HIV, Aids etc

Yesterday I went to a day-long seminar on HIV and Aids.

It was organised by the HIV Clinicians Society, and it was intended for HIV clinicans and religious leaders, and there were a couple of hundred people there. I won't try to summarise the proceedings, but a few points might be worth mentioning.

The first speaker was Clem Sunter, who is a motivational goal-setting bloke, and had just returned from helping the Chinese to beef up their economy. So he was dealing with the question of why it was necessary to have such a seminar. One of the questions he asks in these exercises is "What has changed in the last 5-10 years, and what hasn't changed?" And in this case he noted the following:

• People are dying. The death rate, especially among people aged 25-35, has risen dramatically.
  
• More people are infected
  
• There are more players in the game, including the government
  
• There have been advances in drugs, including triple-drug therapy
  
• There is little change in prevention
  

Professor Des Martin spoke on transmission and testing, from the clinical point of view -- what is known about how HIV is transmitted, the progression of the disease, and advances in testing. Professor Rachel Jewkes spoke on transmission from an epidemiological point of view. Zackie Achmat, the flamboyant Aids activist, gave another motivational presentation from a somewhat different point of view. And so it went.

Speaking for myself, I found it useful to catch up. Some things had not changed -- there seems to be little known about transmission that was not known 5-10 years ago. What has changed quite dramatically is methods of treatment. Dr Leon Levin, a paediatrician, spoke on treatment of children with HIV/Aids. Most of the children with HIV infection would die in 4-8 years if untreated. Many people asked if there was therefore any point in treating such children, if they were going to die anyway. He said that in his clinical practice he had seen dramatic improvement in the health and quality of life of children after treatment.

All the medical speakers emphasised this point. There is no cure for Aids, just as there is no cure for diabetes, or high blood pressure or heart disease. Those who have the disease will have to continue treatment for life. If they stop their medication, the disease will return, and they will die. But the record of treatment for HIV/Aids is much better than that for other chronic diseases. It is more effective than the drugs used for treating heart disease, blood pressure etc.

I found the most useful part of the seminar the factual and scientific information given. When it got on to the role of religious groups, it tended to get fuzzy. Trying to say things that are acceptable or applicable or all religious groups tends to make those things vague and ineffectual. It might be better to disseminate the facts, and then let each religious group to work out for itself how it will interpret and apply the facts.

But there are some questions that one can ask about Aids and its social impact.

One was highlighted the very next day, when there was a news report about a doctor who was facing disciplinary action from a medical body for listing Aids as a cause of death on a death certificate, on the grounds that this was an invasion of the privacy of the patients, and threatened the confidentiality of the doctor-patient relationship.

That seems a strange kind of reasoning, as surely the same would apply to any other cause of death. If it is such a threat to privacy and patient confidentiality, then surely no causes of death should be recorded on any death certificates at all.

There are several good reasons for recording the cause of death on death certificates: to see if death was caused by foul play, to see what is statistically responsible for most deaths, which can guide efforts aimed at prevention or cure -- should we concentrate our efforts on reducing deaths from road accidents, or snake bites, for example. Which kills more people -- shark bites or mosquito bites?

The other thing is that at this Aids seminar, and in many other similar seminars, people have urged that the stigma must be removed from Aids. But surely keeping it off death certificates is one thing that perpetuates the stigma. When medical people speak with two voices, one urging the removal of the stigma, and the other urging its retention, to the extent of prosecuting those who list it as a cause of death, there will never be concerted action against this epidemic.