World Aids Day 2005

With great fanfare, visits from a king and a president (of a university), the HIV clinic where JoAnna will work is opened. (Link).

Exciting, a little bit frightening. They will dispense first-line antiretroviral drugs to children, which can all but nullify the effects of HIV, making a normal life possible.

Exciting, because until recently these have been unavailable, especially to the poor. There are still not near enough drugs for the 30% or so of the population that is estimated to have HIV.

Frightening, because drug resistance develops very rapidly, and the first line drugs are the only ones available at a reasonable cost. If resistance to these develops, it will again only be the rich who can afford treatment.

It's not cold medicine - these drugs must be taken according to the prescribed regimen - if you miss one pill out of 30, that can be enough for the virus to adapt and develop resistance.

I think I would have a hard time remembering to take my medicine twice a day for the rest of my life. (Especially if my tooth brushing frequency is any indication). Now how about a 6-year-old orphan, cared for by different people at different times of the year? Not to mention the huge stigma associated with HIV, which means it can feel a little bit socially awkward to be popping the pills when you're in a public place. And it's tough to take a medicine that has side effects, when you feel just fine. And no thanks to the quacks on South African radio arguing that the drugs are an experiment pushed by American pharmaceutical companies, and instead of taking them, you should try their herbal remedies. Consider this little tidbit:

Swaziland, which has one of the highest adult HIV infection rates in the world at some 40 percent, scrapped World AIDS Day events entirely while South Africa's health minister repeated her much criticized prescription of garlic and beetroot as an AIDS treatment. (Link)

It seems like it would easy to miss a dose or two, doesn't it?

The best answer we have is counseling, so every time the patients come in, they sit down with a social worker or a nurse, who talks to them for half an hour about the importance of sticking to the plan. They bring back the pill bottle for the refill, so the pharmacist is supposed to check that the right number of pills are left, and have a talk with the patient if they aren't.

Is it enough? Maybe. Unfortunately, few HIV clinics keep good enough records to know if we're giving people life or just spreading resistance. I'm hoping to help JoAnna gather enough data in her time here to be able to tell whether this is actually working, or something needs to change. If we can convince people we're not selling their medical data to the big, bad pharma.