Friday, October 12, 2012

(STICKY) We need new HIV responses

COMMENT - The 'new response' we need, is to thoroughly examine the way we estimate national HIV prevalence rates. If only DHS surveys were used, which do not rely on the massive overrepresentation of positive results among pregnant women (which is what Zambia's HIV figures are largely based on), and then use a Western Blot confirmation test for positive ELISA (P24, P55) screening tests, then I would say Zambia's HIV prevalence rate will go from 13% to 1.3%, like the DRC's. (I quote from the 2007 DHS of the DRC: " According to the EDS-RDC, 1.3 percent of the population age 15-49 years is HIV-positive. The prevalence is 1.6 percent for women and 0.9 percent for men. "

By contrast, Zambia's HIV data is heavily skewed to blood collected from pregnant women, who are not only not representative of the general population, but whose pregnancy itself generates massive numbers of false positives on single ELISA HIV tests, as well as many other tests. (Read: (Washington Post) How AIDS in Africa Was Overstated - Reliance on Data From Urban Prenatal Clinics Skewed Early Projections, by Craig Timberg. This is what is skewing the Zambian data upwards.)

Men Tested 80,659 (15.7%)
Women Tested 430,607 (84.3%)
Pregnant Women tested 364,331 (71%)
Total Tested 511,266 (100%)

To quote from the research: "The high number of females tested was mostly from the PMTCT programme which accounted for 364,331". Source: ZAMBIA COUNTRY REPORT Monitoring the Declaration of Commitment on HIV and AIDS and the Universal Access Biennial Report.

We need to improve data analysis/testing, and the 'epidemic' will disappear. Meanwhile, the diseases caused by the poverty that comes from free market economics will be addressed at it's root - the massive impoverishment of the people through the stealing of the people's resources, from copper to land.

The solution is: 1) only use DHS surveys, no more PMTCT data, and 2) use Western Blot to confirm positive ELISA screening tests. Those are the new responses we desperately need. And then we can address the diseases of poverty, by addressing poverty itself.

Also read, from the Boston Globe in 2004: (BOSTON GLOBE) Estimates on HIV called too high - New data cut rates for many nations, by John Donnelly, Globe Staff | June 20, 2004

Read more here.

We need new HIV responses
By The Post
Fri 12 Oct. 2012, 14:00 CAT

We have been dealing with the problem of HIV and AIDS for close to 30 years. But nothing much seems to have been achieved in fighting this problem.

We are being told the rate of infection has reduced from 16.1 per cent to 14.3 per cent. And this small reduction is being celebrated when the problem is far much bigger because this is a reduction among those who have been tested. What more those who are not tested?

And among those who are tested and have been found to be positive, it is believed that only about 20 per cent are receiving treatment. What is happening to the other 80 per cent?

It is very clear that we are approaching this problem in a very piece-meal and partial way. We are not in any way trying to uproot the whole problem and live without it. No amount of HIV is desirable or should be tolerated in a country. We are talking about not tolerating the virus and not the people who carry the virus. This needs to be clearly understood because while the virus should never be tolerated, the people who carry it are human beings deserving our love, understanding and compassion. They should not be discriminated against in any way. And stigmatisation should have no place in our country; it shouldn't be tolerated in any way.

We have to be innovative or creative in the way we fight HIV. So far, we have been heavily dependent on other people's approaches or formulas simply because they come to us with deep pockets. And whatever they tell us, we do because they have the money. They employ our own people to champion their formulas and programmes. And our people can't question even that which is wrong, that won't work simply because that's what their paymasters want. If they object to what the financiers want, they will simply be fired and new people will be recruited in their place.

And this runs through private and public HIV programmes. This is so because even what may be said to be government programmes are also funded by donors. And it is the donors who call the tune. It is time we started putting our own public resources in the fight against HIV to save the lives of our people. Yes, donations and help from others are highly welcome and we should be grateful for that. But while we should have a sense of gratitude, we should also accept the fact that the people who are helping us are not super human and do not possess the sum total of human knowledge on the issue of HIV and AIDS. Today, the ideas and programmes of donors dominate our entire HIV campaign.

It is time we started designing our own programmes and reduced our dependence on others. This is not to say we should not co-operate or collaborate with others. What we are trying to say is let's learn from others but at the end of the day, let our decisions and actions be our own. This is a problem that we cannot deal with totally by ourselves. It is a problem that calls for international co-operation. But international co-operation does not deprive us of the right to national initiatives.

There is something we have learnt over the last 30 years of fighting HIV, let's put it to use. If over the last 30 years we have learnt nothing and we know nothing other than what the donors tell us, then we stand no chance of conquering HIV in the near future.

We shouldn't be afraid to come up with our own initiatives, programmes we think can work for us. As Dr Kenneth Kaunda taught us, "Let us be bold and not be afraid of creating precedents, for more often than not, today's precedent may well show as tomorrow's stroke of genius" (address to the 40th annual congress of Rotary International, Kitwe, April 4, 1965).

And as Dr Manasseh Phiri has urged, Zambia needs to start looking for its own resources to deal with the HIV problem.

The suggestion by Prof Paolo Marandola of putting everyone positive on treatment makes sense. One doesn't need to be a scientist to see sense in what is being suggested by Prof Marandola. Yes, putting everyone who is positive on treatment is going to be very expensive for us; it's going to increase our expenditure on the HIV problem. But this cost is not going to continue rising.

It is a cost that is going to start dropping or decreasing. As more and more people who are HIV positive are put on treatment, the rates of infection and re-infection are going to start dropping. And with it the number of people who will develop full-blown AIDS is also going to go down and eventually our costs will also go down. Within a period of five to seven years, this cost can drop to below what we are now spending on giving treatment to the few we are giving the treatment to.

We can't be satisfied with very little achievements. There is very little that has been achieved in this fight. And we shouldn't fool ourselves that we are on our way to conquering the HIV problem. We are far away from it. Until we start to address the problem in its entirety, and not in the partial way we are doing, we will continue moving backwards in very long strides. We can't say we are giving universal treatment to all those living with the virus when we are just giving treatment to a few of them with full-blown AIDS. The majority of the people who are positive, whether they know it or not, are not on treatment.

And the starting point is to get every citizen tested for HIV. In that way, we will know the full scope of the work we need to do and the financial resources we need to mobilise. The number of people testing for HIV is not increasing and it's actually going down. Every citizen needs to know his or her status.

And capacity needs to be created for us as a nation to give treatment to every citizen who is HIV positive so that their potential to transmit the virus to others is reduced as far as possible to zero. And also so that those who have developed AIDS are given treatment to reduce the possibility of them dying as a result of this.

While it cannot be denied that the numbers dying from AIDS have reduced, this does not in itself mean that the spread of HIV has in the same way been arrested.

Let's pay a lot of attention to the need for testing every citizen and putting every positive person on treatment. It is expensive but it will be worth the expense and it is not something totally beyond our reach. But as Felix Mwanza says, we need political will to start owning the HIV response in our country. And all this is possible with political will.

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