Stigma and HIV

While Lindsay give the quote of the night to Bill Gates and much of the coverage in the press this morning focuses on his talk of microbicides, his wife Melinda spent much of her time discussing the stigma that comes with being diagnosed with HIV. She discussed how political figures won't accompany her when she goes out to discuss the virus with sex workers, and how many women in AIDS hospices have been abandoned even by their own families.

Stigma makes it easier for political leaders to stand in the way of saving lives....This is a serious obstacle to ending AIDS. In the fight against AIDS, condoms save lives. If you oppose the distribution of condoms, something is more important to you than saving lives.

Some people believe that condoms encourage sexual activity, so they want to make them less available. But withholding condoms does not mean fewer people have sex; it means fewer people have safe sex, and more people die.

She emphasized that sex workers play a key role in the epidemiology of the disease, and that they should be our allies. But standing side by side with a sex worker certainly isn't the image many politicians want to project. Gates suggests:

(Continued at AIDS at 25)

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We're living in a crazy world and this is absolutely astonishing.
The scientific community kicks out eminent scientists like Peter Duesberg and Kary Mullis, because they have ideas that don't fit comfortably.
The scientific community treats reasonable but critical people as ignorant fools and denier dummies who have no right to talk because they have no professional authority.
Only to haul back in people without any medical authority at all but with big money to spend.
Why do you care about what the Gates think that should be done to stop AIDS? According to your standards they are completely ignorant! Why don't you just say thanks to the money and make them shut up?

Please cite where I've ever said anything along the lines that, because the Gates' (or anyone) lacks a scientific degree, they should "shut up." Quite the contrary, I've written previously on arguments from authority and said:

Scientists--even highly degreed ones--can be very wrong, especially when they stray outside their area of expertise...But, that doesn't mean they should be dismissed simply because they lack degrees, either, as Janet mentioned. Indeed, several contributors to The Panda's Thumb (such as Ed) have no formal training in evolutionary biology--they've taken the time to learn about the arguments on their own, and know as much as (or more than!) many biologists about creationism and intelligent design.

I don't take anyone's word simply *because* they have a degree, nor do I dismiss it because someone lacks it. It's the evidence that counts; I don't care if Melinda Gates or the ghost of Albert Einstein explains it.

Tara, you know its far easier to post about evil conspiracies of the "scientific community" than to actually do the reading. Stop being a spoilsport.

More on topic, it's good to see someone addressing it. Even now, with the AIDS crisis very old news, people (and politicians) tend to squirm around the more uncomfortable parts of the topic when it comes to sex, sex workers and gays. It's good that someone is at least trying to force them to look it squarely in the eyes.

These irrelevant pontifications about prostitutes and AIDS cases only evoke more yawns and shoulder shrugs.

Heterosexual female prostitutes are at risk for developing AIDS only if they are plying their sex worker trade for the specific purpose of getting the money necessary to feed an IV drug habit.

Those prostitutes are harming themselves not by having (evidently) massive amounts of condomless sex but by shooting up with or otherwise indulging in psychoactive, usually dangerous street drugs with the money they get from performing all manner of sex acts.

In that regard, their AIDS cases are statistically similar to college aged heterosexual females (who number 6-7 million) who take charge of their own birth control devices, dare not leave it to men to use condoms, engage in all manner of heterosexual activities, yet continue to record a vanishingly tiny number of AIDS cases.

Regarding the risk of drug use versus HIV status:

In a study by van Haastrecht et al. in the american journal of epidemiology (1996) risk of mortality was compared between non-injecting drug users, HIV- injecting drug users, and hiv+ injecting drug users. They found a mortality rate per 1,000 person-years of 7 for HIV-negative noninjection drug users, 18 for HIV-negative injection drug users, and 64 for HIV-positive injection drug users.

Obviously, injecting drug use carries with it an array of increased risks, but HIV+ status increases the risk of mortality significantly, even when compared to HIV- IV drug users.

howell.

You say it is an obvious inference that drug use carries with it an array of increased mortality, and I absolutely agree. However, one must always be careful with assumptions, as one is not always looking at the "bigger picture". Your deduction that:

HIV+ status increases the risk of mortality significantly, even when compared to HIV- IV drug users.

is leaving out the absolute probability of other factors being involved. One could easily understand that the HIV positive cohort is also additionally taking many very toxic LEGAL drugs for the treatment of HIV, with the well documented mortality that is not uncommon with the use of these drugs, let alone in combination with many of the illicit drugs.

And this perhaps is not the only factor. Another factor to consider would be the amount of antibiotics used by the hiv positive cohort, leading to further de-stabilization of intestinal flora, increased yeast infections, further drugs to treat these, as well as treatment for the side effects of all of the above.

And lets also mix one more factor, not so easy to measure, and that is the stress, and ensuing hopelessness of one who is given a diagnosis of HIV. Certainly they have an increased expectation of imminent death and all of the associated lowering of immunity that is common to those whom are stuck in a foxhole with bombs dropping around them. Stress is a well known, though impossible to measure factor, in the health of an immune system.

> And lets also mix one more factor, not so easy to
> measure, and that is the stress, and ensuing
> hopelessness of one who is given a diagnosis of HIV.

Not so easy to measure, but the researcher in question has considered this. They looked at the risk of overdose and suicide after recieving a positive diagnosis versus the total population of injecting drug users & found no increase.

W/R/T the influence of antiretroviral therapy- injecting drug users are unfortunatly a good example of this, due to the low levels of adherance to therapy. Patients who report taking their retrovirals show lower mortality than those who do not.