The end of HIV?

Update from author:

I misinterpreted Alanna’s original post when I wrote this. Please see her new post about universal HIV treatment at the change.org global health blog here.Sorry for the misunderstanding.

-Jon

Alanna Shaikh over at the change.org global health blog has some sharp words for the New Scientist, which recently published an article titled, “Are we about to eliminate AIDS?” and an editorial titled, “New hopes over elimination of AIDS”. In both articles, the authors for the New Scientist explore the possibility that HIV could be effectively eliminated from the planet by a massive scale up of testing and treatment for HIV patients. By reducing an individual’s viral load, not only are you extending the individuals life, but you are also drastically reducing that individuals chance of spreading the virus.

Alanna retorts:

… way to oversimplify a complicated problem and propose an unbelievably bad solution. They allude to some of the huge problems with this plan in the article, “Persuading everyone with HIV to start therapy purely for public health reasons could be ethically dubious. To identify everyone who is HIV positive would require such widespread testing that some may feel it breached their civil liberties. Then there is the question of who would fund such a massive undertaking.” But that doesn’t even begin to touch the problems with this idea.

… getting ARVs to everybody with AIDS runs much deeper than a funding problem. You need health care providers who can prescribe and manage treatment regimens, and a logistics system that will get the drugs to the places that need them. None of this could be solved overnight with a cash infusion. You need training, and that takes time. There’s no way around it.

I agree with Alanna’s observation that the New Scientist drastically underestimates the challenges and barriers to achieving 100% global ART treatment for HIV patients. However, I’m really surprised that she seems to be saying that it’s not something that we should strive for. Why is advocating treatment for sick people an “unbelievably bad solution”? I know some people who would not only argue that providing treatment for the sick is the morally right solution, but that it can actually work and be sustainable in places of dire poverty.

It seems to me that the goals for people striving for equity in global health should revolve around advocating for – not against – the funds, the systems, and the medical expertise necessary to build the health systems which will allow ambitious plans such as this to be successful. Utility arguments are good, but I think that ultimately it comes down to a sense of fairness and justice. Promoting health as a human right should be at the core. The world has the resources, the effective medications, and the technical expertise to make 100% treatment a reality. The question is: are we willing to share with those who need them most?