Stuart Rennie blogs: In his 2004 book The Invisible People, Greg Behrman recounts how over the last twenty years the response of successive US administrations to the global AIDS pandemic has been hampered by denial, complacency, negligence, bureaucracy, political conflicts between and within government agencies, passive racism and much, much more.
This week, the Bush administration is supplying Mr. Behrman with material for The Invisible People II. Two news items expose how the administration is supporting AIDS policies likely to increase HIV transmission in developing countries. The editorial of last Sundays Washington Post, entitled Deadly Ignorance, shows how the government is opposing the distribution of uncontaminated needles to drug addicts in federally funded AIDS programs in other countries. The policy flies in the face of a large body of scientific evidence indicating that the free provision of clean needles slows the spread of HIV among injection drug users without increasing rates of addiction. But this has hasnt stopped administration officials from trawling through the wilds of PUBMED and MEDSCAPE, looking for any needle-exchange study which might, with some shoehorning, support their position.
The pursuit of this policy could have devastating consequences in Eastern Europe, Russia, China and South East Asia. Injection drug use is at the heart of the epidemic in Eastern Europe and Russia, and accounts for nearly half of new infections in Malaysia, China, Vietnam and Ukraine. As the editorial notes, once a critical mass of users carry the virus, the epidemic spreads via unprotected sex to non-drug users. As the editorial does not note, injection drug use is rapidly increasing in Africa[ ], where the transmission of HIV has traditionally been via unprotected heterosexual sex.
The Kaiser Daily HIV/AIDS Report of February 28[ ] describes the Bush administrations new requirement that US-based HIV/AIDS organizations seeking funding to provide services in other countries must make a pledge (with their right hand on the oh never mind) opposing commercial sex work. Denying funding to organizations providing HIV/AIDS education and condoms in brothels and bars will not help narrow this conduit of HIV transmission. This policy may do more than just make sex workers and their clients invisible; it could make them literally disappear.
But these policies are less about global public health and the best science, and more about moral values. They send a message: junkies and whores all over the world must behave or die. Few of the fervent supporters of the present administration may own a passport, and fewer still may know the capital of Burundi, but their moral sentiments have global impact. – Stuart