Tuesday, July 20, 2010

South African Roulette

Today the world has been rocked by the good news that South African scientists have developed a gel, which if applied inside the vagina or anus of the female, will prevent HIV infections up to 39% of the time. While this sounds like an astonishing achievement, and a positive move in the fight against the pandemic sweeping Africa, this raises a few interesting points and questions for me.

1) The TV news this evening mentioned that 50% of the female test subjects were given the new gel and the other 50% a placebo. A placebo in this case would mean a blank, generic gel which has no effect or protective qualities at all. Bear in mind this was reported on SABC news, so while I am left wondering whether the people at the state's broadcaster slash mouth-piece, said too much - or whether they even got it right - however, this article is written based on the possibility they were correct.

2) It doesn't take much intelligence to figure out that the use of this gel in such a test - during sexual intercourse - would mean NOT using other safety precautions such as condoms, because then you would have spoiled test results in a test that would need definite results either way.

3) Of course, considering the point of the tests, proving HIV infection statistics using the gel, the female test subjects would have to be HIV negative to begin with, and all the male subjects would naturally have to be HIV positive - because to my limited knowledge, two HIV negative people can't infect each other with HIV, with or without any form of protection, no matter how hard they try. I could of course be wrong, as I am not a doctor, and therefore only an idiot.

Question: Considering these points, is it logical to assume that these scientists and doctors managing this little experiment KNOWINGLY and WILLFULLY gave half these test subjects an ointment or gel that would give them NO PROTECTION at all, and then told them to go out and have unprotected sex with HIV positive partners?

I suppose this is how you conduct tests on new asthma medication, give half the test subjects the new drug, the other half a placebo, tell them to stop all their other medication and go for a brisk jog every morning - and whoever gets sick or has an asthma attack can be treated in the facility performing the tests and regular check-ups, with medical staff on standby. If somebody dies - well, the legal department has already taken care of that, so it will only mean more paperwork and sending flowers and condolences to the correct address. Pity.

HIV/AIDS however, is not asthma. And regardless of whether there is a gel or not, any idiot these days should be able to tell you that despite the medical advances they have made in the past 30 years in the treatment of this disease - it still has no cure - with no definite cure in sight - and you only need to get it once.

Consider for a moment that you volunteered to help this HIV research program. If you were given the actual gel to test out, it means (in hindsight) you still only had 39% chance of not getting infected with HIV - even if you had otherwise unprotected intercourse with an HIV positive partner. First off, that's supposed to be the "lucky" scenario - also bearing in mind that while you are testing it, this is a new product which is clinically untested, which means until the test is completed and the results have been tabulated, there are NO GUARANTEES that it even works.

To me it still sounds like playing Russian roulette in a dark room with a pistol loaded by your worst enemy. Pardon me for saying so, but you would have to be either very, very desperate for money, not have anything to live for - or incredibly stupid to do this.

Taking this a step further, I suppose the gel is worth something in the continued fight against HIV infection, so I suppose a few lives lost here or there is worth the end result, isn't it - and it seems to me that in this case, the end justifies the means.

Again, 39% is still not really much good to me. I mean, the statistics show a significantly lower chance of people getting onto an airliner that won't reach its destination, and that's why people still fly Aeroflot. If people are going to rely on this stuff to keep them safe from the "groot siekte" then they will expect to see a major improvement in those odds. Come on, 39% still means that there is a greater chance of getting infected than not - some breakthrough. In the end, yes - use the gel whatever percentage risk they thumb-suck - but also use latex and good old fashioned common sense. Get tested first.

Now I feel really sorry for the poor sods that received the placebo gel, thinking they were given the actual medication. They would have had otherwise unprotected sex with an HIV positive partner, and most likely would now be sitting with HIV. As I said earlier, you only need to get it once, and it's game over.

I have to wonder what kind of medical care the test subjects who contracted HIV during the course of testing this "marvelous" new gel the people in Vienna are raving about, will receive from the developers? Assuming that money could make up for the promise of ill-health, life-long dependence on the anti-retro-viral drugs (which our clinics are out of stock of currently), and inevitable death from the disease - will they receive any financial compensation for it? I have to ask - how much is enough?

Then again, soldiers and cops don't get paid much to take such risks or to stop a bullet for king and country. I might be wrong, but this seems less likely to be fatal or crippling than taking such a test. By the same token, ordinary South Africans get hi-jacked and murdered all over the country every day, and there is a fair chance that you can get shot during a robbery at your neighborhood shopping mall - and the government continually claims that "crime is lower than ever". There is something sick about that sense of values.

Now I am sure the company involved in managing the testing made sure the test subjects signed a non-disclosure document, and indemnity form - and promised them tidy sums of money to participate and risk their otherwise healthy lives on this gamble. I'm also sure they explained the risks they took to the poor and possibly illiterate people they may have contracted to do the tests, and made sure they understood exactly what they were getting into. I am in no doubt whatever that they covered themselves from a legal point of view.

But to my sense of right and wrong, how right is it to knowingly give someone a placebo, tell them it will protect them from harm, tell them there is a possibility they may get shot - and then send them into battle wearing cardboard armor?

There is, in my view at least, something horribly wrong with this system.

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