... Oh, dear.
More than 20 years after the AIDS epidemic arrived in the United States, a significant proportion of African Americans embrace the theory that government scientists created the disease to control or wipe out their communities, according to a study released today by Rand Corp. and Oregon State University. That belief markedly hurts efforts to prevent the spread of the disease among black Americans, the study's authors and activists said. African Americans represent 13 percent of the U.S. population, according to Census Bureau figures, yet they account for 50 percent of new HIV infections in the nation, according to the Centers for Disease Control and Prevention.
Nearly half of the 500 African Americans surveyed said that HIV, the virus that causes AIDS, is man-made. The study, which was supported by the National Institute of Child Health and Human Development, appears in the Feb. 1 edition of the Journal of Acquired Immune Deficiency Syndromes.
More than one-quarter said they believed that AIDS was produced in a government laboratory, and 12 percent believed it was created and spread by the CIA.
A slight majority said they believe that a cure for AIDS is being withheld from the poor. Forty-four percent said people who take the new medicines for HIV are government guinea pigs, and 15 percent said AIDS is a form of genocide against black people.
You know ... there's just no way these beliefs aren't a multilevel indictment against government at all levels -- federal, state, county, and local. Clearly, for example, education about AIDS is signally failing to reach people most in need of that information. That can only be seen as a failure of local and state governments.
At the same time, the belief in government conspiracies is not entirely unfounded, historically. Given that the Tuskeegee experment ended only in 1972, there are still probably quite a few people alive who were directly affected by those experiments, who were seriously damaged by how the federal government behaved at that time. For all that it was 40 years ago, many people who were in their teens, twenties, thirties at that time will still be alive and will still have vivid memories.
All that said ... the organizations and people putting out prevention information aren't all governmental. Even if there was a conspiracy, what would it hurt anyone to use those prevention methods -- to use condoms, to use clean needles? At worst, if there is a conspiracy, then no, it really wouldn't make any difference. At best, without a conspiracy, you're still far less likely to catch the disease, right? Either way, abdicating personal responsibility to conspiracy theory is just plain stupid.
Elsewhere, apparently the government -- conspiracy ridden or otherwise -- is finally moving to recommend prophylactic AIDS treatment for rape victims:
U.S. Recommends AIDS Drug Regimen for Rape Victims
ATLANTA, Jan. 20 -- The government recommended for the first time Thursday that people exposed to the AIDS virus from rapes, accidents or occasional drug use or unsafe sex receive drug cocktails that can keep them from becoming infected.
Previously, federal health officials recommended emergency drug treatment only for health care workers accidentally stuck with a needle, splashed in the eye with blood, or exposed in some other way on the job. That recommendation was first made in 1996. [...] It is a shift away from a policy that some doctors had called unconscionable and that put the United States years behind much of Europe and other nations....
Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services
MMWR Morbidity and Mortality Weekly Reports
Recommendations and Reports
January 21, 2005 / 54(RR02);1-20
The most effective means of preventing human immunodeficiency virus (HIV) infection is preventing exposure. The provision of antiretroviral drugs to prevent HIV infection after unanticipated sexual or injection-drug--use exposure might be beneficial. The U.S. Department of Health and Human Services (DHHS) Working Group on Nonoccupational Postexposure Prophylaxis (nPEP) made the following recommendations for the United States. For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission, a 28-day course of highly active antiretroviral therapy (HAART) is recommended. Antiretroviral medications should be initiated as soon as possible after exposure. For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person of unknown HIV status, when such exposure would represent a substantial risk for transmission if the source were HIV infected, no recommendations are made for the use of nPEP. Clinicians should evaluate risks and benefits of nPEP on a case-by-case basis. For persons with exposure histories that represent no substantial risk for HIV transmission or who seek care >72 hours after exposure, DHHS does not recommend the use of nPEP. Clinicians might consider prescribing nPEP for exposures conferring a serious risk for transmission, even if the person seeks care >72 hours after exposure if, in their judgment, the diminished potential benefit of nPEP outweighs the risks for transmission and adverse events. For all exposures, other health risks resulting from the exposure should be considered and prophylaxis administered when indicated. Risk-reduction counseling and indicated intervention services should be provided to reduce the risk for recurrent exposures. [...] In a study of sexual assault survivors in Sao Paolo, Brazil, women who sought care within 72 hours after exposure were treated for 28 days with either zidovudine and lamivudine (for those without mucosal trauma) or zidovudine, lamivudine, and indinavir (for those with mucosal trauma or those subjected to unprotected anal sex) for 28 days. Women were not treated if they sought care >72 hours after assault, if the assailant was HIV-negative, or if a condom was used and no mucosal trauma was seen. Of 180 women treated, none seroconverted. Of 145 women not treated, four (2.7%) seroconverted (25). Although these studies demonstrate that nPEP might reduce the risk for infection after sexual HIV exposures, participants were not randomly assigned, and sample sizes were too small for statistically significant conclusions.
In a study of rape survivors in South Africa, of 480 initially seronegative survivors begun on zidovudine and lamivudine and followed up for at least 6 weeks, one woman seroconverted. She had started taking medications 96 hours after the assault. An additional woman, who sought treatment 12 days after assault, was seronegative at that time but not offered nPEP. At retesting 6 weeks after the assault, she had seroconverted and had a positive polymerase chain reaction result (Personal communication, A. Wulfsohn, MD, Sunninghill Hospital, Gauteng, South Africa).
Of course, since this does not constitute a recommendation that such treatment be covered through Medicare or Medicaid, then poor and elderly rape victims are dependent on the kindness of the emergency room ... and even then, most emergency rooms are unlikely to stock 30-day treatment courses; that's not what they're for, after all. And big city emergency rooms, at least, could never stock a 30-day course in quantities great enough. Maybe they'll have enough supplies to give people a two, three day series of treatments until they can get to their doctor, but then, how many of the poor and elderly will have a doctor to get to? And even if they do, how will they afford the prescription?
Still, for those people who do have some form of health care insurance, this is at least something. Since most private health care plans treat HIV/AIDS in and of itself, they're likely to see the benefits in spending once for a 30-day course of treatment, which will keep them from spending more and more for lifetime treatment of those who do seroconvert.
Posted by iain at January 25, 2005 03:22 PM
