviour in the target groups in the short term.
Australia has one of the highest rates of skin cancer in the world, and our government has been running the “Slip, Slop, Slap” (now wrap has been added too) for many years. It would have been almost unthinkable in my childhood that in a country as sun-worshipping as this one you could successfully persuade large sections of the population to protect themselves from the sun, but you only have to walk down the street on any summer day to see just how widely the message has been adopted by the general community. Whether these measures ultimately lower our skin cancer rates remains to be seen, but certainly a very large section of the community has radically changed its behaviour as a result of a campaign specifically designed to bring about that change.
Breast self-examination, regular Pap smears, more people giving up smoking, and more people watching their diet and exercising have all resulted from wide-spread public health campaigns specifically targetted at behaviour (either creating a behaviour or encouraging people to modify an existing behaviour).
No matter what strategy is adopted in relation to the HIV/AIDS pandemic, it will never be 100% effective. If a free vaccine became available tomorrow, there would be a proportion of people who wouldn’t be immunised for any number of reasons, just as there are currently people who do not take measures to limit the harm of their risk-taking behaviours.
That neither a vaccine nor health education campaigns can ever be 100% effective in preventing further transmission of HIV/AIDS is not sufficient reason to abandon the pursuit of either strategy. Even a 20% reduction in the transmission of HIV would have a substantial impact in terms of reducing human misery and the size of the future disease reservoir.
reprise, I, for one, won’t argue that social programs can’t work, or won’t help. But I will argue that it isn’t enough and never will be. If we never find a vaccine, we never find a vaccine. But relying on public awareness and education to combat a disease isn’t a reliable solution.
It has worked, however, at least marginally well in the case of handwashing.
erislover, I’m not arguing against the development of a vaccine (as one of the AIDS widows on this board I’m totally supportive of any and all research in that direction). I just don’t see that in the next decade it’s going to address the pandemic in Africa.
In the absence of a vaccine, the only thing we CAN do to reduce transmission rates of HIV in developing countries is try to develop education campaigns which are workable in the context of those cultures.
Hmmm… will Brutus condemn the new Muppet with AIDS for living the fast life?
And we are spending lots of money on education, as well as South Africa making deals to receive condoms for testing to help get more rubbers for the people from Germany. But behaivor changes will not happen overnight, look how long the civil rights movement took.