Wednesday, 7 March 2012

treating HIV: did antibiotic misuse teach us nothing?

learn more about HIV at hivaware.org.ukWith pitched battles surrounding the NHS reforms as interest-groups protect their own, issues inevitably pass under the radar. Whether by accident or design, one of these is plans to give foreigners free treatment for HIV.

This seems uncontroversial, as foreigners (eg asylum seekers) can at present receive free treatment for other infectious diseases, for example TB.

What is worrying is that the latest thinking about treating HIV is to prevent contraction with what’s known as PREP (Pre-Exposure Prophylaxis). This involves prescribing anti-retroviral medication to people who are at risk of developing HIV but don’t yet have it.

Let’s backtrack to the last century, when antibiotics were appallingly overprescribed and sometimes prescribed with no medical justification, eg over the course of the winter for frail but otherwise healthy people (ie prophylactically). We now inherit "an unthinkable scenario of untreatable [bacterial] infections" such as E. Coli, gonorrhoea and the aforementioned TB.

Viruses evolve resistance to medications just like bacteria. PREP can be very effective if – crucially – there’s a high adherence rate to the prescribed regime. If not – and would you adhere to an antibiotic regime if you had no illness? – it is ineffective, and can unleash a strain of the virus immune to the antiretroviral used.

People from Sub Saharan Africa are particularly susceptible to HIV; not because of ethnicity or colour, but lifestyle. There’s the practice of female genital mutilation, for one thing, and also the egregious "virgin myth", the belief that sex with a virgin – often regardless of age or consent – will cure a man of HIV.

All very upsetting; but our Government should not squander disappearing resources on policies that can make bad situations worse. A government’s first duty is to look after its own – a principle that, if practiced internationally, would greatly reduce the world's burden of misery.

Gerry Dorrian
(former Blood Borne Viruses Worker)
300 words

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