Friday, August 29, 2008


We just had the XVIIth International AIDS Conference in Mexico City, and I feel I should say a bit about it. Many are excited because the number of AIDS deaths is down by 200,000 from 2.2 million in 2005 to 2 million in 2007. And this is big news. As a statistician, though, I am trained to be wary of such figures without looking at lurking variables and correlated variables (world population, HIV prevalence rate, infection rate, AIDS population, etc.). But as of today we still face many challenges.

It looks as if we won’t make the 2010 deadline of having all person with AIDS on ARV’s. In fact, here in Sub-Saharan Africa and even just in South Africa we still have a greater number of new infections per day than the number of new ARV treatments initiated per day. The second problem is both the cure and the vaccine. Someone the other day asked me if we were close. I put it like this to her: if close means eliminating possibilities (assuming there are 200 things to try and we tried 138 of them), then yes; if close means actually one step away from making the vaccine work or finding the cure, then no. I told you about the trials that we were doing at UCT (I was not a part of it) in earlier updates last year. Nothing good to report. Even with microbicide trials in the final stages—we have got nothing. The Economist reports that three microbicide trials, two genital herpes-suppression trials, and one diaphragm trial have all failed (genital herpes is a means of increased risk of contracting HIV and you may know what a diaphragm is).

The Economist goes on that there are currently three options people are looking to explore: giving ARV’s to people as microbicide (kind of like using it as contraception

Because ARV’s tend to concentrate in the vaginal tissue), giving ARV’s to uninfected people as prevention, and increase treatment in those infected since treatment lowers the viral load and the infectiousness.

There really are so many issues going on with this and I’ve realized how important the social scientists are in the fight who reveal our attitudes, the politicization, the biases—all social aspects of this. It’s important because since cures and vaccines seem very far off we need to change our attitudes and behaviors in order to fight this thing. Doctors without Borders list as their biggest issues today

A shortage of healthcare workers (big here in South Africa-BHSA)

HIV-TB co-infection (BHSA)

Access to needed drugs and diagnostics (BHSA)

Program indicators of quality and continuity of care (not sure about this one)

Pediatric care and prevention of mother-to-child-transmission (BHSA)

And I’m sure the 4th one is big here in South Africa, too, and I just don’t know. I have a friend named Elisa who is in a continual process of discovering herself which I appreciate. She plans to work on the 4th problem in Kenya volunteering for a year to help build up their health information systems to better aid the fight and epidemiology especially for our most affected populations.

I’ve another friend named Suzanna who encapsulates passion. Suzanna is a medical student at Baylor who took a few months and did AIDS research in Switzerland learning about biostatistics and public health (something I recommend for all good doctors or aspiring doctors). She actually went and presented her work at the conference in Mexico City!! I am so proud of her especially because she used words like sero-discordant and meta-analysis and cohort. Here is a link to her talk, followed by a link to other talks (they include video).

The Africa that I am building has a golden platter in front of it that will never be empty and has the ability not only to feed its own people but to feed the nations of the world.

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