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Fauci gonged again. Are two Nobels next?

June 22nd, 2008

Director of NIAID awarded Presidential Medal of Freedom, but may be losing influence

Critics of paradigm complain that massive censorship is not “freedom”

Is the SS HIV/AIDS running into pack ice? Why are its officers hiding?

bushandfauci.jpgThe much honored and celebrated director of NIAID, the smartly tailored and trimmed Anthony Fauci, was once saluted by President Ronald Reagan as a “hero of AIDS”, and he pocketed a Lasker Award last year (see previous post Fauci wins Lasker).

Now this outstanding bureaucrat, more responsible than anybody else in the US for the massive war on “HIV/AIDS” being conducted here and around the world, and in particular, its rationale that “HIV” and nothing else causes “AIDS”, was awarded, as the Washington Post notes with a very nice picture in Bush bestows Presidential Medal of Freedom awards, the Medal of Freedom on Friday (Jun 20 2008).

Here is what the President said as he awarded the prizes (or at least, what the pr release from the White House said he said):

Three decades ago, a mysterious and terrifying plague began to take the lives of people across the world. Before this malady even had a name, it had a fierce opponent in Dr. Anthony Fauci. As the Director of the National Institute of Allergy and Infectious Diseases for more than 23 years, Tony Fauci has led the fight against HIV and AIDS. He was also a leading architect and champion of the Emergency Plan for AIDS Relief, which over the past five years has reached millions of people — preventing HIV infections in infants and easing suffering and bringing dying communities back to life.

The man who would lead the fight against this dreaded disease came from an Italian American family in Brooklyn. Even as a boy, Tony was distinguished by his courage. In a neighborhood full of Brooklyn Dodgers fans — (laughter) — he rooted for the Yankees. (Laughter.) Tony earned a full scholarship to Regis High School, a Jesuit school in Manhattan. And he still quotes what he learned from Jesuit teaching: “Precision of thought, economy of expression.” And now you know why he never ran for public office. (Laughter.)

Those who know Tony do admit one flaw: sometimes he forgets to stop working. He regularly puts in 80-hour weeks. And from time to time, he’s even found notes on his windshield left by coworkers that say things like, “Go home. You’re making me feel guilty.” (Laughter.) A friend once commented that Tony was so obsessed with work that his wife must be a pretty patient woman. The truth of the matter is, she’s very busy herself. Christine Grady is a renowned bioethicist. And together they raised three talented daughters: Jennifer, Meghan, and Allison. And I hope each of you know that for all Tony has accomplished, he considers you to be one of his — not one of his — his most important achievement. Your love and support have strengthened him as he works to save lives across the world.

For his determined and aggressive efforts to help others live longer and healthier lives, I’m proud to award the Presidential Medal of Freedom to Dr. Anthony S. Fauci. (Applause.)

Of course, the big news here for this audience is that Fauci’s wife, Christine Grady, is a “bioethicist”, which must amaze those who like to call her husband the Dr. Mengele of HIV/AIDS, which is very impolite, but not undeserved on the grounds that he has blocked media review of the rationale on which the often fatal drug AZT was and still is administered (though less of it, along with other ARVs) to his loyal congregation of gay AIDS patients.

Perhaps the truth is that Dr Fauci never sees his wife, what with his 80 hour work week running the global anti-HIV political and propaganda machine. He barely has enough time for sleep, it would seem, which may explain why he resists further thinking about the issue of HIV and AIDS, and wishes nobody else to raise the vexed topic. Or perhaps it is because he has already given an inattentive world the final answer to HIV/AIDS, and no one has yet noticed (see below).

6pierrepiot.jpgSometimes the Medal is awarded to grease the honoree’s exit from his official position, as in the case of George Tenet, mushy headed ex-director of the CIA, so we hope this is not indicative of this great public servant’s imminent departure from his leadership role. After all, it is not certain that the global HIV/AIDS system could survive the loss intact, especially when the UNAID’s unshaven Pierre Piot is stepping down as he quietly announced in April (Head of UN’s AIDS program Piot to step down).

Why not the Nobel?

Can the Nobel be far behind? This blog hurries to point out that we have already nominated the natty functionary for the top prize in science, despite our fundamental quarrel with his propaganda on behalf of the unlikely, unproven, in fact thoroughly reviewed and rejected and effectively disproven notion that HIV causes “AIDS” or any illness of any kind (“AIDS” illnesses all have other clear causes, as elucidated from 1986 onwards by the best scientist in the field, Peter Duesberg, see rest of blog, starting with post number one).

Of course, we deplore the neatly groomed NIAID director’s imposition of censorship on the ‘What is the true cause of AIDS?’ debate for the last two decades. Long ago Fauci notoriously noted in a AAAS newsletter than any reporter who raised the topic of Peter Duesberg, and Duesberg’s complete rejection of HIV as the cause of “AIDS” in reviews written in the highest journals in science, would be treated as unqualified to report on the topic of “AIDS” and his/her phone calls never again returned by the pr staff or the scientists under Dr Fauci’s paramilitary NIAID command:

AIDS has created a whole new interaction between scientists and the press (…) Journalists who make too many mistakes or who are too sloppy are going to find that their access to scientists may diminish.

But we have no trouble at all in recognizing the great man as a leader in advancing the cause of the critics of HIV.

6fauci-in-white-coat.jpgFor in Fauci’s discreetly schizophrenic analysis of how HIV/AIDS works, he publicly acknowledged in answer to an question by the distinguished Science Guardian consultant Robert G. Houston that HIV not only did not kill T-cells, it provoked their increased production. This helpful admission was made at the New School panel in 2006 (see previous post AIDS elite at 25 – top trio meets in public at the New School tonight) in which Fauci explained to Houston how HIV caused T cell depletion and AIDS by provoking such a generous expansion of the number of these vital foot soldiers of the immune system that the supply was somehow exhausted in the end, though why this should happen was not clear. Eventually the body “ran out of steam”, Fauci offered.

A thorough account of this watershed event and the Fauci Steam Theory of AIDS is at this post, How Fauci solved AIDS, which also had interesting comments attached.

The main point, however, is one which we hereby underline while Fauci is basking in the glory of his new Medal, since we are not sure it is widely appreciated yet as his greatest achievement of all: Fauci is the one who has discovered the ultimate vaccine against HIV, the one sure antidote to HIV/AIDS, and still no one except the editors of Science Guardian has recognized this giant step forward for mankind: Fauci has shown that the best answer to HIV…is HIV!

Fauci’s Steaming HIV Theory

It is a pity that the media seem to have ignored the true significance of these important SG/NAR posts, and the Fauci views they recorded.

For the bottom line of what Fauci publicly told Houston, and wrote in the quiet backwaters of a specialist textbook perused only in the library by the dedicated deep researchers of Science Guardian/New AIDS Review, in paragraphs apparently hidden from the eyes of mainstream media reporters who otherwise faithfully follow, transcribe and reproduce every precious word that comes from the handsomely clipped head of the best dressed man in Washington, is that HIV/AIDS can solved without drugs:

Several investigators have demonstrated that there is an increase in CD4+ T-cell proliferation in both HIV and SIV infection. In certain studies, the enhanced T-cell proliferation that was observed during active disease was significantly decreased following the initiation of anti-retroviral therapy, and proliferation increased again in parallel with plasma viremia following the cessation of treatment in these individuals.

What we are trying to draw attention to is what now must be labeled The Fauci Steam Theory of and Solution to HIV/AIDS , which is a double barreled solution to World AIDS as follows:

1) If there is any concern that HIV is causing any problems, simply add more HIV.

2) If the body shows any sign of “running out of steam”, add proper nutrients.

This is why we nominate Anthony Fauci for the Nobel. For in company with Peter Duesberg, John P. Moore of Cornell, Robert C. Gallo, Luc Montagnier, and Kevin De Cock, he has revealed the truth about HIV/AIDS which he has long attempted to curtain off from the media, namely, that HIV is not harmful, and that any and all of “AIDS” illnesses are caused by other factors, which are not even “co-factors”, but entirely independent factors, which do not need HIV to do their dirty work.

But it is Anthony Fauci, and Anthony Fauci alone, who has made the ultimate breakthrough and endorsed HIV as a positive antidote to itself, the single best answer to HIV positivity.

For this, this fine bureaucrat, despite his strenuous attempts to restrain media recognition and discussion of this line of thinking (that lets HIV off the hook as a cause of “AIDS”), which we can only presume are motivated by a sincere modesty and unwillingness to take credit for his seminal breakthrough, has brought to the world what it has long sought, in fact spent billions over two decades trying to find: the Final Solution to HIV/AIDS.

Fauci’s cost free solution to “AIDS”

6anthony-fauci.jpgWhat is more, the cost of Fauci’s solution is minimal, compared to the projected cost of AIDS drugs and an AIDS vaccine. It is, in fact, cost free.

Fauci’s answer to HIV/AIDS is the simplest one of all, and one long advocated by the critics of the paradigm. When tested HIV positive, take the following action: Do nothing at all, other than eat and live in healthy fashion, and most particularly, do not have anything at all to do with conventional HIV/AIDS treatment and medication.

The lesson of course for policymakers is to withdraw all funding from HIV/AIDS, and apply it to ensuring that the health infrastructure, nutrition and living conditions of nations and individuals are maximized, and all possible measures to combat real disease such as TB and malaria (together probably the real nature of most of African “AIDS”, other than undernourishment and starvation) be taken.

Much AIDS is malnutrition in Africa, and food restores HIV+ babies to normal

Just how damaging and widespread malnutrition is in Africa is being underlined tonight on 60 Minutes, which has a section on Plumpynuts, a simple and wildly successful intervention in Africa where the visible and hidden malnutrition of Niger’s black tots is countered by bags of a ready-to-eat peanut mix equivalent to milk plus vitamins. The aim is to get it to 120,000 kids by next year, but it still be a drop in the bucket – 120 million starving small children around the world need it, and five million die each year without it.

This is the kind of thing which the makes the New York Times editorial yesterday, A Global AIDS Campaign Stalled, wringing its hands over the hold up to the $50 billion expected to be authorized by Congress for the Global AIDS-Malaria-TB campaign, look a little more ignorant than normal. Apart from the usual boiler plate of “H.I.V., the virus that causes AIDS,” the concern for the enormous jump in funding for the next five years (it was $19 billion for the last five years) seems entirely focused on “all the treatment and prevention programs needed to quell the epidemic”. Hurry up and pass the bill before the purse strings tighten next year urges the editorial writer, anxious to circumcise as many Africans as possible.

Perhaps someone should force this writer to sit down and watch the 60 Minutes episode, and then thrust this paper (noted today at AIDSWiki) in front of them: Home-based therapy with ready-to-use therapeutic food is of benefit to malnourished, HIV-infected Malawian children (Acta Paediatr. 2005 Feb;94(2):222-5), which shows that food restores children to normal weight more effectively that ARVs:

CONCLUSION: More than half of malnourished, HIV-infected children not receiving antiretroviral chemotherapy benefit from home-based nutritional rehabilitation. Home-based therapy RUTF is associated with more rapid weight gain and a higher likelihood of reaching 100% weight-for-height

.
Here is the full summary:

Home-based therapy with ready-to-use therapeutic food is of benefit to malnourished, HIV-infected Malawian children.Ndekha MJ, Manary MJ, Ashorn P, Briend A.
College of Medicine, University of Malawi, Malawi.
AIM: To determine if home-based nutritional therapy will benefit a significant fraction of malnourished, HIV-infected Malawian children, and to determine if ready-to-use therapeutic food (RUTF) is more effective in home-based nutritional therapy than traditional foods. METHODS: 93 HIV-positive children >1 y old discharged from the nutrition unit in Blantyre, Malawi were systematically allocated to one of three dietary regimens: RUTF, RUTF supplement or blended maize/soy flour. RUTF and maize/soy flour provided 730 kJ x kg(-1) x d(-1), while the RUTF supplement provided a fixed amount of energy, 2100 kJ/d. These children did not receive antiretroviral chemotherapy. Children were followed fortnightly. Children completed the study when they reached 100% weight-for-height, relapsed or died. Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups. RESULTS: 52/93 (56%) of all children reached 100% weight-for-height. Regression modeling found that the children receiving RUTF gained weight more rapidly and were more likely to reach 100% weight-for-height than the other two dietary groups (p < 0.05).CONCLUSION: More than half of malnourished, HIV-infected children not receiving antiretroviral chemotherapy benefit from home-based nutritional rehabilitation. Home-based therapy RUTF is associated with more rapid weight gain and a higher likelihood of reaching 100% weight-for-height. PMID: 15981758

Such studies bring home the extreme tragedy that anyone should think that AIDS drugs are the right intervention for African children.

With NIAID shut down, a second Nobel?

nobelpeaceprize1.jpgSince Anthony Fauci’s view, on the other hand, implies the immediate shutdown of all NIAID activity, we are newly stunned by the daring and public responsibility of his leadership in this respect.

Could it be that the man deserves two Nobels, the Biochemistry prize for solving HIV/AIDS shared with Peter Duesberg and Robert Gallo, and the Nobel Peace Prize, shared with Peter Duesberg, for doing the most to serve the public interest by diverting the billions spent on HIV/AIDS to the proper targets?

After all, for any bureaucrat, let alone a champion milker of the public purse such as the dapper Fauci, to propose shutting down his own fiefdom is probably unprecedented in the history of Washington.

The AIDS platform is cracking

Of course, we have to note as an afterthought Dr. Fauci’s willingness to step off the high platform on which he has perched and preened for so many successful fund raising years may be influenced by hearing it creaking under his polished shoes.

The UNAID rushed to issue a press release in the aftermath of Kevin De Cock’s watershed admission that heterosexual AIDS is a non starter after all, trying to reassure all concerned that the urgent global HIV/AIDS threat remains as vast as ever –
Aids claim sparks backlash for WHO

The World Health Organisation was struggling yesterday to control the global backlash from an admission by one of its most senior directors that the threat of a generalised heterosexual epidemic of Aids outside Africa may be over.

The WHO has been under siege since Kevin de Cock, head of its HIV/Aids department, told The Independent on Sunday that, outside sub-Saharan Africa, the disease was recognised to be largely limited to high-risk groups, such as injecting drug users.

Facing headlines such as “World Aids pandemic over”, specialists fear a media onslaught could hinder efforts to help those infected, and fuel further spread. One said: “People are using the interview to say all scientists are lying and funding for Aids should be cut. Kevin de Cock is the most committed, cautious epidemiologist but now a lot of people want to take him down.”

In a statement in response to the interview, the WHO said: “Aids remains the leading infectious disease challenge in global health. To suggest otherwise is irresponsible and misleading.”

The latest WHO report says that at the end of 2007 there were 33 million people with HIV; 2.5 million were infected that year; and 2.1 million died of Aids.

But the damage control was late, for at least one on line columnist, Brendan O’Neill at the Guardian of London (no relation to Science Guardian) had already committed himself to accepting De Cock’s rash admission, complaining that we have all been misled for two decades for the plain reason that HIV/AIDS governmental and non governmental organizations need funds from the public, and these will only flow freely if the threat to heterosexuals is talked up.

As O’Neill wrote in
The exploitation of Aids: the Aids scare was one of the most distorted, duplicitous and cynical public health panics of the last 30 years

Finally we have a high-level admission that there is no threat of a global Aids pandemic among heterosexuals. After 25 years of official scaremongering about western societies being ravaged by the disease – with salacious, tombstone-illustrated government propaganda warning people to wear a condom or “die of ignorance” – the head of the World Health Organisation’s HIV/Aids department says there is no need for heterosexuals to fret.

Kevin de Cock, who has headed the global battle against Aids, said at the weekend that, outside very poor African countries, Aids is confined to “high-risk groups”, including men who have sex with men, injecting drug users, and sex workers. And even in these communities it remains quite rare. “It is very unlikely there will be a heterosexual epidemic in countries [outside sub-Saharan Africa]”, he said. In other words? All that hysterical fearmongering about Aids spreading among sexed-up western youth was a pack of lies.

Finally we have a high-level admission that there is no threat of a global Aids pandemic among heterosexuals. After 25 years of official scaremongering about western societies being ravaged by the disease – with salacious, tombstone-illustrated government propaganda warning people to wear a condom or “die of ignorance” – the head of the World Health Organisation’s HIV/Aids department says there is no need for heterosexuals to fret.

Kevin de Cock, who has headed the global battle against Aids, said at the weekend that, outside very poor African countries, Aids is confined to “high-risk groups”, including men who have sex with men, injecting drug users, and sex workers. And even in these communities it remains quite rare. “It is very unlikely there will be a heterosexual epidemic in countries [outside sub-Saharan Africa]”, he said. In other words? All that hysterical fearmongering about Aids spreading among sexed-up western youth was a pack of lies.

Much of the media has treated Dr De Cock’s admission as a startling revelation. In truth, experts have known for many years that in the vast majority of the world, Aids has little impact on the “general population”. In her new book The Wisdom of Whores, Elizabeth Pisani – who worked for 10 years in what she refers to as “the Aids bureaucracy” – admits that by 1998 it was clear that “HIV wasn’t going to rage through the billions in the ‘general population’, and we knew it”.

Some people knew it earlier. In 1987, my friend and colleague Dr Michael Fitzpatrick wrote a fiery pamphlet titled The Truth About the Aids Panic. At the height of the Conservative government’s scary tombstone campaign (“Don’t die of ignorance”), he wrote: “There is no good evidence that Aids is likely to spread rapidly in the West among heterosexuals.” In Britain, most of the small-scale spread of “heterosexual Aids” has been a result of infected individuals arriving from Africa. In the UK in the whole of the 1980s – the decade of the Great Aids Panic – there were 20 cases of HIV acquired through heterosexual contact with an individual infected in Europe.

And it isn’t the case that the heterosexual pandemic failed to materialise because officialdom’s omnipresent pro-condom propaganda was a success. According to James Chin, a clinical professor of epidemiology at the University of California at Berkeley and author of the new book The Aids Pandemic, it was always a “glorious myth” that there would be an “HIV epidemic in general populations”. That myth was the product of “misunderstanding or deliberate distortions of HIV epidemiology” by Unaids and other Aids activists, says Chin.

It is time to recognise that the Aids scare was one of the most distorted, duplicitous and cynical public health panics of the past 30 years. Instead of being treated as a sexually transmitted disease that affected certain high-risk communities, and which should be vociferously tackled by the medical authorities, the “war against Aids” was turned into moral crusade.

Both Conservative and New Labour governments exploited the disease to create a new moral framework for society. Through baseless fearmongering, officials sought to police and regulate the behaviour of the public. No longer able to appeal to outdated Victorian ideals of chastity or restraint, the powers-that-be used the spectre of an Aids calamity to terrify us into behaving “responsibly” in sexual and social matters.

They were aided and abetted by the rump of the radical left. Gay rights campaigners, feminists and left-leaning health and social workers stood shoulder-to-shoulder, first with the Tories and later with Labour, in spreading the “glorious myth” of a possible future Aids pandemic. An unholy alliance of old-style, prudish conservatives and post-radical, lifestyle-obsessed leftists latched on to Aids as a disease that might provide them with a sense of moral purpose.

And they ruthlessly sought to silence anyone who questioned them. Those who challenged the idea that Aids would devour sexually promiscuous young people and transform once-civilised western societies into diseased dystopias were denounced as “Aids deniers” and “heretics”. Anyone who suggested that homosexuals were at greater risk than heterosexuals – and therefore the focus of government funding and, where necessary, medical assistance should be in gay communities – was denounced as homophobic. Nothing could be allowed to stand in the way of the glorious moral effort to make everyone submit to the sexual and moral conformism of the Aids crusaders.

Even in Africa – where there is a serious and deadly Aids crisis in some countries – the international focus on Aids has been motivated more by pernicious moralism than straightforward charity. Diseases such as malaria and tuberculosis are bigger killers than Aids. Yet focusing on Aids allows western governments and NGOs to lecture Africans about their morality and personal behaviour. It also adds a new gloss to the misanthropic population-control arguments of western charities, which now present their promotion of condoms in “overly fecund” Africa as a means of preventing the spread of disease.

The relentless politicisation and moralisation of Aids has not only distorted public understanding of the disease and generated unnecessary fear and angst – it has also potentially cost lives. James Chin estimates that UNAIDS wastes around $1bn a year in activities such as “raising awareness” about Aids and preventing the emergence of the disease in communities that are at little risk. How many lives could that kind of money save, if it were used to develop drugs and deliver them to infected or at-risk communities? It is time people treated Aids as a normal disease, rather than as an opportunity for spreading their own moral agendas.However, the damage control seems to have dampened the fires somewhat, with few follows up by the major media other than Fox News. Liam Scheff, one of only three mainstream journalists still willing (courageous/foolhardy) to cover the topic of flaws in HIV/AIDS ideology and practice (Celia Farber and Anthony Liversidge being the other two), and well known for his investigative pieces in AIDS drug experiments conducted on orphans in New York, coverage which resulted in a BBC documentary, took the opportunity to land a few more blows in a notable piece on the Web at GNN (Guerilla News Network) on the subject of what else might be wrong with the standard line of propaganda in HIV/AIDS, There Will Be No Heterosexual AIDS Epidemic, Experts Admit:

How do “Hiv tests” work? In sum, they don’t work at all. They come up as “false positives” in numbers far exceeding “true positives”:

“Sir, In the May 9 issue of The Lancet, Round the World correspondents discussed AIDS-associated problems in former Eastern bloc countries…I would like to emphasize another alarming concern – namely, the rapid growth in false-positive HIV tests in the former USSR, and in Russia especially. In 1990, of 20.2 million HIV tests done in Russia only 12 were confirmed and about 20,000 were false positives. 1991 saw some 30,000 false positives out of 29.4 million tests, with only 66 confirmations.” (The Lancet, June 1992)……

So how did we get to, “it’s only gay men, Africans, drug addicts and prostitutes,“ from the advertised version for twenty-five years: “Everyone is at equal risk to contract HIV and to develop AIDS.” What happened to the theory of sexual transmission?

The 10-year 1997 study by Dr. Nancy Padian had a lot to do with its downfall. The study took 175 “mixed” heterosexual couples (that is, one partner testing “positive” and one “negative”), who practiced vaginal and anal sex [for the latter – 37.9% at the commencement of the study, decreasing to 8.1% by the end], both with and without condoms [32.2% condom use at the beginning, increasing to 74% at the end]. But no matter how these folks did it, nobody who was negative became positive:

“We followed up 175 HIV-discordant couples [one partner tests positive, one negative] over time, for a total of approximately 282 couple-years of follow up… No transmission [of HIV] occurred among the 25% of couples who did not use their condoms consistently, nor among the 47 couples who intermittently practiced unsafe sex during the entire duration of follow-up…”

“We observed no seroconversions after entry into the study [nobody became HIV positive]…This evidence argues for low infectivity in the absence of either needle sharing and/or other cofactors.”“…

Here is the whole article, There Will Be No Heterosexual AIDS Epidemic, Experts Admit, though if you hit the link to GNN above you get the context and the photo; hit “Show” now, and “Hide” after reading to collapse it again:There Will Be No Heterosexual AIDS Epidemic, Experts Admit

WHO confesses to 25 years of misguided AIDS policies. But they still want you to believe them.

By Liam Scheff
Thu June 12 2008

It is official: AIDS is not explicable by sexual transmission, at least not outside of Sub-Saharan Africans, gay men, intravenous drug users and prostitutes. For the rest of us, there is no heterosexual AIDS pandemic, and further, there will be no heterosexual AIDS pandemic.

“Threat of world AIDS pandemic among heterosexuals is over, report admits,” The Independent announced on Sunday, June 8, 2008, mimicking what I have been reporting for years (and what some of my colleagues have been reporting for decades).

No, really. But take it from someone you trust, Dr. Kevin de Cock of the World Health Organization(WHO): “[T]here will be no generalised epidemic of AIDS in the heterosexual population outside Africa.”

“A 25-year health campaign was misplaced outside the continent of Africa,” the article concedes, daring you hang them all. And so they’re quick to add a massive fiction: “But the disease still kills more than all wars and conflicts.”

The authorities explain that they misled the entire world, for decades, because admitting the grandeur of their farce would have encouraged their critics: “Any revision of the threat was liable to be seized on by those who rejected HIV as the cause of the disease.” Of course! We’ve got to protect flawed science from criticism!

But, regardless of past and current performance (and admissions of outright massive fraud), the authorities at the WHO and UNAIDS still want you to believe them, when they talk about AIDS, Bird Flu, Sars, and other advertised but not achieved super-pandemics.

Such a weak defense might encourage a curious mind to wonder at the other flaws in their paradigm. For example, are we now to believe that there is a virus that causes a fatal disease, but only in Africans, (wherever in the world they may be), gay men and drug addicts? But not the entirety of the human population that is sexually active?

The answer to the riddle may be found in the actual cause of “HIV” – namely, “HIV testing.” Figure out who is tested, how the tests work (or, more to the point, how they don’t work), and who the tests are said to be accurate for, and you’ll get an understanding of how the “AIDS” diagnosis – now, no better than a brand name applied to poverty and drug addiction – actually works.

How do “Hiv tests” work? In sum, they don’t work at all. They come up as “false positives” in numbers far exceeding “true positives”:

“Sir, In the May 9 issue of The Lancet, Round the World correspondents discussed AIDS-associated problems in former Eastern bloc countries…I would like to emphasize another alarming concern – namely, the rapid growth in false-positive HIV tests in the former USSR, and in Russia especially. In 1990, of 20.2 million HIV tests done in Russia only 12 were confirmed and about 20,000 were false positives. 1991 saw some 30,000 false positives out of 29.4 million tests, with only 66 confirmations.” (The Lancet, June 1992)

They have no ability to determine if someone has or does not have the antibodies they think they’re looking for; the interpretation of “HIV positive” is subjective and not consistent:

“At present there is no recognized standard for establishing the presence or absence of antibodies to HIV-1 and HIV-2 in human blood.” (Abbott labs HIV-1/2 test, 1986 to the present).

They don’t produce singular or diagnostically specific results – they cross-react all over the map:

“Heterophile antibodies are a well-recognized cause of erroneous results in immunoassays. We describe here a 22-month-old child with heterophile antibodies reactive with bovine [Cow] serum albumin and caprine [Goat] proteins causing false-positive results to human immunodeficiency virus [HIV] type 1 and other infectious serology testing. (CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY, July 1999)

“False-positive ELISA test results can be caused by alloantibodies resulting from transfusions, transplantation, or pregnancy, autoimmune disorders, malignancies, alcoholic liver disease, or for reasons that are unclear.” (Doran, et al. False-Positive and Indeterminate Human Immunodeficiency Virus Test Results in Pregnant Women. Arch Family Medicine, 2000)

The secondary tests that are sometimes used to give a sense of validity to an initial test are either reformulations of the same material (the Western Blot), or are synthetic genetic probes (PCR Viral Load) that likewise cross-react and give no diagnostically specific reaction (and these tests are rarely to never used when you’re talking about “AIDS in Africa”).

“Persons at risk of HIV-1 infection have been classified incorrectly as HIV infected because of Western blot results, but the frequency of false-positive Western blot results is unknown.” (JAMA. 1998; 280: 1080-1085)

“The HIV-1 PCR assay was designed to monitor HIV therapy, not to diagnose HIV infection…In patients (like ours) with a low prior probability of disease, almost all positive test results are false positive.” (False Positive HIV Diagnosis b HIV-1 Plasma Viral Load Testing. Ann Intern Med, 1999.)

“Helminth (parasitic worm) “load“ is correlated to HIV plasma Viral Load, and successful deworming is associated with a significant decrease in HIV plasma Viral Load.” (Threatment of intestinal worms is associated with decreased HIV plasma viral load. J.AIDS, September, 2002)

How is “AIDS” diagnosed in Africa? AIDS in Africa is and has always been a clinical diagnosis. It is here too, but we’re more attached to a process of testing, which is, in essence, illusory, because the tests are limited to use in certain groups, for whom the non-specific tests are said to have a “higher positive predictive value,” or to be “more accurate.” But in Africa, this is dispensed with entirely, and “AIDS” is diagnosed based on the symptoms of hunger, thirst, TB and malaria – in other words, poverty.

“Our attention is now focused on the considerably large number of the seronegative group (135/227, 59%) who were clinically diagnosed as having AIDS. All the patients had three major signs: weight loss, prolonged diarrhoea, and chronic fever. Many of them also had other AIDS-associated signs, such as lymphadenopathy, tuberculosis, dermatological diseases, and neurological disorders.” (Hishida O et al. Clinically diagnosed AIDS cases without evident association with HIV type 1 and 2 infections in Ghana Lancet. 1992 Oct 17).

The numbers that have been reported are also entirely fabricated based on exponential projections from one small group to entire populations. Very recently, these numbers have been revised to such a massive degree so as to drive the the AIDS prognosticators to painful public redaction:

In Swaziland this year, the rate of HIV infection among young women decreased remarkably, from 32.5 to 6 percent. A drop of 81% – overnight. UNICEF’s Swaziland representative, Dr. Alan Brody, told the press “The problems is that all the sero-surveillance data came from pregnant women, and estimates for other demographics was based on that.” (August, 2004, IRIN News, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. Cited by Scheff, 2005, Knowing is Beautiful. GNN)

Who are the tests considered “accurate” for? The tests are only considered to be “accurate” for certain groups. Those considered to be at “high risk” are much more likely to be tested, and to have their tests interpreted as either a “true positive,” or, as you can see below, a “false negative.” In other words, if they want you for the “AIDS” diagnosis, they’ll get you:

“Suppose, for example, a single rapid test that has 99.4% specificity is administered to 1,000 people, meaning six will test false-positive. That error rate won’t matter much in areas with a high prevalence of HIV,because in all probability the people testing false-positive will have the disease.”

What disease? AIDS? Or Poverty? And can you tell the difference from the tests?

“But if the same test was performed on 1,000 white, affluent suburban housewives – a low-prevalence population – in all likelihood all positive results will be false, and positive predictive values plummet to zero. (Coming to Your Clinic – Candidates for Rapid Tests. AIDS Alert, 1998)

Here is the new philosophy of AIDS, and it’s quite a shift (From the Independent): “Whereas once it was seen as a risk to populations everywhere, it was now recognised that, outside sub-Saharan Africa, it was confined to high-risk groups including men who have sex with men, injecting drug users, and sex workers and their clients.”

So how did we get to, “it’s only gay men, Africans, drug addicts and prostitutes,“ from the advertised version for twenty-five years: “Everyone is at equal risk to contract HIV and to develop AIDS.” What happened to the theory of sexual transmission?

The 10-year 1997 study by Dr. Nancy Padian had a lot to do with its downfall. The study took 175 “mixed” heterosexual couples (that is, one partner testing “positive” and one “negative”), who practiced vaginal and anal sex [for the latter – 37.9% at the commencement of the study, decreasing to 8.1% by the end], both with and without condoms [32.2% condom use at the beginning, increasing to 74% at the end]. But no matter how these folks did it, nobody who was negative became positive:

“We followed up 175 HIV-discordant couples [one partner tests positive, one negative] over time, for a total of approximately 282 couple-years of follow up… No transmission [of HIV] occurred among the 25% of couples who did not use their condoms consistently, nor among the 47 couples who intermittently practiced unsafe sex during the entire duration of follow-up…”

“We observed no seroconversions after entry into the study [nobody became HIV positive]…This evidence argues for low infectivity in the absence of either needle sharing and/or other cofactors.”“

Padian determined that outside of intravenous drug use, this was not a very transmissible “sexually-transmissible disease.” But there is a contention made by Dr. de Cock that some sort of special sexual activity in Sub-Saharan Africa must (but is not evidenced to) explain the differences in “HIV prevalence”. It’s worth looking at studies of sex and “HIV positivity” for comparison. Does sex correlate with “HIV positivity” more than I.V. drug addiction?

In West Africa, these women, all prostitutes, have remained negative for more than five years:

“[This study involved] a group of repeatedly exposed but persistently seronegative female prostitutes in The Gambia, West Africa…have worked as prostitutes for more than five years, use condoms infrequently with clients and only rarely with their regular partners and have a high incidence of other sexually transmitted diseases” (Rowland-Jones S et al. HIV-specific cytotoxic T-cells in HIV-exposed but uninfected Gambian women. Nat Med. 1995 Jan)

In sum, lots of STDs, lots of exposure to HIV positive persons, and no HIV. Here, as reported on PBS’s “RX for Survival” (2005) a group of prostitutes refuses to get sick:

“In Nairobi, a group of prostitutes appear to have natural immunity against H.I.V…. because they have an abnormally large number of killer T-cells.” (New York Times, 2005. Author: ANITA GATES)

In this study in Tel Aviv, girl and boy prostitutes, (with and without original bits and pieces), don’t turn “positive,” unless they’re injection drug users:

“Human immunodeficiency virus (HIV) prevalence was studied in an unselected group of 216 female and transsexual prostitutes … All 128 females who did not admit to drug abuse were seronegative; 2 of the 52 females (3.8%) who admitted to intravenous drug abuse were seropositive. “ (Modan B et al. Prevalence of HIV antibodies in transsexual and female prostitutes. Am J Public Health. 1992 Apr)

In Tijuana, among a group of hundreds of prostitutes, condoms were used by a slight majority, but then, they said, for less than half the time:

“In order to determine whether prostitutes operating outside of areas of high drug abuse have equally elevated rates of infection, 354 prostitutes were surveyed in Tijuana, Mexico… None of the 354 [blood] samples…was positive for HIV-1 or HIV-2. Condoms were used by 59% of prostitutes but for less than half of their sexual contacts. … Infection with HIV was not found in this prostitute population despite the close proximity to neighboring San Diego, CA, which has a high incidence of diagnosed cases of AIDS, and to Los Angeles, which has a reported 4% prevalence of HIV infection in prostitutes.” (Hyams KC et al. HIV infection in a non-drug abusing prostitute population. Scand J Infect Dis. 1989)

No condoms, no drug use – zero positivity. The same is found in the US and throughout Europe. Injection drug use, not sex, equals “HIV positivity.”

“HIV infection in non-drug using prostitutes tends to be low or absent, implying that sexual activity does not place them at high risk, while prostitutes who use intravenous drugs are far more likely to be infected with HIV. Other prostitute studies tend to be small but similarly emphasize the central role of drug use as a major risk factor: in New York City, 50 per cent of 12 drug users were positive, compared with 7 per cent of 65 nonusers; in Italy, 59 per cent of 22 drug users were positive, whereas none of the nonusers were. None of the 50 prostitutes tested in London, 56 in Paris, or 399 in Nuremberg were seropositive.” (Rosenberg MJ, Weiner JM. Prostitutes and AIDS: a health department priority?. Am J Public Health. 1988 Apr)

That doesn’t sound like much of an STD.

So, do you still believe the WHO, and the medical authorities when they talk about AIDS? Despite their incredible, world-changing lies and deceptions, advertising campaigns and persecution of dissenting scientists, do you still believe them when they say that AIDS is still a sex-disease, but now, only if you’re Black, gay or poor enough?

We used to have a science in the early 20th Century, that similarly was able to pick the unfit out of risk groups – it was called Eugenics. If humanity is nothing else, we are certainly dogged in our ability to re-invent our old, bad ideas, again and again.Elizabeth Pisani, author of an interesting new book The Wisdom of Whores: Bureaucrats, Brothels and the Business of Aids, dissecting international AIDS statistics with a moderately skeptical eye (she does not yet notice that it all makes sense if the paradigm HIV=AIDS is jettisoned), wrote a piece in the London Times, pointing out that the UN press release did not withdraw any of the facts stated by de Cock:

It was not to last. Before the meeting was even over, the WHO and UNAids came out with a press release, signed by Dr de Cock, billed as a “correction” to the newspaper report. But it didn’t point out any errors of fact, nor did it suggest that he had been misquoted. Instead, it claimed that HIV is a heterosexual disease that affects us all.

Just as it looked as though it might make a step forward, the UN has jumped back into a refusal to acknowledge the truth about Aids. Its stance will defend the jobs and budgets for a while, perhaps. But unless a better job is done of preventing the epidemic, we the taxpayer will tire of refilling the Aids funding trough. And we can’t do a better job of preventing HIV if we refuse to be honest about where it’s spreading.

Here’s the piece in full:Aids? There’s big money at stake
If the UN is serious about stopping HIV; then it must face up to some inconvenient facts
Elizabeth Pisani

Last week, I stood in the blinding sunshine outside the United Nations building in New York, watching cars disgorge eunuchs, activists and bureaucrats – all the usual suspects for another “UN high-level meeting on Aids”. Besides swelling profits of the New York hotel trade with money that could have been used to buy condoms and clean needles, what did this meeting achieve? Not a lot, I was prepared to report, but in fact the UN has managed to take a step backwards.

For all the talk of a “global pandemic”, there are two completely separate HIV epidemics in the world. One is in parts of Africa, where HIV is spread by unprotected sex between men and women who have more than one steady partner. Governments – such as Uganda’s, with its “zero grazing” approach to fidelity – that recognised the perils of the custom of having concurrent sexual partners confined the epidemic. Most didn’t. The result of the neglect is that in some countries up to two in five adults are infected with a fatal virus.

The second epidemic covers the rest of the globe. Nine out of ten humans (and three in ten of those infected with HIV) live in countries where the virus is spread mostly when people buy and sell sex, when they shoot up drugs, and when men have anal sex with lots of other men. Only a minority do these things in any country, but that still adds up to several million people worldwide. We know how to prevent HIV in these populations, and we have known for years that in Asia, the Americas, Europe, North Africa and the Middle East, if you do that prevention well, HIV won’t spread farther. Even if you don’t control HIV in these populations, it won’t go all that much farther.

If we don’t recognise this, we will never effectively prevent the spread of HIV. But a lot of UN agencies, governments and even Aids activists don’t want to recognise it. Governments don’t want to because it would mean recognising that if they want to deal with HIV they have to spend money on services for junkies, sex workers and gay men – groups that don’t top the popularity stakes with voters. Ironically, they will happily fund treatments for these people with expensive medicines once they do get sick. That is more acceptable to voters than to give cheap condoms and needles to prevent them getting infected in the first place.

Activists don’t want to recognise it because they fear (with some justification) that if HIV is seen as a disease of junkies, prostitutes and gays, they will lose both public support and money for prevention, as well as increasing prejudice against groups that are already vilified. A couple of UN agencies – the ones that actually spend money on doing things for those politically sensitive groups – share that fear. But most have a much greater fear of getting pushed away from the Aids funding trough. Since that trough now holds around $12 billion (£6 billion) a year and rising, it’s a lot to lose out on.

If the UN were to recognise that in most of the world Aids is not a multisectoral problem that threatens security or undermines economic development, then the agencies that work with agriculture or children would have to deal with drugs, commercial and homosexual sex, or get out. Since they want the money but not the inconvenience of dealing with such dirty issues, there is a conspiracy of silence.

If you dig into the entrails of the epidemiology chapters of the WHO/ UNAids reports, you will find that the UN’s public health experts acknowledge that HIV is never going to rage through other continents the way it has raged through Africa. But the numbers are usually sandwiched between “HIV affects us all” rhetoric that panders to the interests of everything but the truth.

That is why it was so surprising that Kevin de Cock, the head of the World Health Organisation’s HIV division, told a British newspaper the truth last week. He was quoted as saying “It is very unlikely there will be a heterosexual epidemic in other countries [outside Africa]. Ten years ago a lot of people were saying there would be a generalised epidemic in Asia – China was the big worry with its huge population. That doesn’t look likely.”

That Dr de Cock, a respected scientist, said this just before the Aids circus at the UN was surely a great sign. Maybe the worthies in attendance would agree to focus prevention outside Africa on the people who need it most, instead of throwing away money on multisectoral planning jamborees and programmes for schoolgirls.

The UN even planned a session on how to find the political will to do exactly that, chaired by the President of El Salvador. (Sadly he could not summon up the political will to talk about how gay and commercial sex is driving the epidemic in El Salvador, and pulled out.) But still, at least the WHO had finally told it like it is. That must certainly make it harder for other UN agencies, grouped under UNaids, to defend their institutional interests against scientific evidence and the rational use of taxpayers’ money.

It was not to last. Before the meeting was even over, the WHO and UNAids came out with a press release, signed by Dr de Cock, billed as a “correction” to the newspaper report. But it didn’t point out any errors of fact, nor did it suggest that he had been misquoted. Instead, it claimed that HIV is a heterosexual disease that affects us all.

Just as it looked as though it might make a step forward, the UN has jumped back into a refusal to acknowledge the truth about Aids. Its stance will defend the jobs and budgets for a while, perhaps. But unless a better job is done of preventing the epidemic, we the taxpayer will tire of refilling the Aids funding trough. And we can’t do a better job of preventing HIV if we refuse to be honest about where it’s spreading.

Dr Elizabeth Pisani is an epidemiologist who has worked for more than a decade as a consultant to UNAids and the WHO and is the author of The Wisdom of Whores: Bureaucrats, Brothels and the Business of Aids.The levees are leaking

So is this brief step forward nullified and forgotten, and are we back to the same old denialism which marks official HIV/AIDS policymaking and media coverage under the iron rule of Anthony Fauci’s censorship?

We think not. The admission by De Cock is a permanent part of history now, and it has not been successfully denied, just swept under the carpet and effectively banned from mainstream media coverage, it seems clear. But it can be quoted with great effect in any objective review of the official ideology of HIV/AIDS, which has now turned into a litany of failure in finding cause or cure, global pandemic or even any increase in deaths in any population outside gays and drug addicts, and the unfortunate heterosexuals bamboozled into taking the damaging and often fatal AIDS drugs.

Let us pause to acknowledge that over half of all AIDS deaths are due to symptoms of drug intake, recreational or medical, and not AIDS symptoms.

Contrary to the HIV-AIDS hypothesis, over 50% of all American and European AIDS patients now die of liver, heart and kidney diseases – none of which are caused by HIV according to CDC definition. But these are the classical diseases of drug- and chemotherapy-related toxicity. (Duesberg, email).

In our view, the paradigm promotion propagandists in HIV/AIDS are not doing too well at present. The members of the Semmelweis society who objected to the Clean Hands prizes awarded to Duesberg and Farber this year and sabotaged their award ceremonies have been forced to resign from the society, and a statement supporting Duesberg has been issued by the Semmelweis president and posted on the front page of the HIV/AIDS paradigm critics site Rethinking AIDS:

Semmelweis Society International does not present the Clean Hands Award lightly. In Dr. Duesberg case, it is hard to imagine anyone more deserving than Professor Peter Duesberg and investigative reporter Celia Farber. These two have withstood a vicious and ongoing multiyear multicontinent personal onslaught against their livelihoods, their character, and their families that is unparalleled since the Spanish Inquisition.

Their sole “crime” is to ask if there has not been a colossal error in our thinking to date.

The simple facts are that nobody has ever been cured of AIDS. No Vaccine has ever been developed. Something is wrong here.

Dr. Duesberg has an idea, a contrarian idea; to be sure, it is an idea, nothing more, but nothing less.

Celia Farber’s “crime” is to have reported this contrarian idea, into a First Amendment Free Speech Protected Society, or so we all thought.

We pray that our elected officials will not succumb to the hostility and pressures that the AIDS/Pharma industry will use to discredit and further silence this most vital debate.

We at Semmelweis are proud of our decision to present Dr. Peter Duesberg and Celia Farber with our highest honor and wish them both all the best as they continue to find concrete answers to this elusive and misunderstood disease.

Sincerely, Roland F. Chalifoux Jr., DO, President, Semmelweis Society International

Of course, this might have been better phrased. Dr Duesberg has more than “an idea”, gentlemen: he has a series of thorough and complete reviews of the hypothesis, universally accepted but entirely unproven and unjustified, that HIV is the cause of HIV/AIDS, in peer reviewed, elite journals, with copious footnotes and no answer at the same level in twenty years to his thorough rejection of any role for HIV in causing any human sickness, except in its ability to trigger the administration of powerful and often fatal drugs.

But it stands for one more victory for the forces of reason who have argued so long and so reasonably for review of the politically generated and protected paradigm of HIV/AIDS.

Similarly, the admissions of de Cock once published in a major British daily serve as a signal setback for the promoters of the paradigm led by Dr Fauci. After all, this is a crumbling of the first main pillar of the HIV/AIDS ideology. The second, of course, is the eternally challenged idea that HIV is the cause,

One shoe has been heard

vangoghshoes.jpgOr to put it more simply, one shoe has dropped.

When the other shoe will drop is of course the $240 billion question in HIV/AIDS, and unanswerable for now. But it surely must be coming closer, as De Cock’s admissions now amount to a large crack in the AIDS platform on which Fauci et al stand. Like Bill Clinton at the UN, it must be slightly disconcerting to find the planks beneath one’s feet creaking ominously as one delivers one’s propaganda speeches.

What might be a tiny sign of this nervous retrenchment is the remarkable removal of the names of John P. Moore and Richard Jefferys from the list of names serving the operations of the falsely named AIDSTruth.org site, actually a disinformation site attempting to undermine critics of the paradigm with spurious contradictions and ad hominem attacks.

John P. Moore of Cornell was one of the founders of this misleading, anti-scientific, slanderous embarrassment. Could it be that someone at last has threatened these two with a lawsuit for slander?

If so, it is about time. There is nothing more shameful in science than the shenanigans of John P. Moore and Mark Wainberg of Montreal in their underhanded and vicious counterattacks on critics of the HIV paradigm, which include calling the officials of a university and trying to get thoughtful and outspoken teachers fired for having an unconventional opinion on HIV/AIDS, an opinion which matches the peer reviewed critique of Peter Duesberg and the evidence in the best literature, which clearly shows year after year that the theory launched by Gallo that HIV causes AIDS should have been shelved as an embarrassment to science from the very beginning.

AIDS enablers alarmed at funding drops

June 13th, 2008

No wonder Roger England’s BMJ editorial evoked such panic in Rapid Responses

AIDS funding is sinking in New York and groups are scrambling to stay afloat

Will delivery of damaging care be interrupted?

aids-care.jpgLong experience reading the statements of HIV/AIDS beneficiaries over the years (by which we mean those such as Tony Fauci of NIAID and John P. Moore of Cornell who depend on the largesse of public and private HIV/AIDS funding to maintain themselves and their HIV propaganda machines and/or labs) has inured us to the high levels of self justification reached in every paragraph, but we have to say, the Rapid Responses at BMJ.com that came in answer to Roger England’s courageous suggestion that HIV/AIDS spending was out of proportion to the money available to fight diseases from which most of us die, such as cancer and heart disease, are truly remarkable in the transparency of their motivation and the blatancy of their competing interests, none of which are declared, of course.

Here they are, in all their predictable indignation at his besmirching of the hitherto sacrosanct principle that there can never be enough spent to combat HIV/AIDS, except for the one proviso that nothing must be spent on double checking the ideology that underlies it, even though the rationale they are all so enthusiastic about has more gaps in logic and evidence than you can shake a stick at, and very few dollars are needed to fully fund the obvious studies which could answer the now widespread questioning in a very few months, as Peter Duesberg and many others have pointed out to the NIH more than once.

Testing the life span and symptoms of mice on equivalent doses of AZT and other current AIDS drugs, double checking the statistics for HIV positive Army recruits over the years, reviewing possible causes other than HIV for the very peculiar results of testing the black population, and enumerating the various causes of cross reactions to the HIV test occur to us off the top of our head, and none of these would much impact the $2.9 billion being spent by NIAID annually on its unsuccessful 22 year quest to elucidate by what mysterious route the vaunted Virus could possibly cause problems for anyone’s immune system, since it provably does not kill T cells as Robert Gallo fervently hoped and claimed in 1984.

But look at the outrage with which the prospect of diminishing funding in greeted on all sides! Here is the section as it stands at present, June 12 Thu, repeated here verbatim in case the BMJ decides to hide it from the public as it did its previous series covering problems with HIV=AIDS when too many skeptics contributed. A few quotes first:

Mr Roger England suggests that the AIDS epidemic is like every other health problem and doesn’t deserve an exceptional response. He couldn’t be more wrong.

HIV was and still is an emergency requiring an unprecedented response. AIDS doesn’t fit neatly into a health box. Yes, AIDS is a disease and there are specific health needs, but AIDS has its tentacles in all sectors.

AIDS is mostly about sensitive issues—sex, gender inequality, sex work, homosexuality, drug use, stigma and discrimination—all have proved to be enormous barriers to government and civil society….

Roger England’s attack on UNAIDS is part of a broader effort to undermine the international response not only to HIV but also to other priority diseases like TB and malaria. He never considers recommending expanding the health funding pie to cover the other needs identified but rather uses the AIDS exceptionalism trope to claim that we would all be better off if global health programs were uniformly underfunded and inadequate as they were in the 80s and 90s. He is pitting poor sick people with one disease against poor sick people with other diseases….

Mr England would like to see AIDS dealt with by only health services but even the best health services in the world cannot tackle AIDS alone. They certainly play a major role in providing HIV treatment, but health ministries do not cover other vital elements of the AIDS response such as working directly with vulnerable populations to reduce their risk of HIV infection, caring for orphans, providing food support and social welfare, and tackling gender inequities.

With 5 new infections for every 2 people on treatment in 2007, it is obvious that we are never going to treat our way out of this epidemic. Mr. England gives short shrift to the social dimensions of HIV and to the well known facts of HIV prevention. He trivializes the immediate needs for human rights protection of vulnerable groups, and writes off multisectoral programmes entirely….

In light of this offensive attempt at revisionist history, it is worth noting that it was the exceptional ignorance, bigotry and prejudice of many people – including those whose responsibility it was to launch the public health response to AIDS – that laid “the foundations of exceptionalism.” That bigotry and prejudice is now typically articulated in less overt terms than it was in the 1980s, but it certainly persists, and extends to many groups seen by bigots as marginal to “mainstream” society or the “general population,” not just gay men…

In a desperate plea for increased attention to the urgent need to strengthen health systems in developing countries, Roger England angrily lashes out at the international AIDS community, calling for the abolition of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and arguing that increased funding for HIV in recent years is to blame for the chronic underfunding of broader health systems. While the inflammatory nature of Mr. England’s proposal is sure to garner attention, his use of a rather simplistic analysis of how global health priorities are established risks pitting natural allies against each other, and obscures the very real synergies that exist between the global response to HIV and the push to strengthen health systems in poor countries…

And so on and so on, with a nice brief intervention by David Rasnick. Click this Show tab for the whole thing:Rapid Responses to:

VIEWS & REVIEWS:
Roger England
The writing is on the wall for UNAIDS

BMJ 2008; 336: 1072 [If you need to skim the full text again click this additional Show tab:Views & Reviews
The writing is on the wall for UNAIDS

Roger England, chairman, Health Systems Workshop, Grenada

roger.england@healthsystemsworkshop.org

The creation of UNAIDS, the joint United Nations programme on HIV and AIDS, was justified by the proposition that HIV is exceptional. The foundations of exceptionalism were laid when the “rights” arguments of gay men succeeded in making HIV a special case that demanded confidentiality and informed consent and discouraged routine testing and tracing of contacts, contrary to proved experience in public health.1 But exceptionalism grew—to encompass HIV as a disease of poverty, a developmental catastrophe, and an emergency demanding special measures, requiring multisectoral interventions beyond the leadership of the World Health Organization.

The exceptionality argument was used to raise international political commitment and large sums of money for the fight against HIV from, among others, the World Bank, through its multi-country AIDS programme, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US Presidents’ Emergency Plan for AIDS Relief. With its own UN agency, HIV has been treated like an economic sector rather than a disease.

The proposition of exceptionality is now under stress. The poverty argument has been exposed as baseless. The country surveys carried out by Measure DHS (Demographic and Health Surveys) of, for example, Ethiopia, Kenya, and Tanzania show that prevalence is highest among the middle classes and more educated people.2 Although HIV can tip households into poverty and constrain national development, so can all serious diseases and disasters. HIV is a major disease in southern Africa, but it is not a global catastrophe, and language from a top UNAIDS official that describes it as “one of the make-or-break forces of this century” and a “potential threat to the survival and well-being of people worldwide” is sensationalist.3 Worldwide the number of deaths from HIV each year is about the same as that among children aged under 5 years in India.

Similarly, multisectoral programmes were misguided and have got nowhere slowly and expensively. Some small projects of non-governmental organisations (NGOs) have successfully integrated sectoral efforts, but government ministries such as agriculture and education have not succeeded in the HIV roles imposed on them. Vast sums have been wasted through national commissions and in funding esoteric disciplines and projects4 instead of beefing up public health capacity that could have controlled transmission.5 Only 10% of the $9 billion (£4.5 billion; {euro}5.8 billion) a year dedicated to fighting HIV is needed for the free treatment programme for the two million people taking those treatments. Much of the rest funds ineffective activities outside the health sector.

These fractures in the structure of exceptionalism are now obvious. Less obvious is the possibility that it is exceptionalism, not rural Africans, that drives stigma and discrimination.6 Managers of Médecins Sans Frontières’s pioneering treatment project in South Africa fretted about what to call the centres providing the treatment, fearing that stigma would deter clients, so they called them infectious disease clinics. Patients had no such inhibitions, however, and within days were queuing to get into the “AIDS clinic.”7 But relentless promotion of HIV as different can only have reinforced stigma, the equivalent of a public health “own goal.”

It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems.8 9 10 11 Although HIV causes 3.7% of mortality, it receives 25% of international healthcare aid and a big chunk of domestic expenditure. HIV aid often exceeds total domestic health budgets themselves, including their HIV spending. It has created parallel financing, employment, and organisational structures, weakening national health systems at a crucial time and sidelining needed structural reform.12 13 Massive off-budget funding dedicated to HIV provides no incentives for countries to create sustainable systems, entrenches bad planning and budgeting practices, undermines sensible reforms such as sector-wide approaches and basket funding (where different donors contribute funds to a central “basket,” from which a separate body distributes money to various projects), achieves poor value for money, and increases dependency on aid. Yet UNAIDS is calling for huge increases: from $9 billion today to $42 billion by 2010 and $54 billion by 2015. UNAIDS is out of touch with reality, and its single issue advocacy is harming health systems and diverting resources from more effective interventions against other diseases.

Steadily, the demand is increasing for better healthcare systems, not funding for HIV. Mozambique’s health minister stated: “The reality in many countries is that funds are not needed specifically for AIDS, tuberculosis, or malaria. Funds are firstly and mostly needed to strengthen national health systems so that a range of diseases and health conditions can be managed effectively.”14 Guyana’s national health sector strategy notes the need “to convince our development partners (who support us with external aid) that some of the money they provide us with should no longer be earmarked for their favourite diseases, mainly HIV, but must be spent to improve our general health services so that we can handle all diseases better and according to our actual disease priorities.”15

HIV exceptionalism is dead—and the writing is on the wall for UNAIDS. Why a UN agency for HIV and not for pneumonia or diabetes, which both kill more people? UNAIDS is scurrying to reposition itself in the face of these realities and will no doubt soon join the Global Alliance for Vaccines and Immunisation (GAVI) and the Global Fund in claiming expertise in how to strengthen health systems. But continuation of a dedicated HIV organisation can only distort healthcare financing and delivery systems. UNAIDS should be closed down rapidly, not because it has performed badly given its mandate, which it has not, but because its mandate is wrong and harmful. Its technical functions should be refitted into WHO, to be balanced with those for other diseases.

Putting HIV in its place among other priorities will be resisted strongly. The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake, too many single issue NGOs (in Mozambique, 100 NGOs are devoted to HIV for every one concerned with maternal and child health),14 too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory. But until we do put HIV in its place, countries will not get the delivery systems they need, and switching $10 billion from HIV to support general health budgets would make a big difference—roughly doubling health workers’ salaries in the whole of sub-Saharan Africa, for example (or trebling them, if you don’t include South Africa).

References

1. De Cock KM, Abori-Ngacha D, Marum E. Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. Lancet 2002;360:67-72.[CrossRef][ISI][Medline] 2. Demographic and Health Surveys. www.measuredhs.com/start.cfm.
3. Piot P. “Why AIDS is exceptional” (speech given at the London School of Economics, London, 8 Feb 2005). http://data.unaids.org/Media/Speeches02/SP_Piot_LSE_08Feb05_en.pdf.
4. World Bank Operations Evaluation Department. Committing to results: improving the effectiveness of HIV/AIDS assistance. www.worldbank.org/oed/aids/?intcmp=5221495.
5. England R. Coordinating HIV control efforts: what to do with the national AIDS commissions. Lancet 2006;367:1786-9.[CrossRef][ISI][Medline] 6. Jewkes R. Beyond stigma: social responses to HIV in South Africa. Lancet 2006;368:430-1.[CrossRef][ISI][Medline] 7. Kasper T, Coetzee D, Louis F, Boulle A, Hilderbrand K. Demystifying antiretroviral therapy in resource-poor settings. Essential Drugs Monitor 2003;32:20-1.
8. Halperin D. Putting a plague in perspective. New York Times 2008 Jan 1. www.nytimes.com.
9. England R. Are we spending too much on HIV? BMJ 2007;334:344.[Free Full Text] 10. England R. We are spending too much on AIDS. Financial Times, 2006 Aug 14. www.ft.com.
11. Foster M, Gottret P. Scaling up to achieve the health MDGs in Rwanda: a background study for the high-level forum meeting in Tunis 12-13 June 2006. www.hlfhealthmdgs.org/Documents/June2006ScalingUptoAchievetheHealthMDGsinRwanda.pdf
12. England R. The dangers of disease specific programmes for developing countries. BMJ 2007;335:565.[Free Full Text] 13. Health Systems 20/20. Systemwide effects of the Global Fund: evidence from three country studies. Bethesda, MD: Health Systems 20/20, 2007.
14. Garrido PI. Women’s health and political will. Lancet 2007;370:1288-9.[CrossRef][ISI][Medline] 15. Ministry of Health of Guyana, National health sector strategy 2008-12. Georgetown, Guyana: Ministry of Health, 2008.
Rapid Responses published:

AIDS remains an exceptional issue 9 May 2008
Rapid Response Top
Paul De Lay,
Director, Evidence, Monitoring and Policy Department, UNAIDS
Geneva, 1211

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Re: AIDS remains an exceptional issue

Dear Sir,

In his Personal View published in BMJ on 10 May 2008, Mr Roger England suggests that the AIDS epidemic is like every other health problem and doesn’t deserve an exceptional response. He couldn’t be more wrong.

HIV was and still is an emergency requiring an unprecedented response. AIDS doesn’t fit neatly into a health box. Yes, AIDS is a disease and there are specific health needs, but AIDS has its tentacles in all sectors.

AIDS is mostly about sensitive issues—sex, gender inequality, sex work, homosexuality, drug use, stigma and discrimination—all have proved to be enormous barriers to government and civil society.

For these reasons and more, the United Nations Joint Programme on HIV/AIDS was created as a secretariat, not an agency, coordinating the UN’s response in an innovative way. That means working with ten UN Cosponsors such as UNICEF on AIDS orphans and with the World Health Organization on HIV treatment. It also means partnering with civil society in a meaningful way and focusing our efforts on global advocacy and country action.

We are beginning to see clear progress—for example Namibia enacted legislation to guide greater effort on HIV by a broad array of national ministries and sectors. This work is paying off with improved coverage for prevention and treatment initiatives, and favourable behavioural and epidemiological trends. Knowledge of HIV, and condom use have increased, while sex before the age of 15 and sex with more than one partner in the last 12 months have decreased. Adult HIV prevalence appears to have stabilized, while HIV prevalence in young women declined from 18 per cent in 2003 to 14 percent in 2007.

However, despite the achievements the epidemic continues to outpace the response. Over 60 million men, women and children have become infected with HIV since its discovery in 1981. AIDS has already killed 25 million people in as many years. AIDS remains the leading cause of death in Africa.

Resources are still desperately short in almost every area of public health in low- and middle-income countries. In low- and middle-income countries total health expenditure was estimated at just $644 billion in 2006. The percentage spent on HIV from all sources including donors, governments, international foundations and from the pockets of people affected was a mere 1.4% of these health expenditures in low- and middle- income countries.

Despite the relatively small percentage of available funds spent on HIV, funding does provide an opportunity and entry point for health and social service systems strengthening. In many African countries, HIV services and treatment keep desperately needed health workers alive, well, and able to work. And in countries where a large proportion of hospital beds are occupied by patients with AIDS, HIV treatment is reducing hospitalizations, freeing up health workers and valuable resources to dedicate to other health care.

Mr England would like to see AIDS dealt with by only health services but even the best health services in the world cannot tackle AIDS alone. They certainly play a major role in providing HIV treatment, but health ministries do not cover other vital elements of the AIDS response such as working directly with vulnerable populations to reduce their risk of HIV infection, caring for orphans, providing food support and social welfare, and tackling gender inequities.

With 5 new infections for every 2 people on treatment in 2007, it is obvious that we are never going to treat our way out of this epidemic. Mr. England gives short shrift to the social dimensions of HIV and to the well known facts of HIV prevention. He trivializes the immediate needs for human rights protection of vulnerable groups, and writes off multisectoral programmes entirely — although the key decisions and policies needed to protect human rights and provide social protection for orphans and vulnerable children are rarely under the control of the health sector.

AIDS funding can and does bolster health systems more widely—providing wins for both AIDS and health in general. The bottom line is that we need a strong AIDS response as much as we need to strengthen public health.

Paul De Lay
Director, Evidence, Monitoring and Policy Department, UNAIDS

Competing interests: None declared
Do not undermine the international response to HIV 9 May 2008
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Mark Harrington,
Executive Director, Treatment Action Group
New York, 10012

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Re: Do not undermine the international response to HIV

Roger England’s attack on UNAIDS is part of a broader effort to undermine the international response not only to HIV but also to other priority diseases like TB and malaria. He never considers recommending expanding the health funding pie to cover the other needs identified but rather uses the AIDS exceptionalism trope to claim that we would all be better off if global health programs were uniformly underfunded and inadequate as they were in the 80s and 90s. He is pitting poor sick people with one disease against poor sick people with other diseases. Yesterday at the HIV STAC we heard from Tony Harries that the only programs that work in Malawi are the HIV program and the TB program, and they work because they have routine program data embedded in the program to follow patients, and they don’t have commodity stockouts, whereas the general health system funded under a so-called sector-wide approach is rife with stockouts and obtains horrible results. For example in the recent Lancet special issue on maternal and child health targets towards the MDGs Malawi was reported to have the 2nd worst rate of maternal deaths in the world (above only DRC and right below Nigeria). That is not the fault of the AIDS program or of the international AIDS activist movement and mobilization but is due to woeful underfunding for health care overall, and can only be resolved by increasing health spending to cover all the MDG target health areas as well as other components of a comprehensive primary health care system development package.

Competing interests: None declared
Misreading the Writing on the Wall 9 May 2008
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Gregg S Gonsalves,
Co-ordinator
AIDS and Rights Alliance for Southern Africa, Cape Town, South Africa 8001

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Re: Misreading the Writing on the Wall

Roger England makes a common mistake in assuming correlation indicates causation when he blames spending for HIV/AIDS for the crisis in health systems in developing countries.

Funding for health in developing countries from both external and domestic sources is far below the level needed to create sustainable systems. Even if funding for AIDS was to be reallocated, health systems would remain in a crisis of fiscal insufficiency, that is, without the necessary financing “to strengthen national health systems so that a range of diseases and health conditions can be managed effectively.”

By pitting AIDS against other health concerns, England misreads the current situation. In order to provide comprehensive primary care, rich and poor countries need to devote far more to health spending in the developing world. Without this money, governments will always be in the position of making untenable choices about who lives and who dies instead of being able to ensure that no one perishes of any disease just because they are poor. Without addressing this essential point, England is making a gruesome case: let’s sacrifice people with HIV/AIDS so that others may live, simply parceling out inequities in health more evenly rather than confronting the inequities themselves.

AIDS has brought needed attention to the health concerns of millions of poor people around the globe and can be a stepping stone to push for “health for all,” a call that has languished for decades since the Alma Ata Declaration in the 1970s. Indeed, the future of AIDS treatment depends on strengthening primary care for chronic disease in the developing world, which will bring broad based benefits to many people with other conditions.

Instead of “putting HIV in its place,” perhaps we should put our leaders in theirs: it is the abdication of presidents and prime ministers of their duties to provide health care for their people that has brought us to this moment, not the millions of poor people with HIV/AIDS who have stood up for their own right to health.

Competing interests: None declared
Don’t Derail the Engine for Expanding Health Care Capacity 9 May 2008
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Brook K. Baker,
Law Professor
Northeastern U. School of Law, 400 Huntington Ave., Boston, MA 02115

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Re: Don’t Derail the Engine for Expanding Health Care Capacity

Roger England once again seeks to drive the nail into the coffin of AIDS exceptionalism with error-filled rhetorical blows. His four biggest claims are that AIDS is not exceptional, that AIDS diverts attention and resources from other health priorities, that AIDS financing builds aid dependency, and that the global HIV industry is out of control. All of these claims are demonstrably false – and dangerous to the goals of Universal Access and Health Care for All and to the social movement that has energized global attention not only to HIV/AIDS but to health needs in developing countries more broadly.

AIDS is exceptional because it kills people in the prime of their lives, because it is sexually transmitted, because it is linked with a worsening tuberculosis pandemic, and because its cumulative impacts in sub -Saharan Africa are calamitous. England says that “HIV is a major disease in Southern Africa, but it is not a global catastrophe” somehow suggesting that what happens in Africa is not important globally. This is North-centric at best and racist at worst. Likewise, contrary to England’s assertion that “the poverty argument has been exposed as baseless,” evidence shows that HIV incidence is higher in mobile populations and in income groups that can afford to buy sex, but that it has its most devastating effects over time in poor communities that lack access to health services.

AIDS programming does not divert attention from other health needs – those needs have been neglected for decades by both rich and poor countries and by international financial institutions that used macroeconomic and structural adjustment policies to dismantle weak but improving health systems throughout the 1980s and 90s. This neglect preceded so-called AIDS exceptionalism, and it has persisted to this day with some exceptions, e.g. childhood immunization and polio eradication. England insists on claiming that HIV spending damages health systems without confronting the evidence that AIDS programming often strengthens health service delivery more broadly, especially where donors are convinced to integrate programming and to spend money diagonally, as both the Global Fund and PEPFAR are now doing, but should do more.

AIDS spending does not create aid dependency and a lack of sustainability. The impoverishment of many developing countries in the existing neo-liberal economic order guarantees that the right to health cannot be realized within the “fiscal envelope” of poor countries unless complicit donors make substantial, long-term, and predictable investments in both priority disease programming and in more horizontal health system strengthening.

The HIV industry is not out of control nor is it a single issue campaign. Unlike most health initiatives, the AIDS movement has actually empowered people and communities to demand their right to health and to construct the response to the disease that afflicts them. The AIDS movement fights inequality, gender and sexual orientation oppression, the economies that structure vulnerability, the corporations that withhold life-saving medicines, the weak health systems that restrict scale-up, and the national and international political systems have mounted a lethargic response at best. The AIDS movement is and has been the catalyst for health-related demands on power. And, it is seeking an increasingly strong alliance with health systems proponents who want the IHP+ and other HSS initiatives to put real money on the table. Instead of seeking to divide and weaken this strong and emerging coalition, England should be celebrating the convergence of a social movement and of mutually beneficial priority disease programming and health systems strengthening that might actually achieve health care and public health needs.

Competing interests: None declared
Roger England was clearly right about one thing 9 May 2008
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David Rasnick,
Chief Science Officer
Boveran, Inc. 94607

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Re: Roger England was clearly right about one thing

The Rapid Responses to Roger England’s commentary demonstrate one of his points: “Putting HIV in its place among other priorities will be resisted strongly. The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake…”

David Rasnick, PhD

Member of The Presidential AIDS Advisory Panel, South Africa

Competing interests: None declared
Prevailing stigma demands continued leadership from UNAIDS 10 May 2008
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Christo Greyling,
Board Chair: African Network of Religious Leaders Infected or personally affected by HIV and AIDS
Johannesburg, South Africa, 1746

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Re: Prevailing stigma demands continued leadership from UNAIDS

Is HIV and AIDS different than any other disease? Does it demand a separate body such as UNAIDS? By all means – YES! We believe that HIV is more than a disease. HIV, AIDS and its resulting effect on children, families and society are driven by stigma. People continue to be infected and die from a preventable and manageable disease due to self-stigma and the fear of societal stigma. At the end of 2006 only 28% of people who immediately needed to have access to ARVs were able to access it. UNAIDS has been instrumental to provide leadership and to unite activists and scientists, political leaders and people living with HIV. Through their leadership governments made commitments towards UNGASS. Through the energy of UNAIDS local governments worked towards developing strategic HIV and AIDS plans.

HIV and AIDS remains a disease that cries for immediate and constructive leadership. UNAIDS provides this leadership at global, regional and country levels. Until HIV has become a normalized disease, stigma has been defeated and all people have access to comprehensive treatment (including ARVs, treatment for Opportunistic infections, STIs and all related services) we will need a body at the level of the UN to provide this leadership and momentum.

As the African Network of Religious Leaders Infected or personally affected by HIV and AIDS (ANERELA+) we support UNAIDS, and will continue to call on decision makers to recognize HIV and AIDS as a disease that demands an organization such as UNAIDS to provide the global leadership it deserves.

Competing interests: None declared
No Trade off in Health Care Financing 10 May 2008
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Otwoma Tom Otwoma,
HIV/AIDS BCC Leader
Nairobi,Kenya

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Re: No Trade off in Health Care Financing

People like Roger England will always be there and articles like the one he puts across now will always be with us. However, before reading or writing such an article, people need to note two issues: 1 that in budgeting and health care financing, including in health and HIV/AIDS resource allocation, there can never be a trade off. Never! You cant take resources from HIV to respond to other ailments, say child and maternal deaths. If anything, health resource allocation is still unacceptably low; 2)The Joint United AIDS programmme on AIDS (UNAIDS) is a different entity from HIV and AIDS. Even when a writing will be in the wallfor HIV and AIDS, thiswriting on the wall (or mind) willnot extend to UNAIDS. Some of the challenges in the health and development sector have not been occasioned by UNAIDS. Instead, UNAIDS is trying to respond to these challenges. In many countries,inluding Kenya, health resource allocation to HIV and AIDS still outside the UNAIDS infrastructure(Natinal AIDS Council). More importantly, it is unacceptable to look at HIV and AIDS against other diseases and/or conditions. If one wants a better way of comparing things, including budgets, one may need to move beyond the health sector. Look at defence, for example. Nevertheless, even if you look at defence, there is no room for trade-off. You can increase resource allocation to health and health care without putting any writing on the wall orin your mind (Otwoma Tom, Kenya)

Competing interests: No competing interests
Response to AIDS and Strengthening of Health Infrastructure are not mutually exclusive 10 May 2008
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Lesley-Anne Knight,
Secretary General -Caritas Internationalis
Caritas Internationalis, Palazzo San Calisto, V-00120 Vatican City Europe

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Re: Response to AIDS and Strengthening of Health Infrastructure are not mutually exclusive

As Secretary General of Caritas Internationalis, the global confederation of national Catholic humanitarian assistance, social service, and development organizations operating in more than 200 countries of the world, I am writing to register my urgent concern in response to the mean-spirited and inaccurate “personal view” by Roger England published in the British Medical Journal, on 10 May 2008 (Volume 336). For a publication that prides itself on communicating “evidence-based information”, the BMJ has committed a grave error to disseminate Mr. England’s personal opinion, which is not at all substantiated by the lived experience of millions of people currently living with or affected by HIV and of the additional millions who already have died – most an early age – of AIDS-related illnesses. If AIDS is not an “exceptional” situation (which goes far beyond the health sector but touches the very core of the family and of local communities), we ask Mr. England to explain the desperate decline in life expectancy, mostly in sub-Saharan Africa. 

 
As an organization which primarily serves the poorest of the poor in low-, middle, and high-income countries, Caritas Internationalis invites Mr. England to visit such persons in order to learn from them how poverty serves both as cause of vulnerability to and as effect of HIV infection among those segments of the population.

It is interesting to note that Mr. England ignores the Southern African countries when he puts forward the hypothesis that HIV prevalence is highest among the middle class and more educated people. Since only some 10% of people know their HIV status, one would have expected Mr. England to discern the fact that the middle class and more educated people have much more easy access to HIV testing while the poor. The writer spouts off statistics that AIDS deaths are responsible for only 3.7% of global mortality. Yet he fails to acknowledge the fact that Africa has only 11% of global population yet carries some 60% of the global HIV burden.

 
Caritas staff and volunteers throughout the world, but most especially in sub-Saharan Africa, witness firsthand the dramatic effects of access to anti-retroviral medications that have been made possible through funding from the Global Fund to Fight AIDS, TB, and Malaria and through PEPFAR. Parents who were at the brink of death and whose death would have caused serious increases among the millions of AIDS orphans, have been able to return to work, provide for their families, and are able to serve as responsible members of civil society, many of whom are lending their own efforts to increase access to HIV education and treatment among their peers.

If there is any defect in funding mechanisms such as the Global Fund, it is that the majority of the funds have been tied up in government bureaucracies, to which Mr. England apparently wishes to channel more, and not enough have been shared with civil society, most especially with faith – based organizations which supply up to 40% of the health care infrastructure in many developing countries, particularly in the most rural areas and among the most marginalized populations.




Mr. England might be quite surprised to learn that many, perhaps most, AIDS treatment programmes are far from vertical. They facilitate access to early HIV testing, anti-retroviral treatment for those found to be living with HIV; diagnosis and treatment of HIV-related Opportunistic Infections, of co- infections, such as tuberculosis and Hepatitis C, and of other sexually transmitted infections; prevention of mother-to-child transmission of HIV and safe motherhood and baby programmes; nutritional supplements; economic development; educational programmes for AIDS orphans; emotional support; self-help; and (in the cases of faith-based organizations) spiritual assistance when such is requested. 




The very existence of UNAIDS stands as a model for a coordinated approach to an otherwise overwhelming threat to the human family. As an global faith- based organization, Caritas Internationalis is most appreciative of its Memorandum of Understanding with UNAIDS, first signed in 1999 and then renewed in 2003, in which our two organizations pledged mutual collaboration in those areas where our missions and mandates coincide and mutual understanding and respect in those areas in which we differ. Mr. England should not be seeking to dismantle UNAIDS but rather to celebrate it as a model to tackle other global health and development emergencies, not only because UNAIDS promotes a unified programme and budget among its ten co-sponsor UN agencies but also because it stands out as a shining example of collaboration with civil society responses to HIV, including those of faith-based organizations. Mr. England should not be posing an “either/or” scenario for AIDS care vs. strengthen of health care infrastructure but should advocate for adequate funding of both.



Ms. Lesley-Anne Knight Secretary General of Caritas Internationalis Rome, Italy

Competing interests: None declared
Fighting Aids is not in opposition to strenghening health systems 10 May 2008
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Mariangela Simao,
Director
National STD/Aids Program/ Misnistry of Health/Brazil

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Re: Fighting Aids is not in opposition to strenghening health systems

Not recognizing Aids as an exceptional challenge and that it has be faced as a potential global threat is somewhat baffling, specially from a public health perspective. It is a sexually transmitted disease, a chronic disease, it does not have a cure, its treatment is long term and very costly, and we have different epidemics around the world. If not addressed with appropriate resources, given its characteristics, the potential to further burden health systems is enormous. Unless, of course, we are talking about not treating people, which is, by the way, a human rights issue, or ignoring the huge burden that stigma and discrimination surrounding place on Aids patients and vulnerable populations.

The author of “The writing in on the wall for UNAIDS” clearly focus on a biased analysis. It may sound repetitive, but clearly Aids cannot be fought only by the health sector. It brought us, health professionals in Brazil, working on building up our national health system for the past 20 years, the need to act on a concerted manner with other governmental sectors, as fighting Aids means also promoting human rights of vulnerable groups and discussing the implementation of public health policies with civil society organizations. Had we not treated Aids as exceptionality in my country, and that does not mean resources were “siphoned” from other health priorities, we would have more than double the estimated number of infected people. And this would certainly burden even more our national health system.

Maybe it will help bring this discussion on the right perspective if we compare the fight against Aids with strategies to combat violence in our countries. If we focus only on the much needed structural changes, expressed in better education and equal opportunities for young people, for example, which are certainly long term goals, and ignore the need to address crime here and now, what would happen in our societies?

I am not downsizing the need to strengthen health system, but I would like to end by saying we, governments, and UN agencies as well, have to tackle structural changes at the same time we address immediate needs, expressed in the fight against Aids by addressing the needs of people needing treatment and social inclusion, as well as prevention strategies, including vulnerable groups, which show their results on a long term basis.

UNAIDS is playing an extremely strategic role on this fight, helping focus UN efforts towards strengthening national responses to fight this epidemic.

Competing interests: None declared
England needs nuance 12 May 2008
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Alan W Whiteside,
Professor
HEARD Durban 4031

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Re: England needs nuance

I have just published’HIV/AIDS A Very Short Introduction’ with Oxford University Press. It is only 37 000 words, which means every word is important.The final chapter focused on major issues around HIV and AIDS including some of the uncomfortable ‘realpolitik’. It states HIV/AIDS would receive less attention as other concerns hit the global agenda. This is inevitable and I think what we need to do is work with the reality. However and more relevant there is a section on AIDS exceptionalism. This was the most difficult section to write and went through six drafts with me havering between it being exception then saying perhaps not. In the end I said:

AIDS is exceptional

Should AIDS be treated differently from other diseases? Should it be dealt with as a crisis or as a long-term development issue? This is an ongoing debate with no single or simple answer. Let me sum up the points. AIDS is primarily a sexually transmitted infection affecting young adults. The spread is silent and the long incubation period means the virus has infected many people before illnesses manifest and the threat is apparent. Eminent British scientist Professor Roy Anderson modelled the course of the epidemic and estimated it will take 130 years to work through the global population.

There is no cure. There are treatments but these remain relatively expensive. In poor countries the cost of treating one AIDS patient is many times the average expenditure on health. Even if money were no object, there are human resource-constraints to providing treatment. Science has made huge strides but there will be no vaccine or microbicide available in the medium term. AIDS is already having a devastating impact on some countries. In Swaziland the chance of a 15-year-old boy living to 50 years is 28%, for a girl it is just 22%. Before AIDS it was 92% and 97% respectively. The UNDP estimated 2004 life expectancy in Botswana to be 34.9 years. Populations in some African countries are projected to decline. Reversing life expectancies and falling populations are events unknown in the past 200 years. Economists question whether economic growth is possible in these circumstances. Sociologists and political scientists have not begun to consider the ramifications.

The debate between normalisation and exceptionalism is sterile. AIDS is exceptional and needs to be treated as such. But the measures needed to deal with the schisms and fractures that give rise to the epidemic are long-term. Preventing AIDS means equitable development: providing education, health, employment opportunities and social support. These are development goals, and not (just) about HIV/AIDS

Perhaps a more pertinent question is why don’t the leaders and officials in the worst affected countries treat the edpidemic as exceptional? Why is is so often the activists who take this up? The reality is that the decision makers don’t care about what happens in Africa and some African leaders DON’T CARE about health and HIV/AIDS as is witnessed in very concrete terms by the lack commitments to various declarations.

Competing interests: None declared
Human rights are critical to the HIV response 13 May 2008
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Jonathan E. Cohen,
Director, Law and Health Initiative
Open Society Institute, 400 W. 59th St. New York, NY, USA 10019,
Francoise Girard and Ralf Jurgens

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Re: Human rights are critical to the HIV response

Many “magic bullets” have been offered as a solution to the global AIDS crisis. Roger England, quoting himself liberally, offers a new one: stop paying so much attention to HIV, and somehow the stigma and discrimination associated with the disease will subside.

This is a curious proposal. Human rights violations against people living with and affected by HIV run rampant throughout the world. Gay men avoid HIV services for fear of being arrested on sodomy charges. Women hide their pills from their husbands to avoid domestic violence or eviction. Drug users share syringes to avoid being caught with their own syringes by the police.

The human rights violations suffered by many of those at highest risk of HIV not only offend human dignity, but also undermine the goal of universal access to HIV prevention, treatment, and care. Instead of calling for a less exceptional response to HIV, England should praise the efforts of AIDS and human rights activists to end this epidemic of abuse.

Human rights activists have achieved great gains in the fight against AIDS: the right to nondiscrimination on the basis of HIV status; the right to treatment as part of essential health care; and the right of people living with HIV and AIDS to participate in the development of AIDS policies and programs. Some have criticized these activists as being more concerned with “individual rights” than with the public’s health. In fact, contrary to what England implies, human rights are essential to public health and to a successful response to HIV.

Human rights activists were among the first to emphasize the importance of increasing access to HIV testing. When proponents of “routine” HIV testing accuse human rights activists of allowing the “three Cs” of consent, counseling, and confidentiality to override the importance of widespread and early detection of HIV, they forget that it is possible to increase access to HIV testing without sacrificing the three Cs, and easier to engage people in sustained HIV prevention and treatment efforts if the three Cs are protected. Moreover, efforts to increase access to HIV testing must be accompanied by vastly scaled-up efforts to confront the stigma and human rights abuses that deter people from seeking HIV tests in the first place, as well as increased access to antiretroviral treatment and evidence-based HIV prevention.

Human rights activists have also led the fight for increased access to effective HIV prevention measures, insisting that governments provide access to information, condoms, needles and syringes, methadone, drugs needed to prevent HIV transmission from mother to child, and protection from violence and property rights abuses that increase vulnerability of women. These demands have been based both in human rights and in effective, science-based HIV prevention.

Jonathan Cohen
Françoise Girard
Ralf Jürgens

Competing interests: None declared
An exceptional issue but a business-as-usual response 13 May 2008
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Michael L Rekart,
Director, STI/HIV Prevention and Control
British Columbia Centre for Disease Control, 655 West 12TH Avenue, Vancouver, BC, Canada V5Z 4R4

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Re: An exceptional issue but a business-as-usual response

Roger England has shined a light into a dark corner of the collective psyche of all of us who work to prevent HIV infection and deal with its ramifications. Why has so much effort to contain HIV spread in middle and low income countries produced so few results? This is an honest and important question which should not be dismissed with either a recitation of the terrible living conditions of people at risk or an exaggeration of our paultry successes.

Is HIV exceptional? Yes! The HIV pandemic fits the definition of exceptional, “unusual, not typical”. We all know this in our hearts and, if we need reminding, the why’s are summarized in the preceding responses to this provocative essay. Can a single-minded, single-disease global effort be successful? Again, the answer is yes! One has only to recall the total success of the small pox eradication campaign of the mid-1900s and the remarkable advances of the STOP-Polio campaign today.

Since the world community is expending more money, time and effort pro-rata on HIV (with far less success) than we devoted to small pox and polio combined, there must be something(s) missing. The obvious difference is that we have vaccines for the latter but not the former. Vaccines indeed are the most powerful tool in disease prevention and control. I would posit, however, that the second and more relevant missing piece is that we have relied on a routine, business-as-usual response to an exceptional pandemic. This can be fixed.

Nation-to-Nation partnering – HIV aid projects and funding too often respond to the priorities of donor countries and global agencies rather than the needs of recipient countries, leading to an overlapping, uncoordinated patchwork of initiatives. With no single plan or lead donor, the impact of aid is compromised and no one sees these failures as their responsibility. Let us debate the feasibility of partnering individual high and low income nations, perhaps with a middle income country as a third team member. The partners could develop a single, detailed plan into which all external aid would play a clear, coordinated and non-overlapping role. Success could be better monitored and the team members would be more likely to own the process and feel a responsibility to succeed.

Centripetal programming – In Vietnam, we have been intrigued to find an inverse relationship between urbanization and success. Our most successful STI/HIV clinics and outreach programs, and those most likely to be sustained, are located furthest from large cities. On the other hand, most projects to improve health systems capacity to respond to HIV and AIDS begin centrally and many of these fail before they can be scaled up to rural areas. Let us explore the hypothesis that capacity building that starts in rural areas and works its way in to urban centers (centripetal) can be more successful and cost effective than those that start centrally and work their way out to rural areas.

Unless an HIV vaccine magically appears, the war against AIDS can only be finally won by addressing the critical, upstream social determinants of health and vulnerability such as poverty, gender inequality and lack of basic education. In the meantime, let’s get creative with the tools at hand.

Competing interests: None declared
Author’s reply to UNAIDS 14 May 2008
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Roger England,
Chairman
Health Systems Workshop, Grenada WI

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Re: Author’s reply to UNAIDS

I am not sure the response from UNAIDS addresses the points I made in my article. These are:

1. That the propositions used to gain HIV its exceptional status are false.

UNAIDS only restates the view that HIV is an emergency, supporting this with the estimate that 25 million people have died of HIV in the last 25 years. But pneumonia has killed 50 million children alone in this time, and an additional 25 million neonates have died from pneumonia/sepsis.[1] Why is this not an emergency?

2. That HIV receives a disproportionate share of financing in relation to its share of deaths or burden of disease (BOD).

UNAIDS cites expenditure biased by big countries with low prevalence. This casts little light on the issue. In Rwanda HIV is responsible for 15% of the BOD, but receives well over 60% of health aid. A analysis of recent DAC and WHO data shows that this is not an isolated case. In the chart below, all countries above the line are receiving more aid for HIV than is justified by its share of BOD. In many African countries, HIV aid is now more than the total domestic health budget.

source: Mark Pearson (personal communication)

3. That much HIV money is being spent on ineffectual interventions and would be better spent in strengthening public health.

It is not just my view that multi-sectoral expenditure is ineffectual. World Bank evaluations have concluded the same thing, including about its own MAP money, much of which was handed out to weak community projects. Jim Chin points out that billions have been wasted on youth and workplace education outside SSA to ‘prevent’ general epidemics that were never going to happen anyway.[2] We know that the big numbers in SSA are about heterosexual sex and concurrent partners.[3] It is not clear why UNAIDS thinks strengthened and focused public health activities using modern communications is not the preferred intervention here. My point is that we have not done enough of that and continue to waste billions whilst calling for more.

4. That the way HIV money is being delivered and used is weakening health care systems.

Exceptionalism has justified the earmarking of aid to HIV and its provision outside of country planning and budgeting mechanisms, and countries must dance to the tunes of PEPFAR and the Global Fund because that’s where the money is. This has frustrated country attempts to harmonise financing and align it to their priorities, which are to strengthen their public health and health care services so as to be able to prevent and treat all diseases better, including HIV. UNAIDS is being forced to recognise this and is starting to make windy noises about how HIV money can bolster health systems. And thereby hangs the HIV tail wagging the health systems dog. HIV should get its proper share of the total health aid pot whether that pot is one billion or fifty billion dollars, but the size of the pot cannot be set by HIV activists with the argument that some of it will rub off on general health improvements. For one thing, what would that do for millions of poor in West Africa and parts of SE Asia where HIV prevalence is low but public health and health care needs are huge? First and foremost aid must be available to help countries build their public health and health care services (and water supplies), not as a by- product of the HIV industry. And this is exactly why we don’t need dedicated HIV funding or UNAIDS.

[1].http://www.unicef.org/immunization/files/Pneumonia_The_Forgotten_Kill er_of_Children.pdf

[2]. James Chin. The Myth of a General AIDS Pandemic. The Campaign for Fighting Diseases January 2008 http://www.fightingdiseases.org/pdf/Jim_chin_AIDS.pdf

[3]. Potts M, Halperin DT, Kirby D, et al. Reassessing HIV Prevention Priorities. Science 320, 749 (2008)

Competing interests: None declared
Writing on the wall 14 May 2008
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James E Parker,
Retired Paediatrician
289 McCallum Rd Abbotsford, B.C. Canada V2S 8A1

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Re: Writing on the wall

I find myself in agreement with Dr Michael Rekart (Responses 13 May 2008) when he states “Roger England has shined a light into a dark corner of all of us who work to prevent HIV infection…” Roger England is ‘spot on’ in his analysis of HIV/AIDS. The mismanagement of declaring a specific disease to be exceptional in the obstruction of conventional public health methods (routine testing, contact tracing etc.) has played an important role in the present situation.

Dr Rekart states that HIV fits the designation of being exceptional in having no vaccine or obvious cure. And yet for a period of some hundreds of years another sexually transmitted disease – Syphilis fell into the same category. In those days counseling was simple. ‘One night with Venus, a lifetime with Mercury’ !

James E Parker

Competing interests: None declared
The Consequences of Methodology 14 May 2008
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Jeremiah Norris,
Director, Center for Science in Public Policy
Hudson Institute 20005

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Re: The Consequences of Methodology

After the expenditure of some $50 billion by donors on global AIDS over the past several years, finally a professional health authority has stepped forward and called our attention to the inherent absurdity of its provenance in our community. In the beginning, UNAIDS grossly overestimated HIV. In November 2007, it issued an updated report, acknowledging that the AIDS pandemic was not increasing or expanding. UNAIDS stated that “global HIV incidence peaked in the late 1990s and has been decreasing since. UNAIDS estimate of global HIV prevalence for 2007 (33.2 million) was lower by over 6 million from its 2006 estimate (39.5 million). The enormity of overestimates can better be appreciated by looking at UNAIDS’ estimates of global HIV incidence (new infections) in 2006 of 4.3 million and its lowed estimate for 2007 of 2.5 million.” (1)

UNAIDS response to these lowered estimates is to call for huge increases, as the author states: “from US$9 billion today to US$42 billion by 2010 and US$54 billion by 2015”!

While UNAIDS expresses no concern about the consequences of an unprecedented resource flow into the developing world for a single disease entity, the International Monetary Fund isn’t as reluctant. In a July 2004 Survey, when expenditures were $8 billion for AIDS, the IMF cautioned on the macroeconomic risks associated with large grants “including high inflation, which retards growth and acts like a tax, especially on the poor; real appreciation of the currency, which can hinder the poor from exporting commodities vital to their livelihood; rising domestic interest rates; and, a squeeze on social spending by raising public debt service payments.” (2)

Global AIDS has attracted large grants, but it is not alone for its ability to generate funds and distort local health systems.. Half of the Millennium Development Goals are health related. A 2005 OECD report detailed the cost of 740 technical advisors working on the MDGs in Cambodia. “Their costs exceeded the combined wages of Cambodia’s 166,000 civil servants.” (3)

The author of the BMJ study correctly defined our collective dilemma by sourcing it in the original proposition that HIV was exceptional. This led to such public health diversions as the discouragement of routine testing in resource limited settings, the use of substandard drugs, and a focus of efforts on the poor. This encouraged the Global Fund to promote Option C in drug use: procurements of products not reviewed by a regulatory authority. In a 2007 report, the Fund said “of 2,254 single or limited source products procured, one-fifth were purchased using Option C, and half were found to be non-compliant to [the Fund’s] QA policy.” (4)

Most importantly, in the treatment of a chronic disease, the principles of clinical medicine were abandoned in favor of an advocacy campaign which effectively posited that price was the barrier on access to medicines for the poor. They became the cause celebre around which evocative exhortations were relentlessly pressed with the media and global donors—while ignoring the incipient causes of HIV and AIDS. “The prime mover of the epidemic is not inadequate antiretroviral medications, poverty or bad luck but our inability to accept the gothic dimensions of a disease that is transmitted sexually. Only when we cease to dodge this fact will effective HIV-control be established. Until then, it is no exaggeration to say that our polite behaviour is killing us.” (5)

Not only is AIDS weakening health systems in the developing world, but it is also having a pernicious effect on Official Development Assistance. It is estimated that AIDS funding from the Government of the United States will consume more than 50% of its ODA by 2016, and “squeeze out U. S. spending on other global health needs [creating] a new global entitlement.” (6)

For the first time, our international health community doesn’t lack for funds; it does, though, as the author intimates, not know how to put them to the best use for patient care. A continuation of the methodology of AIDS would be self-serving to its advocates and perpetuate the dire circumstances of the poor by labeling them as optional patients.

Sources:

1. James Chin, The Myth of a General AIDS Pandemic, How Billions are Wasted on Unnecessary AIDS Prevention Programmes, Campaign for Fighting Diseases, International Policy Network, London, January 2008.

2. IMF, Peter Heller, et al., “Sizeable Boost in HIV/AIDS Assistance Will Challenge Low Income Countries”, IMF Survey, July 12, 2004.

3. OECD, Development Cooperation Report, Vol. 7, No. 1, OECD, Paris, 2006.

4. Global Fund, Global Fund “Option C” allows procurement of products not reviewed by a regulatory authority, Global Fund, 6th Portfolio Committee Meeting, Geneva, February 22-23 2007.

5. Kent A. Sepkowitz, M. D., “One Disease, Two Epidemics—AIDS at 25”, New England Journal of Medicine, Vol. 344, No. 23, June 8, 2006.

6. Mead Over, “Preventing Failure: The Ballooning Entitlement Burden of U. S. Global AIDS Treatment Spending and What to do About It”, Center for Global Development, Washington, D. C., May 5, 2008.

Competing interests: None declared
The foundations of “exceptionalism”: exceptional ignorance, prejudice & bigotry 15 May 2008
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Richard J Jefferys,
Michael Palm Project Director
Treatment Action Group, NYC 10012

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Re: The foundations of “exceptionalism”: exceptional ignorance, prejudice & bigotry

England writes: “The foundations of exceptionalism were laid when the “rights” arguments of gay men succeeded in making HIV a special case that demanded confidentiality and informed consent and discouraged routine testing and tracing of contacts, contrary to proved experience in public health.”

In light of this offensive attempt at revisionist history, it is worth noting that it was the exceptional ignorance, bigotry and prejudice of many people – including those whose responsibility it was to launch the public health response to AIDS – that laid “the foundations of exceptionalism.” That bigotry and prejudice is now typically articulated in less overt terms than it was in the 1980s, but it certainly persists, and extends to many groups seen by bigots as marginal to “mainstream” society or the “general population,” not just gay men.

Here are two excerpts from the first few press conferences at the Ronald Reagan White House where the topic of AIDS arose.[1] At the time of the first one, over 800 people had already died.

THE WHITE HOUSE

Office of the Press Secretary

PRESS BRIEFING BY LARRY SPEAKES

October 15, 1982

The Briefing Room

12:45 p.m. EDT

Q: Larry, does the president have any reaction to the announcement—the Centers for Disease Control in Atlanta, that AIDS is now an epidemic and have over 600 cases?

MR. SPEAKES: What’s AIDS?

Q: Over a third of [the victims] have died. It’s known as “gay plague.” (laughter) No, it is. I mean it’s a pretty serious thing that one in every three people that get this have died. And I wondered if the president is aware of it?

MR. SPEAKES: I don’t have it. Do you? (laughter)

Q: No, I don’t.

MR. SPEAKES: You didn’t answer my question.

Q: Well, I just wondered, does the president—

MR. SPEAKES: How do you know? (laughter)

Q: In other words, the White House looks on this as a great joke?

MR. SPEAKES: No, I don’t know anything about it, Lester.

Q: Does the president, does anybody in the White House know about this epidemic, Larry?

MR. SPEAKES: I don’t think so. I don’t think there’s been any—

Q: Nobody knows?

MR. SPEAKES: There has been no personal experience here, Lester.

Q: No, I mean, I thought you were keeping—

MR. SPEAKES: I checked thoroughly with [Reagan’s personal physician] Dr. Ruge this morning, and he’s had no—(laughter)—no patients suffering from AIDS or whatever it is.

Q: The President doesn’t have gay plague, is that what you’re saying or what?

MR. SPEAKES: No, I didn’t say that.

Q: Didn’t say that?

MR. SPEAKES: I thought I heard you on the State Department over there. Why didn’t you stay there? (Laughter.)

Q: Because I love you Larry, that’s why (Laughter.)

MR. SPEAKES: Oh I see. Just don’t put it in those terms, Lester. (Laughter.)

Q: Oh, I retract that.

MR. SPEAKES: I hope so.

Q: It’s too late. Nothing I could write could be more damning than this, could it?

And by the time of the following conference, over 8,000 people had died.

THE WHITE HOUSE

Office of the Press Secretary

PRESS BRIEFING BY LARRY SPEAKES

December 11, 1984

The Briefing Room

12:03 p.m. EST

Q: An estimated 300,000 people have been exposed to AIDS, which can be transmitted through saliva. Will the President, as Commander-in-Chief, take steps to protect Armed Forces food and medical services from AIDS patients or those who run the risk of spreading AIDS in the same manner that they forbid typhoid fever people from being involved in the health or food services?

MR. SPEAKES: I don’t know.

Q: Could you — Is the President concerned about this subject, Larry —

MR. SPEAKES: I haven’t heard him express–

Q: –that seems to have evoked so much jocular–

MR. SPEAKES: –concern.

Q: –reaction here? I — you know —

Q: It isn’t only the jocks, Lester.

Q: Has he sworn off water faucets–

Q: No, but, I mean, is he going to do anything, Larry?

MR. SPEAKES: Lester, I have not heard him express anything on it. Sorry.

Q: You mean he has no — expressed no opinion about this epidemic?

MR. SPEAKES: No, but I must confess I haven’t asked him about it. (Laughter.)

Q: Would you ask him Larry?

MR. SPEAKES: Have you been checked? (Laughter.)

1 The White House transcripts are quoted at the beginning of Jon Cohen’s book, Shots in the Dark: The Wayward Search for an AIDS Vaccine, W. W. Norton & Company (December 2001) p3-4 & p15-16.

Competing interests: None declared
Statement in Response to Letter by Roger England published in the 10 May 2008 BMJ entitled, “The writing is on the wall for UNAIDS” 16 May 2008
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Pedro Cahn,
President
International AIDS Society, Switzerland, 1216,
Julio Montaner, Craig McClure

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Re: Statement in Response to Letter by Roger England published in the 10 May 2008 BMJ entitled, “The writing is on the wall for UNAIDS”

Statement in Response to Letter by Roger England published in the 10 May 2008 BMJ entitled, “The writing is on the wall for UNAIDS” By Pedro Cahn, President, Craig McClure, Executive Director, Julio Montaner, President-Elect, International AIDS Society

In a desperate plea for increased attention to the urgent need to strengthen health systems in developing countries, Roger England angrily lashes out at the international AIDS community, calling for the abolition of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and arguing that increased funding for HIV in recent years is to blame for the chronic underfunding of broader health systems. While the inflammatory nature of Mr. England’s proposal is sure to garner attention, his use of a rather simplistic analysis of how global health priorities are established risks pitting natural allies against each other, and obscures the very real synergies that exist between the global response to HIV and the push to strengthen health systems in poor countries.

The argument that AIDS is exceptional and therefore requires a similar response is not, as Mr. England states, a function of politics, but of facts. HIV is a special virus, with genetic mutability unseen before that constantly challenges a “status quo” approach to treatment and research.

Unlike many other diseases, HIV’s link with sex and drugs demands a social, as well as medical, response. And, because HIV attacks young adults in the prime of their economic and reproductive lives, the effects on economies and societies are long-term and intergenerational. In some African countries with generalized epidemics, AIDS-related mortalities have all but eliminated gains in life expectancies resulting from decades of development. And, in countries with more concentrated epidemics, the impact on particularly vulnerable populations – including men who have sex with men, injecting drug users and sex workers — has been hugely disproportionate. In sub-Saharan Africa, the estimated number of children under 18 orphaned by AIDS more than doubled between 2000 and 2007, currently reaching 12.1 million. While such statistics may not convince Mr. England that we are in midst of a global catastrophe, they have fortunately been persuasive for policymakers and much of the general public.

The success of the global response to HIV, including treatment and prevention scale up, is not in competition with the goal of strengthening health systems, but rather depends on it. In fact, strengthening health systems is at the very core of the global response against HIV/AIDS. No one understands this better than AIDS professionals on the frontlines who regularly struggle to do their jobs, often with insufficient physical and human resources. Blaming the AIDS response for a shortcoming that was many decades in the making is unwarranted. It fails to recognize how the roll out of HIV treatment has in many cases eased the pressure on such systems by reducing demand for hospital beds, thereby allowing them to be used for non-HIV patients, and by putting health care workers living with HIV back to work. The creation of new diagnostic laboratories, clinics and medical training facilities has and will continue to have broader, positive effects on public health, as will more aggressive screening and care for pregnant women living with HIV. Moreover, performance-based financing, such as that used by the Global Fund to Fight AIDS, Tuberculosis and Malaria, is surely a model that other health initiatives could use to encourage local flexibility while maintaining financial and programmatic accountability.

The push for universal access has also had a major effect on global health advocacy by galvanizing patients to demand their right to health care and combating stigma and discrimination against vulnerable populations. It also has engaged iconic figures such as Bill and Melinda Gates, former President Clinton, former President Mandela and Bono to great effect. For the first time in decades, global health issues are front and centre on the international agendas of such bodies as the United Nations, the G8 and the African Development Forum. Rather than fight this trend, many advocates for primary care, pre- and post-natal care, maternal health and sexual and reproductive health are finding ways, at the country and international levels, to join forces with those working on HIV to develop an even stronger movement for global health. These advocates and providers understand that it is the rare politician who is motivated by calls to “strengthen health systems”. Instead, it is the mobilization of real people, with specific health conditions and with tangible needs, who are best able to move this shared agenda forward. As the AIDS movement gains traction and recent investments begin to demonstrate tangible progress, it’s no surprise that criticisms from those outside the field would increase. But demanding a bigger slice of the global health funding pie, which was never big enough in the first place, is short-sighted, at best. The magnitude and exceptionalism of AIDS provides an opening and a mandate to address the chronic under-financing of health systems in developing countries. If we, as a global community, allow this opportunity to slip away, it may never return.

Competing interests: None declared
“AIDS Spending harms health systems”: Passionately disputed but hardly refuted 23 May 2008
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Mead Over,
Senior Fellow
Center for Global Development, 1776 Massachusetts Ave, NW, Washington, DC 20008 USA

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Re: “AIDS Spending harms health systems”: Passionately disputed but hardly refuted

Roger England’s article on “AIDS exceptionality” in the British Medical Journal argues that AIDS has received a larger share of total health spending than its contribution to the burden of disease would justify and that this large increase is having negative effects on the rest of the health care system in recipient countries. His article has so far generated 17 often passionate and lengthy responses.

Some of the effort of responders is devoted to demonstrating that the effects of AIDS are worse than its burden of disease would indicate. This effort to justify donor spending on AIDS seems futile, since the same is true of many other diseases, including tuberculosis, motor vehicle deaths, smoking caused disease, etc.. (In any case, cost-effectiveness should play a larger role than the total burden of disease in guiding the allocation of public health spending.) Much of the rest of this prodigious rhetorical effort asserts that AIDS spending is really helping, not harming, the rest of the health sector.

If Roger England’s assertion that AIDS spending harms the health sector could have been refuted by data, one of those posting would have cited such data and the others would not have felt the need to post. The problem is that we really don’t know, in any general way, what the extraordinary scale-up of AIDS spending has done to other parts of the health sector.

An interview I had last November with the nurse who was responsible for managing a health center in Western Kenya is perhaps revealing. His district health center had tripled in size due to the addition of clinic, lab, waiting and storage space for treating AIDS patients and for warehousing the fresh produce, cooking oil, flour and other groceries given to supplement the diets of many AIDS patients. The staff nominally reporting to him had increased by several young physicians, who had received special training in AIDS case management.

I asked this gentleman if he could compare the treatment his patients received in the two parts of his clinic. He said, “The patients who receive AIDS treatment leave with a smile. Those here for other problems do not. As I’ve told my ministry, we now have two systems of health care in Kenya.”

Then I asked him, “As the manager of this particular center, is there anything you can do to redress this imbalance?”

He said, “I insist that all of my staff, including the physicians who have been specially trained in AIDS treatment, rotate through all parts of the clinic, taking their turns serving non-AIDS as well as AIDS patients. I hope that the specially trained AIDS personnel carry some of their motivation and skill from the AIDS treatment part of the clinic to the non -AIDS part.”

On the one hand, this story supports Roger England’s claim that the resources going to AIDS treatment are vastly greater relative to the burden of disease than the resources available for other health care problems.

On the other hand, the story suggests, especially to those of us who have known how poor have been the conditions of African district health centers, that the presence of AIDS spending has tended to improve non-AIDS care as well, even if by much less than it has improved AIDS care.

This comment also appears as a blog on our site at: http://blogs.cgdev.org/globalhealth/2008/05/aids_spending_harms_1.php together with other blogs that discuss this issue.

Competing interests: None declared
Strengthening Health Systems with Vertical Programs 23 May 2008
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Donna J Barry,
Advocacy & Policy Manager
Partners In Health 02115,
Dr. Joia S. Mukherjee, Medical Director

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Re: Strengthening Health Systems with Vertical Programs

Dear Editor,

Several excellent responses to Roger England’s Personal View, ”The writing is on the wall for UNAIDS”, have been published on BMJ.com. One wonders how many times the topic of AIDS funding as a threat to other health interventions must be raised. During the last 18 months, this debate has been ongoing in a variety of media from The New York Times1 to the journal Foreign Affairs2. Paul Farmer’s response to Laurie Garrett in the latter could be reprinted verbatim as a response to England’s assertions3. The staff at Partners In Health and the patients we serve believe that this is is a false debate. Rather than siphoning resources away from other areas, the interest in and funding for HIV and AIDS has allowed us to lay bare the woeful underfunding in health systems and has given us a long awaited chance to invest their development. We have documented that when HIV testing and treatment is integrated into the delivery of primary care4 rather than simply directed as a vertical program, health systems are strengthened5 as are services to the most vulnerable6. PIH has now replicated this model in 4 countries and more than 23 public facilities.

There are both programmatic and financial collateral benefits to AIDS programs. First, when we adopt the logic frame that prevention, testing and treatment of HIV and AIDS are inseparable from the most basic aspects of health care, including the case detection and treatment of tuberculosis and sexually transmitted diseases and the provision of women’s health, then it follows that vertical funds should be used to support health systems. This approach has allowed us to justify the use of such monies earmarked for AIDS to provide adequate compensation for general medical staff, improve public infrastructure to allow for the management of both acute and chronic diseases and provide tools for the provision general health services. As previously moribund public health clinics are reanimated by staff, drugs, diagnostics and even some fresh paint, they become more attractive to donors who see that it is possible to provide even complex care thus leveraging the funding for AIDS to attract other monies.

At Partners In Health, we have seen concrete benefits of this approach. HIV is our “chwal batay” (battle horse) in Haiti’s Central Plateau where we currently have 3,500 patients on AIDS treatment and performed more than 76,000 HIV tests in 2007. In addition, from January 2006 to September 2007, over 65,000 prenatal visits were completed, 4,200 institutional births were attended, 301 Ceasarian sections were done at our hospitals, and nearly 40,000 women were using hormonal contraception. Reproductive health and obstetric care constitute just one of many other health interventions that can be strengthened by improved health systems that are boosted with vertical funds. Similar trajectories have been witnessed in a second state in Haiti, three health districts in Rwanda, six clinics in Lesotho and three in Malawi.

The global pie of funding for health has increased rapidly over the past decade—not because the wise sages of public health called for it but rather due to the righteous indignation of people living with AIDS and those who work in solidarity with them. Public health has never had such a forceful voice. It is tragically short sighted to quelch the movement which started as a call for HIV treatment equity and now has, at its core, a rights based approach to health care and health systems strengthening. Arguments made by England and others are neither based on evidence nor on good will but rather rooted in a public health nihilism that would keep millions of people without AIDS treatment to go back to the “good old days.” As an organization who serves the poorest, many of whom are on our staff and living with diseases that 5 years ago would have claimed their lives, we believe that the movement of justice and equity in HIV/AIDS treatment should spark a fire that results in the scorching of the acceptance of under-resourced health systems and rising from the ashes, a system of rights based, public sector comprehensive health care will emerge..

1 Halperin D. Putting a Plague in Perspective. Op-Ed. The New York Times. http://www.nytimes.com/2008/01/01/opinion/01halperin.html?_r=1&scp=1&sq=daniel+halperin&st=nyt&oref=slogin. Last accessed: 21 May 2008.

2 Garrett L. The Challenge of Global Health. Foreign Affairs. 2007;86(1):14-38.

3 Farmer P. From “Marvelous Momentum” to Health Care for All. Success is Possible with the Right Programs. Foreign Affairs. 2007;86(2):155-161.

4 Ivers LC, Freedberg KA, Mukherjee JS. Provider-initiated HIV testing in rural Haiti: low rate of missed opportunities for diagnosis of HIV in a primary care clinic. AIDS Res Ther. 2007; 4(1):28.

5 Mukherjee JS, Eustache E. Community health workers as a cornerstone for integrating HIV and primary healthcare. AIDS Care. 2007; 19 Suppl 1:S73-82.

6 Walton DA, Farmer PE, Lambert W, Léandre F, Koenig SP, Mukherjee JS. Integrated HIV prevention and care strengthens primary health care: lessons from rural Haiti. Journal of Public Health Policy. 2004;25(2):137- 158

Competing interests: None declared
The reality of our lives 24 May 2008
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Fiona J Pettitt,
ICW Member and Project Co-ordinator
London N1 7BJ

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Re: The reality of our lives

The International Community of Women Living with HIV/AIDS (ICW) thought long and hard about whether to deploy its scarce resources to respond to Roger England’s controversial article. However, its tenor caused us great concern and given its imminent publication in the BMJ, a respected publication which is read throughout the world, we felt strongly that a response was necessary.

ICW was founded in 1992 and is the only international network of women living with HIV/AIDS, with a membership spanning 138 countries. We challenge Roger England’s personal view that HIV/AIDS is not exceptional. As women living with HIV our lives are inextricably intertwined and impacted by living with the exceptional consequences of an exceptional health condition which has no cure, for which access to treatment is increasing but is not available to all, which is surrounded by stigma and discrimination rather than support and solidarity, and shrouded in taboo areas of peoples lives.

ICW’s work over the last 16 years has contributed to reducing the impact of HIV, it has also provided us with a unique insight into the lives of our members, and the role poverty plays in the pandemic. We challenge Roger England’s view that ‘the poverty argument has been exposed as baseless’. HIV thrives in environments of poverty, and casts people who are diagnosed HIV positive into poverty. And how does one define poverty? Many of our members are women who do not have an independent income and rely on their partners for economic survival, which places them in a position where they are unable to make decisions about their own lives, including in relation to HIV. For many years now, women’s rights advocates have highlighted the fact that a household is not a single economic unit: a rich man does not mean a rich wife/partner in terms of access to and control over resources.

The need for an exceptional response will continue until HIV/AIDS is no longer an exceptional disease, and leadership at all levels is crucial in achieving this. ICW supports the role that UNAIDS plays on a multisectoral/multilateral level. ICW and other networks of people living with HIV have walked side by side with UNAIDS, supporting their work and being supported by them in our work. Together we have played a role in making positive change, which is something Roger England fails to acknowledge. Amongst these changes are:

· an increasing number of ICW members, and other people living with HIV, accessing treatment and living healthy, productive lives

· an increase in the number of people living with HIV who have chosen to be open about their status and are playing a key role in addressing the impact of HIV at many different levels

· an increase in the number of projects which address HIV, and at the same time address gender inequalities

· an increase in knowledge about the immune system through research into HIV and treatment which will be of benefit to all

· specific to the UN is the formation of UNPlus, which supports HIV positive staff workers within the UK system

More needs to be done, and we cannot be complacent. We should continue to build on the work of those courageous gay men who were among the first to address HIV, and to step up our response – not at the expense of other health conditions, but in addition to. We certainly should not be questioning the existence of one of the key actors in HIV and suggesting that the ‘writing is on the wall’ for UNAIDS.

Competing interests: None declared
The truth is always bitter 26 May 2008
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Subir K Kole,
Lecturer, Dept. of Political Science, University of Hawaii at Manoa, Honolulu HI
Honolulu HI 96822

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Re: The truth is always bitter

England is exceptionally right! All the rapid responses that I am reading here come from those groups of people whom England demonstrate in his article as “monsters with too many vested interests.” Yes, these are the people who “live ON HIV/AIDS (for their survival), but do not live WITH the virus.” So England’s arguments hit at the root of survival for those people, who for maintaining their own comfort-level, go on justifying a higher level of funds for HIV/AIDS. And the result is obvious when anybody’s survival is at stake. I have seen how poor people in Asia and Africa struggle for their own survival. And now I can also see how “HIV-elites and monsters” struggle for their survival at the cost of the poor.

Competing interests: None declared
The “Competition for Resources” is a false debate 27 May 2008
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Aditya Bondyopadhyay,
Coordinator APCOM Secretariat
New Delhi: 110075

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Re: The “Competition for Resources” is a false debate

Dear All,

As a person who has been in the “HIV industry” (as the author of this article calls it) for all of his working life, I must say that I have benefited enormously from it, and therefore I feel a moral obligation to jump up in its defense. This is not withstanding the fact that the de facto status of ‘chamber of commerce’ for this particular industry bestowed on the UNAIDS by the author is a wee bit misplaced.

Shorn of the footnotes, references, and rhetoric, lets face it, this article is a polemic for the moolah by the late risers in the health ‘industry?’. The author lets the cat out of the bag, maybe inadvertently so, in the very last line of the article, when he speaks of tripling of health care workers salaries. Speaking of which, it ties into my first point, my own benefits from the industry.

Being in the industry from my pre-college days I must say that today I can lay claim to serious upper-middle-class-dom, at least by Indian standards. I have a low end diesel small car, I have rent to pay for an apartment, I can support the periodic fancies of a boyfriend who lives with me, I have acquired a dog, and I can often take a day off in a place I am visiting on work and pretend that it’s a vacation I am making.

The only problem is that if I had not stayed in the industry and instead concentrated on developing a legal career, as most of my classmates from law school did, I would probably today be buying a house of my own and driving a high end saloon, not to speak of those real holidays spent in uninhabited exotic beach resorts.

And this is the crucial point that the author totally misses. Yes, there is more money in HIV compared to other diseases. But that has not happened because of any largess that various funding sources suddenly discovered one day. It happened because of mobilisation over years by those that were being treated as outcasts by society at large. HIV was and continues to be a disease that disproportionately affects those who are considered the dregs of society. The author should try and do a bit of research to find out the last time someone was accused of being a faggot or a whore, simply because s/he had pneumonia or diabetes. But it is a daily occurrence with HIV, almost 3 decades after the onset of the epidemic.

And because it disproportionately affects people like us, hundreds like me took a decision to forgo that big car for a bigger stake at dignity. HIV gave us the perfect opportunity to do so. Here was a disease that could not be tackled unless you tackled these other uncomfortable questions and dealt with these other uncomfortable people whom you thus far had refused to even acknowledge. Some of the best brains (even if they were faggots or whores) got mobilised behind a disease, probably for the first time ever in human history, and claimed a seat at the table. And they were successful. This success is not a competition with other illnesses for resources. It is mobilisation for a dignified treatment, period!!

The above is the real ‘proposition of exceptionality’ of HIV. It is not material poverty as the author has made out, it’s the poverty of the human race in treating some amongst themselves with dignity and respect. And almost all those that the author has quoted in this article to emphasise the point of ‘less money for HIV, more for others’ are those whose governments (if not they themselves) believe that homosexuals should be stoned to death. For them this argument is a good bogey to challenge the relative success of the HIV movement to attract some resources, which in turn go to ‘undesirable’ people.

Look at the blood safety situation in India and you would see how HIV has strengthened and reformed certain parts the health sector from which everyone has benefited. One can claim this success as the exception that proves the rule, but I would say that this is the compass that shows the direction it should take. With care and support becoming ever more important, with ARV roll outs in many parts becoming ever more possible, this compass should be clutched even more firmly. The areas of compatibility with the mainstream health sector are increasing and the opportunities this provides to strengthen the overall health sector should not be lost out on.

The fact should not be missed that most of the HIV funds available today are not part of budgetary allocations that governments and ministers make. In other words they have not enough control over these. No wonder they are miffed, if not outright pissed. That much of these funds go towards meeting the health needs of and for serving communities of undesirables is again a matter of outrage. So, the simple question is what is stopping these esteemed governments from allocating more funds in their national budgets to the health sector? And if there is nothing to stop them, and yet they are not doing so, then the so called competition for resources that the author avers to is nothing but a false debate.

Yet these venerables do not stop spouting about the competition for resources and how more need to be available for ‘health sector’ and they even know the source of that more, take it from what is available for HIV. Shorn of rhetoric all they say is that they should be the ones spending the money now available for HIV, not some collective of faggots, whores, or shooters. In case their designs are realised, I cannot say much about the ‘health sector’, but the one sector that would surely benefit are those of Swiss Bankers managing numbered accounts.

So where does that bring us to as far as the real writing on the wall is concerned? Simply this, WHO is a great organisation, so are all other UN organisations. But all of them collectively have either never exercised their minds, or have not had the occasions to expressly state that faggots and whores are human beings that deserve human dignity and respect. UNAIDS have done so, and in the process have carried the burden of the failings or omission of the entire UN system on their back. That they have also done a competent job of managing and controlling HIV along the way is just an aside. That they would continue to do so is a given.

Till diabetics organise enough to stake a claim to their own UN body, not to speak of an entire stream of parallel funding to meet their needs, let UNAIDS continue as the UN agency for faggots and whores. In the process if Swiss Bankers manage a wee bit less business, it’s really their loss.

Best regards to all

Aditya Bondyopadhyay

Competing interests: None declared
Conflicted 2 June 2008
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Dominic D Montagu,
Assistant Professor
UCSF, USA, 94707

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Re: Conflicted

Dear Sir,

I read with great interest Mr. Roger England’s article arguing that AIDS should no long be treated as an exceptional disease and that the existence of UNAIDS is no longer justified. I was particularly struck by the vehemence and the provenance of the responses published by the BMJ.

Sir, if the Director of the Institute for the Promotion of Tobacco Use were to write an article in the BMJ arguing that second hand smoke from cigarettes is less harmful than popularly believed, and claim that she had no competing interests, she would be excoriated for her hypocrisy: her salary, her title, her career, and her continued employment by a funded institution clearly have the potential to bias her opinion. Although as a scientist we may expect her to rise above those biases, as concerned readers we would be scornful if she neglected to acknowledge them.

Now replace “Institute for the Promotion of Tobacco Use” with “UNAIDS”, “Treatment Action Group”, “AIDS and Rights Alliance”, or similar institutions, and replace “second hand smoke” with “HIV”.

Having read through the BMJ’s guidance on declaration of competing interest I note that point 2 asks “Have you…, in the past five years been employed by an organization that may in any way gain or lose financially from the results of your .. letter?” and point 1 asks “Have you…, in the past five years accepted the following from an organization that may in any way gain or lose financially from the results of your… letter: reimbursement for attending a symposium, a fee for speaking,… funds for a member of staff, fees for consulting?”

If the answer to either of those two points is “yes” then the BMJ considers that competing interest which should be declared.

My concern regarding the debate which Mr. England has initiated is that it has quickly devolved into a moral argument rather than a science based argument, and that morals are apparently open to interpretations which do not move us forward towards greater truth. If the tobacco industry, being evil, must declare competing interests, but the AIDS industry, being good, is not obliged to declare similar interests, then we have left behind rules based science and entered a realm of subjective moral certitude from which, I fear, we are unlikely to emerge either wiser or better informed.

Competing interests: None declared

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Truth from the mouths of assistant professors

The immediate question of course is who is Dominic D Montagu, Assistant Professor, UCSF, USA, who dares to stand in the way of the juggernaut like some Chinese waving a shopping bag in front of a tank, and will his career survive? What he says in what is currently the last letter with the last word in the series shows that this is a rare specimen of an academic or layperson in the modern era, one whose mind is not completely overwhelmed by the propaganda of the HIV/AIDS lobby, which currently is still one of the most effective in the US.

Dear Sir,

I read with great interest Mr. Roger England’s article arguing that AIDS should no long be treated as an exceptional disease and that the existence of UNAIDS is no longer justified. I was particularly struck by the vehemence and the provenance of the responses published by the BMJ.

Sir, if the Director of the Institute for the Promotion of Tobacco Use were to write an article in the BMJ arguing that second hand smoke from cigarettes is less harmful than popularly believed, and claim that she had no competing interests, she would be excoriated for her hypocrisy: her salary, her title, her career, and her continued employment by a funded institution clearly have the potential to bias her opinion. Although as a scientist we may expect her to rise above those biases, as concerned readers we would be scornful if she neglected to acknowledge them.

Now replace “Institute for the Promotion of Tobacco Use” with “UNAIDS”, “Treatment Action Group”, “AIDS and Rights Alliance”, or similar institutions, and replace “second hand smoke” with “HIV”.

Having read through the BMJ’s guidance on declaration of competing interest I note that point 2 asks “Have you…, in the past five years been employed by an organization that may in any way gain or lose financially from the results of your .. letter?” and point 1 asks “Have you…, in the past five years accepted the following from an organization that may in any way gain or lose financially from the results of your… letter: reimbursement for attending a symposium, a fee for speaking,… funds for a member of staff, fees for consulting?”

If the answer to either of those two points is “yes” then the BMJ considers that competing interest which should be declared.

My concern regarding the debate which Mr. England has initiated is that it has quickly devolved into a moral argument rather than a science based argument, and that morals are apparently open to interpretations which do not move us forward towards greater truth. If the tobacco industry, being evil, must declare competing interests, but the AIDS industry, being good, is not obliged to declare similar interests, then we have left behind rules based science and entered a realm of subjective moral certitude from which, I fear, we are unlikely to emerge either wiser or better informed.

Of course, little does this politically daring and very sensible presumably young commentator know how right he is to suspect that the AIDS saga is being distorted by “competing interests”. As a matter of incontrovertible fact it can truly be said that it is the prize specimen of the modern gallery of fields distorted by this vast and expanding factor, a Godzilla among macaques, one might say.

Donors growing hardhearted

stairwaycashheaven.jpgHowever, let us not assume that their effectiveness is not dwindling in the face of the national belt tightening now going on in the richest country in the world, for the truth is that AIDS organizations are being strongly affected by a new reluctance to fund them in the excessive manner they feel they deserve (which we would argue they do not deserve at all while they stand in the way of a scientific and political review of the medical ideology by which they live).

In New York City, HIV and AIDS groups are closing ranks and forming collaborations to get through what looks like a new era where funders are reining in so far that their very existence is threatened. The New York Sun reports today that Village Care and the Momentum Project have consolidated their back room operations, SMART University transferred theirs to the Fund for the City of New York, and the MAC AIDS Fund has 2.5 times more pleas for help this year, ie they are getting 1000 a year. Iris House says it will cut staff or programs if things don’t get better soon.

Care for AIDS patients sounds like a no brainer for any charitable person to support but of course not to informed observers of the tragic AIDS scene where worthy people who make the simple mistake of trusting their care providers find themselves dying at the rate of 2000 a year in New York under medication which is represented in drug company ads as enabling them to climb mountains and ski waves glowing with bronzed health and sexual virility.

Since the best scientific journals tell us this is not so one can only hope that the gushing money tap now being screwed down a little might provoke in their caregivers a more responsible attitude to double checking the claims of scientists which have been thoroughly rejected from the beginning by the finest scientist in the field, and have suffered nothing but contradiction every year since in the mainstream literature, with study after study showing that HIV does nothing to undermine human health and the medications do nothing but damage it, in the end fatally.

But with everyone’s spouse, children, dogs, cats, automobiles, mortgages and lab space and equipments, not to mention prizes, awards and media attention, and social contact with Hollywood movie stars, utterly dependent on the ruling paradigm, how likely is this ?

Read the BMJ Rapid Responses and see. Not very.

Gary Taubes explains why AIDS still kills

June 10th, 2008

Renowned mythbuster stumbles on HIV/AIDS, repeats official nonscience

Fans wonder how could it happen to the author of “Big Fat Lie”?

His invisible editor, the HIV Meme

gary_taubes.jpgA piece in New York magazine this week demonstrates how the rationalization of the current HIV/AIDS ideology works in the brains of those taken over by the HIV=AIDS meme.

The meme we refer to is the universal premise that HIV causes AIDS, which has a truly remarkable ability to prevent anyone it inhabits from examining itself anew, to see whether it is a universal truth or the intellectual equivalent of a mischievous monkey which has in twenty years turned into a global Godzilla.

The latest example of a giant journalistic brain hijacked by this self protective gremlin is that of Gary Taubes, a skeptical writer famous in Manhattan for the $700,000 advance hurriedly offered him by the fine old literary house Knopf when he published a dynamite piece in the New York Times Magazine six years ago, What if It’s All Been a Big Fat Lie?. The article explained that fat after all didn’t make you fatter, and the champion of the high fat low carb diet Dr Robert Atkins was quite right to revive the view of an earlier era that obesity, diabetes and heart disease came from the officially recommended diet of white bread, pasta, polished white rice, bagels and sugar (in fruit).

After five years of further extensive research Taubes’ mythbusting 600 page book Good Calories, Bad Calories came out last year, still nailing refined carbohydrates goodcalsbadcal.jpgas the major diet villain and adding for good measure that exercise didn’t lead to weight loss, obesity didn’t result from couch potatoes overeating and that salt did not cause high blood pressure.

Like his article the book generated controversy as it ran into strong defense arguments from those who insisted that the causal chain of fat to heart disease had been proven by good studies, and that high fiber unrefined carbohydrates (fruits, vegetables, beans, and whole grains such as oats, brown rice, and corn) were good for you, and using them in a low fat, high carb diet worked fine in reversing heart disease and losing weight. Also, there were good fats and bad fats, the latter being saturated fats, cholesterol and trans fatty acids which provably block arteries, and in the end the whole subject of bodily metabolism is far more complex than any simplistic rule.

Professional skeptic misled

coverpicgarytaubes.jpgWhile noting that Taubes is an accomplished and serious investigator, the author of Nobel Dreams (1987) and Bad Science: the Short Life and Weird Times of Cold Fusion (1993), and a correspondent for Science who has won several awards in science journalism, we’ll deal with that dispute in depth in a later post. Today’s topic is HIV/AIDS in Taubes’s New York Magazine piece just arrived in Manhattan mailboxes, Who Still Dies of AIDS, and Why: In the age of HAART, the virus can still outwit modern medicine.

In the video, filmed last November, Mel Cheren appears understandably dismayed. He’s being interviewed by a reporter for CBS News on Logo, a gay-themed news program; he’s sitting in a wheelchair, and he’s talking about the indignity and the irony of dying from AIDS at a time when AIDS should be a chronic disease, not a fatal one. Cheren, a music producer and founder of West End Records, had been an AIDS activist since the earliest days of the epidemic. It was Cheren, in 1982, who gave the Gay Men’s Health Crisis its first home, providing a floor of his brownstone on West 22nd Street. In the interview, Cheren talks about what it’s like to lose more than 300 friends to the AIDS epidemic, outlive them all, and then get diagnosed yourself at age 74.

Indeed, the fact that Cheren had plenty of sex through the height of the epidemic, had been tested regularly, and had apparently emerged uninfected had led him to believe that testing was no longer necessary, or at least so one doctor had told him half a dozen years earlier. He’d only learned the truth after he began losing weight, had trouble walking, and was finally referred to a specialist who didn’t consider AIDS an unreasonable diagnosis for a man of Cheren’s experience and advanced years and so ordered up the requisite blood test. “There was one guy,” Cheren says in the interview, explaining how he might have been infected. A male escort. “We really hit it off, sexually … ”

By the time Cheren learned he had AIDS, he was already suffering from a rare, drug-resistant pneumonia, what infectious-disease specialists refer to as an opportunistic infection, and he had lymphoma, an AIDS-related cancer that had spread to his bones.

Within a month of his diagnosis, Cheren was dead. The official cause was pneumonia, although, as his cousin Mark Cheren points out, cause of death in these cases is a moot point. “Infection from pneumonia was probably the culprit,” he says, “but only because that acts quickest when you don’t stop it.”

Dying from AIDS, or dying with an HIV infection, which may not be the same thing, is a significantly less common event than it was a decade ago, but it’s not nearly as uncommon as anyone would like. Bob Hattoy, for instance, died last year as well. Hattoy, 56, was “the first gay man with AIDS many Americans had knowingly laid eyes on,” as the New York Times described him after Hattoy announced his condition to the world in a speech at the 1992 Democratic National Convention. Hattoy went on to work in the Clinton White House as an advocate for gay and lesbian issues. In the summer of 1993, he told the New York Times, “I don’t make real long-term plans.” But the advent of an anti-retroviral drug known as a protease inhibitor, in 1995, and then, a year later, the multidrug cocktails called HAART—for highly active anti-retroviral therapy—gave Hattoy and a few hundred thousand HIV-infected Americans like him the opportunity to do just that.

If the pharmaceutical industry ever needed an icon for evidence of its good works, HAART would be it. Between 1995 and 1997, annual AIDS deaths in New York City dropped from 8,309 to 3,426, and that number has continued to decline ever since. The success of HAART has been so remarkable that it now tends to take us by surprise when anybody does succumb, although 2,076 New Yorkers died in 2006 (2007 figures are not yet available). Though many of the most prominent deaths, like Cheren’s and Hattoy’s, tend to be of gay men, the percentage of the dead who contracted the disease through gay sex is now reportedly as low as 15 percent (with a large proportion still reported as unknown). Intravenous-drug users make up the biggest group, 38.5 percent, and women account for almost one in three of total AIDS deaths.

One of the ironies of the success of HAART is that it has fostered the myth that the AIDS epidemic has come to an end, and that living with HIV is only marginally more problematic than living with herpes or genital warts. This is one obvious explanation for why HIV infection is once again on the rise among young men—specifically, MSMs, as they’re now known in the public-health jargon, for men who have sex with men—increasing by a third between 2001 and 2006. Among those 30 and over, the infection rate is still decreasing, notes Thomas Frieden, commissioner of the city’s Department of Health and Mental Hygiene, suggesting that the increased rate of infection among men under 30 is due in part to decreased awareness of the disease or the toll it can take.

And so on and so on. Here (at the bottom of a couple of further remarks) is the rest of it, as proof of our earlier remark in our previous post, which we repeat and modify slightly to fit this prize specimen of a well informed, intelligent, scientifically attentive journalist who is unable to reexamine his basic assumption however absurdly contradictory and conflicting the Ptolemeic rationalizations served up to him by his prime sources:
The inability of good men in the field of AIDS to realize that all the inconsistencies vanish as soon as the basic premise that HIV is the cause is removed from their analysis is quite astonishing. Apparently the paradigm has some kind of hypnotic effect which prevents anyone ever wondering if it is true, however many absurdities it produces. Or is it simply the inability of honest men to conceive that their sources are misleading them?

Why Taubes wrote the book

What’s even more astonishing in this case of course is that Taubes is a professional skeptic who has just delivered a book in which he manages 600 heavily researched pages on the theme of “Don’t believe what bad scientists tell you”.

In fact, that thought was the initial seed from which his blockbuster sprang. Some scientist had just finished boasting to him that he took pride in being personally responsible for warning the population of America not to eat too many eggs or too much fat.

Taubes rang up his editor and said he didn’t yet know enough about the field but judging from the sheer stupidity of the scientist he had talked to there was obviously a story there somewhere.

As he told Frontline on PBS:

What made you go after this topic in the first place?

Two things. I’d been reporting on salt and blood pressure, which is a huge controversy, and some of the people involved in that were involved in the advice to tell Americans to eat low-fat diets, and they were terrible scientists. These were some of the worst scientists I’d ever come across in my 20-odd year career of writing about controversial science.
You cannot say that because fat consumption associates with heart disease, that that means it causes heart disease, because a lot of other things, for instance, associate with fat consumption.

I literally called up my editor and said, “I just got off the phone with so-and-so, and he’s [taken] credit for getting Americans to eat less eggs and less fat. This guy’s one of the worst scientists I’ve ever talked to, and if he was involved in this, then there’s a story there.” And that was it. I didn’t know what the story was. I just knew there was a story.

Anyhow, here is the rest of the New York magazine piece by Gary and the Meme:
“If you do the mathematics,” Frieden says, “HAART became available in 1996. If you were of age before then, sexually active, and you saw a lot of people dying or sick or disfigured from AIDS, maybe you’re more careful than if you came of age after 1996 and didn’t see that. When we’ve done focus groups, what young men have told us is that the only thing they hear about HIV these days is that if you get it, you can climb mountains, like Magic Johnson. Certainly it’s true that the treatment for HIV is very effective and it’s possible to live a long and productive life with an HIV infection. It’s also true that it remains an incurable infection. That the treatment is very arduous and sometimes unsuccessful. It remains a disease often fatal, and frequently disabling.”

At the moment, some 100,000 New Yorkers are infected with the HIV virus, and AIDS remains the third leading cause of death in men under 65, exceeded only by heart disease and cancer. The question of who will die from AIDS in the HAART era—or who dies with an HIV infection but not technically from AIDS—and what kills them is worth asking now that such deaths have become relatively infrequent.

Frieden’s Department of Health and Mental Hygiene tried to answer this question with a study it published in the summer of 2006. The newsworthy conclusions were that deaths among New Yorkers with AIDS were still dropping, thanks to HAART, and that one in four of these individuals was now living long enough to die of the same chronic diseases that are likely to kill the uninfected—particularly cancer or heart disease—although most of these non-HIV-related deaths were from the side effects of drug abuse. HIV-related illnesses were still responsible for the remaining three out of four deaths. Or at least “HIV disease,” in these cases, was recorded as a cause of death on the death certificates.

What the Health Department study couldn’t do is say precisely what these HIV-related deaths were. For the answer to this question, you have to go to physicians who specialize in treating HIV-infected patients. Michael Mullen, clinical director of infectious diseases at Mount Sinai School of Medicine, for instance, says the best way to think about AIDS deaths is to divide HIV-infected individuals into three groups.

“If it’s 1988, 1989,” says one doctor, “and I have a patient with HIV disease and hypertension, he’s not going to live long enough to die of hypertension. I want to treat the disease.”

The bulk of these deaths occur within the first group, those who either never started HAART to begin with or didn’t stay on it once they did. For these patients, “it might as well still be the eighties,” says Mullen, and they die from the same AIDS-defining illnesses that were the common causes of death twenty years ago—pneumocystis pneumonia, central-nervous-system opportunistic infections (such as toxoplasmosis), lymphoma, Kaposi’s sarcoma, etc.

A large proportion of these victims are indigent; many are intravenous-drug users—IVDUs, as they’re known in the official jargon, accounted for 21 percent of HIV-positive New Yorkers in 2006, but, as noted above, 38.5 percent of the city’s AIDS deaths. The virus is no more aggressive or virulent in these cases. Rather, these are the people who either don’t or can’t do what it takes to fight it. “These individuals are repeatedly admitted to the hospital,” says Mullen, “sometimes for opportunistic infections, sometimes for drug-related issues, often for HIV-related lymphomas and malignancies. They will not take the medication, nine times out of ten, because of drug use.” Often these individuals are co-infected with hepatitis, which increases the risk that the more toxic side effects of the anti-retroviral drugs will lead to permanent liver or kidney damage.

By far the highest death rates in this group are in what the authorities now refer to as concurrent HIV/AIDS diagnoses. These patients never get diagnosed with HIV infection until they already have active AIDS. (Cheren, because of his age and his AIDS awareness, is an extreme case.) These constituted more than a quarter of the 3,745 new cases of HIV infections diagnosed in New York in 2006. “Those people have never been tested before,” says Mullen. “Believe it or not, people like this still exist.” Typically, they’ve had the infection for ten years—the average time between HIV infection and the emergence of AIDS—but won’t know it or acknowledge it until admitted to the emergency room with pneumonia or some other opportunistic infection. These individuals are twice as likely to die in the three to four years after their diagnosis as someone who was just diagnosed with HIV alone. Half of these deaths will occur in the first four months after diagnosis, often from whatever AIDS-related ailment led them to the emergency room in the first place.

It’s because of these concurrent HIV/AIDS diagnoses that the Centers for Disease Control and Prevention and the city’s Department of Health and Mental Hygiene have been lobbying for HIV tests to be given routinely to anyone who visits an emergency room for any reason. In one recent study from South Carolina, almost three out of four of those people with concurrent HIV/AIDS diagnoses had visited a medical facility after their infection and prior to getting their blood tested for the virus—averaging six visits each before they were finally tested and diagnosed. “By remaining untested during their routine contacts with the health-care system,” said Frieden, in testimony to the New York State Assembly Committee on Health, “they have missed the high-quality treatment that could improve their health and extend their lives. Many may have unknowingly infected their partners—and these partners may not learn that they are infected until they too are sick with AIDS. And so this cycle of death continues.”

Who Still Dies of AIDS, and Why

The second group of HIV-infected patients consists of those at the other extreme, the ones who are least likely to die from AIDS or its complications. These individuals were diagnosed with HIV after the advent of HAART and have taken their medications religiously ever since. In these cases, HAART is likely to suppress their virus for decades, and they’re now significantly more likely to die of heart disease or cancer than of anything related to AIDS. To get an idea of the mortality rate among these patients, consider Alexander McMeeking’s practice, on East 40th Street. McMeeking ran the HIV clinic at Bellevue from 1987 to 1989 and then left to start a private practice. To the best of his knowledge, only three of his 300-odd Bellevue patients survived long enough to get on HAART. They are still alive today. “Fortunately, thank God, all three are doing great,” says McMeeking. “I tell them they will essentially die of old age.”

McMeeking’s practice now includes 600 HIV-infected patients, and last year he lost only two of those—one to lung cancer, another to liver cancer.

Now the question is whether these patients doing well with HAART are actually more susceptible to the kind of chronic diseases that kill the uninfected. Are they more likely to die from heart disease, cancers, liver and kidney failure, and other chronic diseases either because of the HIV itself or the anti-retroviral regimen keeping it under control? One observation made repeatedly in studies—including the 2006 report from the Department of Health and Mental Hygiene—is that these HIV-infected individuals appear to have higher rates of several different cancers, in particular lung cancer among smokers, non-Hodgkins lymphoma, and cancers of the rectal area. These cancers appear both more precocious and more aggressive in HIV-infected patients—they strike earlier and kill quicker. The reason is not yet clear, although a likely explanation is that the ability of the immune system to search out and destroy incipient malignancies is sufficiently compromised from either the anti-retroviral drugs, the virus, or the co-existence of several viruses—squamous-cell cancers of the rectal area are caused by the same human papilloma virus that causes cervical cancer in woman—that the cancers get a foothold they don’t get in non-HIV-infected individuals.

“I still expect most of my patients to live a normal life expectancy,” says an AIDS doctor, “but they may do so with a bit more nips and scrapes.”

One finding that’s considered indisputable is that HAART, and particularly the protease inhibitors that are a critical part of the anti-retroviral cocktail, can play havoc with risk factors for heart disease. They raise cholesterol and triglyceride levels; they lower HDL, and they can cause increased resistance to the hormone insulin. These changes often accompany a condition known as HIV-related lipodystrophy, which afflicts maybe half of all individuals who go on HAART. Subcutaneous fat is lost on the face, arms, legs, and buttocks, while fat accumulates in the gut, upper back (a condition known as a buffalo hump), and breasts. The question is whether these metabolic disturbances actually increase the likelihood of having a heart attack. It’s certainly reasonable to think they would, but it’s remarkably difficult to demonstrate that the drugs or the virus itself is responsible: The fact that a relatively young man or woman with AIDS has a heart attack does not mean that the heart attack was caused by HIV or the disturbance in cholesterol and lipid levels induced by the therapy.

Any difference in disease incidence between HIV-infected and uninfected individuals, explains John Brooks, leader of the clinical-epidemiology team within the CDC’s Division of HIV/AIDS Prevention, can be due to the infection itself, to the therapy—HAART—or to “the host, the person who has HIV infection, both physiologically and socioculturally.” It’s the last factor—the host—that complicates the science. Until recently, for instance, physicians saw little reason to worry about heart-disease risk factors in their HIV-infected patients and so didn’t bother to aggressively treat risk factors in those patients, as they did the HIV-negative. “Think about it,” says Brooks, “if it’s 1988, 1989, and I have a patient with HIV disease and hypertension, he’s not going to live long enough to die of hypertension. I want to treat the disease.”

The rate of cigarette smoking among HIV-infected individuals is also twice as high as the national average. The rate of intravenous drug use is far higher, as is the rate of infection with hepatitis B or C, because intravenous drug use is a common route to getting both HIV and hepatitis. So the fact that an HIV-infected patient may seem to be suffering premature heart disease, diabetes, or liver or kidney disease earlier than seems normal for the population as a whole—or the fact that a study reports such a finding about a population of HIV-infected individuals—only raises the issue of whether the population as a whole is the relevant comparison group. “Since one of the major risk factors for HIV is intravenous drug use,” says Brooks, “you have to ask, what’s the contribution of heroin to somebody’s kidney disease versus the HIV versus untreated high blood pressure versus smoking?”

From his own clinical experience, McMeeking agrees that heart disease, certain cancers, and liver and kidney disease do seem to pose a greater threat to his HIV-infected patients than might otherwise be expected in a comparable uninfected population. “I still expect most of my patients to live a normal life expectancy,” he says, “but they may do so with a bit more nips and scrapes.”

The third group of HIV-infected individuals consists of those in the middle of the two extremes. HAART, in these cases, has literally been a life saver, but has not guaranteed a normal life expectancy. These are the patients, like Bob Hattoy, who were diagnosed with AIDS in the late eighties or early nineties, before the advent of HAART. They began on one drug (AZT, for instance) and then stayed alive long enough to get on protease inhibitors and the HAART cocktails. These patients were on the cusp of the HIV transformation from a deadly to a chronic-disease epidemic; they were infected late enough to survive but too early to derive all the benefits from HAART.

The anti-retroviral drugs of HAART work by attacking the life cycle of the virus. The earliest generation of HAART drugs attacked the enzymes that the virus uses to reproduce in the cells. (Protease inhibitors, for instance, go after an enzyme called HIV-1 protease, which the virus uses to assemble itself during reproduction.) The latest drugs go after the methods that the virus uses to enter cells in which it will replicate. The key to the effectiveness of HAART, as researchers discovered in the mid-nineties, was to include at least three drugs in the cocktail to which the patient’s specific virus had no resistance. This would suppress viral replication sufficiently so that the virus wouldn’t be able to mutate fast enough to evolve resistance to any of the drugs. But patients who began on one or two anti-AIDS drugs and only then moved to HAART already had time to evolve resistance to a few of the drugs in the cocktail. This made the entire package less effective and increased the likelihood that they would evolve resistance to the other drugs as well.

“We call it ‘sins of the past,’ ” says Mullen. “We gave these patients sequential monotherapy; it was state-of-the-art at the time, and a lot of those people are alive today because of that. It got them through until HAART came along, but their HAART is not highly active, only fairly active. Their virus has baseline mutations that interfere with the response.” This group of patients also includes those who were infected initially with a strain of HIV already resistant to one or several of the components of HAART, or those patients who were less than 99 percent faithful in taking the regimen of pills that constitute HAART. Anything less than that and the virus has the opportunity to evolve resistance.

Perhaps a quarter of all new cases, says Mullen, are infected with a strain of the virus resistant to one or more drugs in the HAART cocktail. “You can’t use the frontline regimen, because the virus has already seen those drugs,” he says. “You have to go to more complicated regimens. This is why we do resistance testing before we start a person on medication. We see what drugs the virus has seen or is resistant to and can take that into account.”

Sins-of-the-past patients have to have faith that the pharmaceutical industry can stay one step ahead of their disease. The prognosis, at the moment, is promising. There are several entirely new classes of AIDS drugs, including one by Merck, called an integrase inhibitor, that was just approved by the FDA last October. A recent report of the discovery of 270 new human proteins employed by the AIDS virus to hijack cells and start replicating—the definition of a successful infection—means the pharmaceutical industry will not run out of new targets to block the infection in the near future.

Still, some sins-of-the-past patients simply do worse than others, and the occasional patient will lose the battle before new drugs come along or simply give up. “I had a friend who died last week,” one sins-of-the-past patient told me recently. “He just lost faith. He would get sick a lot, would get better, then sick again. Finally he decided to try Eastern medicine, and stopped taking his [HAART] medications entirely. It killed him. It’s not a good example, other than to show that people can reach their breaking point.”In other words, take that, HIV skeptics. The man stopped taking his HAART medications entirely, and….”It killed him”.

Gary’s co-author

Here we have a writer who has prided himself in the past on digging into the truth underneath the news media pap and the layers of public ignorance on the subject of diet, and who has written books on scientists and their Nobel dreams, and the atrociously bad science of cold fusion.

We hereby salute the HIV/AIDS meme, undoubtedly the greatest intellectual infectious virus ever produced.

AIDS reports embarrass Clinton at UN

June 9th, 2008

Clinton will give Forum opening address today, but his platform is creaking

Opinion on HIV/AIDS is shifting, with doubts gathering on size of spending

Even paradigm skepticism is peeking through, at last

bill_clinton.jpgThis afternoon at 3pm (June 9, Monday) President Emeritus William Jefferson Clinton reasserts his stature in the wake of needless analysis of the degree to which his public pronouncements contributed to the demise of his wife’s bid for the Democratic presidential nomination. (Click photo for enlargement of this photo portrait)

The once extremely popular and still strikingly handsome politician and global corporate charity chieftain will address the UN First HIV/TB Global Leaders’ Forum on what we all should do to curb the spread of the arguably harmless virus HIV, now known also to anyone who troubles to read the relevant journals to be almost entirely noninfectious.

This universally recognized threat has been vigorously dealt with since 2002 by the Clinton Foundation HIV/AIDS Initiative (CHAI), which has managed to increase the cash flow of drug companies in the field by a significant amount as it raised enough money to deliver noxious drugs to 1.4 million “HIV positives”, real and supposed, in 22 countries mostly in Africa.

President Clinton to Discuss Strategies for Addressing the Global Threat of HIV/TB

President Clinton Will Deliver Opening Address to the First HIV/TB Global Leaders’ Forum at United Nations

New York, NY – President Bill Clinton will deliver opening remarks to distinguished global leaders at the first HIV/TB Global Leaders’ Forum on Monday, June 9 at the United Nations. The Forum, hosted by former Portuguese President Jorge Sampaio, the United Nations Special Envoy to Stop TB and in conjunction with the WHO, Stop TB Partnership, the Global Fund, the World Bank, and UNAIDS, is being held to highlight the need for collaboration to reduce the number of people living with HIV and dying of Tuberculosis. President Clinton and the William J. Clinton Foundation are committed to turning the tide on the global HIV/AIDS epidemic. Since 2002, the Clinton Foundation HIV/AIDS Initiative (CHAI) has worked to assist 22 countries’ implementation of large-scale, integrated, HIV/AIDS care and treatment programs, and to increase the availability of high-quality AIDS medicine and diagnostics for people in more than 60 developing countries. Today, 1.4 million people around the world have access to life-saving AIDS medicines as a result of CHAI’s efforts.

Overspending on HIV/AIDS

We don’t know which ink stained wretch in the Clinton Foundation PR department worked up the speech for the hot blooded spousal campaigner, but we hope that he/she took note of the BMJ editorial: The writing is on the wall for UNAIDS a month ago pointing out what everyone has know for twenty years, that the funding for fighting HIV/AIDS is wildly out of proportion to the supposed threat from this misinterpreted scourge, which unread top science journal reviews show is really a global epidemic of relabeling other illnesses and nothing more, and it diverts funds from much greater killers such as heart disease, cancer, and many tropical diseases such as TB and the inarguably much more lethal malaria, which kills millions of infants annually in places where $10 mosquito nets have not yet been delivered by the country most responsible for banning DDT.

Views & Reviews
The writing is on the wall for UNAIDS

Roger England, chairman, Health Systems Workshop, Grenada

roger.england@healthsystemsworkshop.org

The creation of UNAIDS, the joint United Nations programme on HIV and AIDS, was justified by the proposition that HIV is exceptional. The foundations of exceptionalism were laid when the “rights” arguments of gay men succeeded in making HIV a special case that demanded confidentiality and informed consent and discouraged routine testing and tracing of contacts, contrary to proved experience in public health.1 But exceptionalism grew—to encompass HIV as a disease of poverty, a developmental catastrophe, and an emergency demanding special measures, requiring multisectoral interventions beyond the leadership of the World Health Organization.

The exceptionality argument was used to raise international political commitment and large sums of money for the fight against HIV from, among others, the World Bank, through its multi-country AIDS programme, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US Presidents’ Emergency Plan for AIDS Relief. With its own UN agency, HIV has been treated like an economic sector rather than a disease.

The proposition of exceptionality is now under stress. The poverty argument has been exposed as baseless. The country surveys carried out by Measure DHS (Demographic and Health Surveys) of, for example, Ethiopia, Kenya, and Tanzania show that prevalence is highest among the middle classes and more educated people.2 Although HIV can tip households into poverty and constrain national development, so can all serious diseases and disasters. HIV is a major disease in southern Africa, but it is not a global catastrophe, and language from a top UNAIDS official that describes it as “one of the make-or-break forces of this century” and a “potential threat to the survival and well-being of people worldwide” is sensationalist.3 Worldwide the number of deaths from HIV each year is about the same as that among children aged under 5 years in India.

Similarly, multisectoral programmes were misguided and have got nowhere slowly and expensively. Some small projects of non-governmental organisations (NGOs) have successfully integrated sectoral efforts, but government ministries such as agriculture and education have not succeeded in the HIV roles imposed on them. Vast sums have been wasted through national commissions and in funding esoteric disciplines and projects4 instead of beefing up public health capacity that could have controlled transmission.5 Only 10% of the $9 billion (£4.5 billion; {euro}5.8 billion) a year dedicated to fighting HIV is needed for the free treatment programme for the two million people taking those treatments. Much of the rest funds ineffective activities outside the health sector.

These fractures in the structure of exceptionalism are now obvious. Less obvious is the possibility that it is exceptionalism, not rural Africans, that drives stigma and discrimination.6 Managers of Médecins Sans Frontières’s pioneering treatment project in South Africa fretted about what to call the centres providing the treatment, fearing that stigma would deter clients, so they called them infectious disease clinics. Patients had no such inhibitions, however, and within days were queuing to get into the “AIDS clinic.”7 But relentless promotion of HIV as different can only have reinforced stigma, the equivalent of a public health “own goal.”

It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems.8 9 10 11 Although HIV causes 3.7% of mortality, it receives 25% of international healthcare aid and a big chunk of domestic expenditure. HIV aid often exceeds total domestic health budgets themselves, including their HIV spending. It has created parallel financing, employment, and organisational structures, weakening national health systems at a crucial time and sidelining needed structural reform.12 13 Massive off-budget funding dedicated to HIV provides no incentives for countries to create sustainable systems, entrenches bad planning and budgeting practices, undermines sensible reforms such as sector-wide approaches and basket funding (where different donors contribute funds to a central “basket,” from which a separate body distributes money to various projects), achieves poor value for money, and increases dependency on aid. Yet UNAIDS is calling for huge increases: from $9 billion today to $42 billion by 2010 and $54 billion by 2015. UNAIDS is out of touch with reality, and its single issue advocacy is harming health systems and diverting resources from more effective interventions against other diseases.

Steadily, the demand is increasing for better healthcare systems, not funding for HIV. Mozambique’s health minister stated: “The reality in many countries is that funds are not needed specifically for AIDS, tuberculosis, or malaria. Funds are firstly and mostly needed to strengthen national health systems so that a range of diseases and health conditions can be managed effectively.”14 Guyana’s national health sector strategy notes the need “to convince our development partners (who support us with external aid) that some of the money they provide us with should no longer be earmarked for their favourite diseases, mainly HIV, but must be spent to improve our general health services so that we can handle all diseases better and according to our actual disease priorities.”15

HIV exceptionalism is dead—and the writing is on the wall for UNAIDS. Why a UN agency for HIV and not for pneumonia or diabetes, which both kill more people? UNAIDS is scurrying to reposition itself in the face of these realities and will no doubt soon join the Global Alliance for Vaccines and Immunisation (GAVI) and the Global Fund in claiming expertise in how to strengthen health systems. But continuation of a dedicated HIV organisation can only distort healthcare financing and delivery systems. UNAIDS should be closed down rapidly, not because it has performed badly given its mandate, which it has not, but because its mandate is wrong and harmful. Its technical functions should be refitted into WHO, to be balanced with those for other diseases.

Putting HIV in its place among other priorities will be resisted strongly. The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake, too many single issue NGOs (in Mozambique, 100 NGOs are devoted to HIV for every one concerned with maternal and child health),14 too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory. But until we do put HIV in its place, countries will not get the delivery systems they need, and switching $10 billion from HIV to support general health budgets would make a big difference—roughly doubling health workers’ salaries in the whole of sub-Saharan Africa, for example (or trebling them, if you don’t include South Africa).

In other words, even if scientifically illiterate officials, bureaucrats, and activists believe as consultant Roger England claims to do (we cannot help wondering if he really does), that “HIV causes 3.7% of mortality,” far too much aid is being directed at it compared with other priorities. HIV/AIDS funding looms so large in Africa that like a cancer on the system it is draining the blood from more effective spending, just as it is in the US.

All students of linguistic manoeuvers in defense of HIV/AIDS funding should read the Comments, known as Rapid Responses, that followed this remarkable outburst of realism in the British Medical Journal, which attracted the usual meaningless rote phrases in defense of the indefensible.

The BMJ honors itself in publishing this kind of editorial, and in fact has been one of the very few journals to occasionally tell it like it is in HIV/AIDS, where all coverage in normally in thrall to the censors led by Anthony Fauci of NIAID who forbid any recognition of the absurdity of the claims of the HIV paradigm promoters in AIDS and the accumulating mountain of evidence that they are quite wrong about HIV and always have been and have known it.

Clinton’s dilemma: will his AIDS charity stature vanish too?

So what will Clinton do in the wake of this kind of comment, which is only one of several recent comments along these lines in recent weeks, which are building up to a kind of retreat from HIV/AIDS gospel that threatens to leave him as naked as an adulterer surprised by detectives in a hotel bedroom in his campaign to rebuild his reputation since his Presidency by raising money for AIDS drugs in Africa?

decock.jpgToday he will come face to face with the author of the most remarkable item in the series, a report by Kevin de Cock, the head of the WHO’s department of HIV/Aids, which concludes that there will be no generalized epidemic of Aids in the heterosexual population outside Africa. You heard it right – this remarkably named UN functionary has concluded that heterosexuals outside Africa won’t get AIDS after all, panic over.

Threat of world Aids pandemic among heterosexuals is over, report admits

A 25-year health campaign was misplaced outside the continent of Africa. But the disease still kills more than all wars and conflicts

By Jeremy Laurance
The Independent, Sunday, 8 June 2008

A quarter of a century after the outbreak of Aids, the World Health Organisation (WHO) has accepted that the threat of a global heterosexual pandemic has disappeared.

In the first official admission that the universal prevention strategy promoted by the major Aids organisations may have been misdirected, Kevin de Cock, the head of the WHO’s department of HIV/Aids said there will be no generalised epidemic of Aids in the heterosexual population outside Africa.

Dr De Cock, an epidemiologist who has spent much of his career leading the battle against the disease, said understanding of the threat posed by the virus had changed. Whereas once it was seen as a risk to populations everywhere, it was now recognised that, outside sub-Saharan Africa, it was confined to high-risk groups including men who have sex with men, injecting drug users, and sex workers and their clients.

Dr De Cock said: “It is very unlikely there will be a heterosexual epidemic in other countries. Ten years ago a lot of people were saying there would be a generalised epidemic in Asia – China was the big worry with its huge population. That doesn’t look likely. But we have to be careful. As an epidemiologist it is better to describe what we can measure. There could be small outbreaks in some areas.”

In 2006, the Global Fund for HIV, Malaria and Tuberculosis, which provides 20 per cent of all funding for Aids, warned that Russia was on the cusp of a catastrophe. An estimated 1 per cent of the population was infected, mainly through injecting drug use, the same level of infection as in South Africa in 1991 where the prevalence of the infection has since risen to 25 per cent.

Dr De Cock said: “I think it is unlikely there will be extensive heterosexual spread in Russia. But clearly there will be some spread.”

Aids still kills more adults than all wars and conflicts combined, and is vastly bigger than current efforts to address it. A joint WHO/UN Aids report published this month showed that nearly three million people are now receiving anti-retroviral drugs in the developing world, but this is less than a third of the estimated 9.7 million people who need them. In all there were 33 million people living with HIV in 2007, 2.5 million people became newly infected and 2.1 million died of Aids.

Aids organisations, including the WHO, UN Aids and the Global Fund, have come under attack for inflating estimates of the number of people infected, diverting funds from other health needs such as malaria, spending it on the wrong measures such as abstinence programmes rather than condoms, and failing to build up health systems.

Dr De Cock labelled these the “four malignant arguments” undermining support for the global campaign against Aids, which still faced formidable challenges, despite the receding threat of a generalised epidemic beyond Africa.

Any revision of the threat was liable to be seized on by those who rejected HIV as the cause of the disease, or who used the disease as a weapon to stigmatise high risk groups, he said.

“Aids still remains the leading infectious disease challenge in public health. It is an acute infection but a chronic disease. It is for the very, very long haul. People are backing off, saying it is taking care of itself. It is not.”

Critics of the global Aids strategy complain that vast sums are being spent educating people about the disease who are not at risk, when a far bigger impact could be achieved by targeting high-risk groups and focusing on interventions known to work, such as circumcision, which cuts the risk of infection by 60 per cent, and reducing the number of sexual partners.

There were “elements of truth” in the criticism, Dr De Cock said. “You will not do much about Aids in London by spending the funds in schools. You need to go where transmission is occurring. It is true that countries have not always been good at that.”

But he rejected an argument put in The New York Times that only $30m (£15m) had been spent on safe water projects, far less than on Aids, despite knowledge of the risks that contaminated water pose.

“It sounds a good argument. But where is the scandal? That less than a third of Aids patients are being treated – or that we have never resolved the safe water scandal?”

One of the danger areas for the Aids strategy was among men who had sex with men. He said: ” We face a bit of a crisis [in this area]. In the industrialised world transmission of HIV among men who have sex with men is not declining and in some places has increased.

“In the developing world, it has been neglected. We have only recently started looking for it and when we look, we find it. And when we examine HIV rates we find they are high.

“It is astonishing how badly we have done with men who have sex with men. It is something that is going to have to be discussed much more rigorously.”

The biggest puzzle was what had caused heterosexual spread of the disease in sub-Saharan Africa – with infection rates exceeding 40 per cent of adults in Swaziland, the worst-affected country – but nowhere else.

“It is the question we are asked most often – why is the situation so bad in sub-Saharan Africa? It is a combination of factors – more commercial sex workers, more ulcerative sexually transmitted diseases, a young population and concurrent sexual partnerships.”

“Sexual behaviour is obviously important but it doesn’t seem to explain [all] the differences between populations. Even if the total number of sexual partners [in sub-Saharan Africa] is no greater than in the UK, there seems to be a higher frequency of overlapping sexual partnerships creating sexual networks that, from an epidemiological point of view, are more efficient at spreading infection.”

Low rates of circumcision, which is protective, and high rates of genital herpes, which causes ulcers on the genitals through which the virus can enter the body, also contributed to Africa’s heterosexual epidemic.

But the factors driving HIV were still not fully understood, he said.

“The impact of HIV is so heterogeneous. In the US , the rate of infection among men in Washington DC is well over 100 times higher than in North Dakota, the region with the lowest rate. That is in one country. How do you explain such differences?”

Nice main point, but in trying to make it consistent with the rest of his beliefs in the complex HIV/AIDS fiction, the good epidemiologist still seems somewhat confused. Perhaps someone should bring to honest Dr de Cock’s attention Nancy Padian’s study showing that transmission of “HIV positivity” through sex among heterosexuals is effectively zero.

The inability of good men in the field of AIDS to realize that all the inconsistencies vanish as soon as the basic premise that HIV is the cause is removed from their analysis is quite astonishing. Apparently the paradigm has some kind of hypnotic effect which prevents anyone ever wondering if it is true, however many absurdities it produces. Or is it simply the inability of honest men to conceive that their superiors are misleading them?

What Clinton should know

Perhaps this is the time for us to contact the embarrassed ex-President with the information we promised him on this topic, since according to this report on DNA, an Indian news site, the retreat from HIV/AIDS gospel which began with the last utter failure of the vaccine effort is now encouraging the rank heresy that HIV/AIDS promoters have been wrong all along, and led the world on a wild virus chase for twenty two years and $250 billion and counting:

Does HIV cause AIDS
Mayank Tewari
Monday, June 09, 2008 02:26 IST

A much sought-after vaccine against the virus has re-ignited an old debate.
Mayank Tiwari explores the controversy

The recently reported pessimism among researchers over the failure of an AIDS vaccine has reignited a spectacular science controversy.
Is HIV the cause of AIDS?

Last September, AIDS researchers were dealt a heavy blow when clinical trials of the most promising candidate for an HIV vaccine were stopped after it turned out to be a dud.

The clinical trials showed that the vaccine might have put the people who received it at greater risk of infection rather than preventing HIV or reducing its effect. A survey of top AIDS scientists conducted by The Independent showed most believed a vaccine was nowhere near, with some even believing that effective immunization against HIV may never be possible.

“Nearly a billion dollars is spent globally on AIDS research annually, and yet the sobering reality is that at present there are no promising candidates for an HIV vaccine,” wrote Harvard Medical School’s Bruce Walker in the journal Science, summing up the failure of the expensive effort.

The development has strengthened the position of a vocal minority of scientists who argue that HIV is a harmless passenger virus (found in diseased tissue, but not contributing to the cause of the disease).

This community of scientists includes Peter Duesberg, professor of molecular and cell biology at the University of California, Berkeley, David Rasnick, a prominent American biochemist, and Nobel laureate Kary Mullis, another American biochemist, and enjoys the support of South African President Thabo Mbeki. They have from the very beginning of the AIDS era—supposed to be 1984 when US biomedical researcher Robert Gallo published a series of papers arguing that HIV was the cause of AIDS—questioned the “causal link” between the virus and the disease.

Other developments, too, have strengthened the position of the AIDS dissidents. Among these are: periodic revisions of the number of people suffering from AIDS; the demographic factor, which is against the nature of infectious viruses to spread regardless of identity clusters; and AIDS symptoms like tuberculosis and cancer being common results of lifestyle conditions.

Duesberg even says that it is AIDS drugs, such as AZT, that cause the disease owing to their high toxicity. The dissenters also cite data showing HIV+ individuals tend to get AIDS when they take AZT and get better if they stop taking the drug.

Among the main reasons dissenters cite in favour of their movement is skewed health funding, especially in developing countries. On May 10, the British Medical Journal carried an article calling for UNAIDS to be shut down as it distorts health funding. In it, Roger England, who heads a Grenada-based think tank, Health Systems Workshop, argued that too much is being spent on HIV compared to other diseases which kill more people.

“It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems. Although HIV causes 3.7% of mortality, it receives 25% of international healthcare aid and a big chunk of domestic expenditure. HIV aid often exceeds total domestic health budgets themselves.”

Purushottam Muloli, a New Delhi-based member of Rethinking AIDS, a loose group of scientists and policy makers who do not agree with the prevalent HIV/AIDS theory, says he has been questioning the Indian health ministry and UNAIDS about the scientific evidence behind labelling sections of the population, such as homosexuals, high-risk
groups.

“The health policy of the country is being controlled by international donors. Can you believe that the entire health budget of India is less than the amount of international funding the country receives on HIV?”

Rethinking AIDS president David Crowe says the AIDS “dogma” persists because doctors are trained to obey their superiors. “There are many examples of bad medical advice becoming dogma due to the power of senior medical people. The dogma of AIDS has resulted in hopelessness and despair caused by the stigma of HIV+ status. ”

The view from India

gatess-wave-beside-aids-ribbon.jpg
With AIDS funding enormous, there is a disincentive to quarrel with its rationale. As the man says, “The health policy of the country is being controlled by international donors. Can you believe that the entire health budget of India is less than the amount of international funding the country receives on HIV?”

India, of course, is where the Academy of Science published the last definitive broadside against the belief that HIV causes AIDS by Peter Duesberg, the only competent and distinguished scientist to examine this topic thoroughly at the peer reviewed level. Like his other masterworks demolishing the HIV/AIDS paradigm in every respect, it has gone uncontested at the same level in that journal or elsewhere.

With Duesberg awarded the Semmelweiss Clean Hands award last month in Washington for his honorable public service and integrity in this matter (see below), perhaps this is what allowed the Indian correspondent to learn more about true facts of this lethally twisted global scientific paradigm.

But since Clinton is probably in need of a fuller briefing on the topic, we will contact him as soon as events allow, now that the enormous distraction of Hillary’s brave but ill fated campaign is over.

We predict he will go along with the steady trend in the field of global disease and move away from HIV/AIDS to the real killers, on which the Gates’s alone have spent hundreds of millions already.

If he doesn’t he will become known as the man who delivered useless and harmful drugs to
Africans at a cost of hundreds of millions of wasted dollars, at a time when any schoolkids who buy $10 nets to protect African babies from malaria will be doing more to save lives.


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