Harm reduction, AIDS, and wildly different takes on reality

The AIDS conference in Vienna just rejected a resolution calling for harm reduction for injection drug users despite this being a proven good strategy.  Most nations ignored it, with only one supporting it.  Only one openly rejected it (hint: it starts with ‘C’ and borders the arctic).

But here is the really interesting thing:  The great triumph announced at the conference is the invention of a vaginal gel that seems to reduce HIV transmission by about half.  The reason that a method with such limited effectiveness is even needed is that because in many of the places with the worst epidemics, many men refuse to use condoms (which are much more effective), even if their partners want them to.  So here we have a advocacy community that is fatalistic about getting people to use condoms to prevent rapid death at an early age, but they are not willing to embrace needle exchanges.

But at least they are half reality-based, which makes them more realistic than those who think we can eliminate smoking without THR.  The AIDS activists recognize that people will just not do what they are told because rich or powerful people say it is best.  If people will not even choose condoms, how sensible is it to assume that they will choose to become abstinent from nicotine.  And remember, THR is not just about people rich enough to afford pharmaceuticals and counseling services.  There are and will be hundreds of millions of people smoking in the same places where they are at highest risk for AIDS.

 

– Carl V. Phillips

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Comments

  • Elaine Keller  On July 23, 2010 at 12:18 pm

    The thing I found interesting in the report about the gel was a comment that it is only 60% effectivce at preventing HIV infection, and the FDA would likely not approve it unless it is 80% effective. Why then, did the FDA approve NRTs that in the short-term clinical trials were showing, at best a 10% cessation rate at 24 weeks?

    And the medical community has the nerve to characterize NRTs as “effective”. By what measure?

  • Carl V Phillips  On July 23, 2010 at 7:30 pm

    Elaine,

    I am not sure what report made that declaration. I cannot imagine that FDA would refuse to approve something that reduced risk of HIV by half (that 60% you cite seems to overstate the data, btw) unless it crowded out something better. Condom use is better, so it would be important to make sure it was not marketed as a good substitute for condoms. Both would be better still, though probably rather extreme on spec though maybe reasonable for a known HIV+ man with a HIV- woman.

    As for anti-smoking meds, they are grasping at any straw they can find, so they accept a minuscule benefit. Of course, the aggressive marketing of those meds portrays them as a superior substitute for harm reduction, even though the opposite is true (see my article: http://www.harmreductionjournal.com/content/6/1/29), so therein lies the real problem.

    –Carl

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