Clinton’s HIV-Free Generation Delusion

Clinton got a lot of attention by claiming that an AIDS-free generation is now possible. She claims this on the basis of fairly flimsy reasoning. Firstly, the best way of preventing mother to child HIV transmission is to ensure that mothers do not get infected. Blindingly obvious as that may sound, until that is made a priority, there will be no AIDS-free generation.

The facts that HIV can be transmitted sexually and that pregnant women have almost certainly been engaging in unprotected sex does not mean that HIV positive pregnant women, and those who have recently given birth, were necessarily infected sexually. If their sexual partner was also tested, it would be found that many of them are HIV negative. But partners are not routinely tested.

Instead, it is assumed that if a woman is infected with HIV, either her partner infected her or she has other partners, one of whom infected her. The fact that she insists otherwise is not generally taken into consideration. It is implied that African women, the biggest HIV positive group in the world by a long shot, generally lie.

Clinton also grabs at mass male circumcision, another highly questionable HIV prevention intervention. Even some HIV politbureau approved sources have shown that the evidence is not conclusive, that while in a number of countries HIV prevalence appears to be higher among uncircumcised men, in others prevalence is lower. In addition, while male circumcision is said to reduce transmission from females to males, it has also been suggested that it increases transmission from males to females.

The third intervention Clinton mentions, because these things so often come in threes, is scaling up treatment for people living with HIV. She may remember the ‘three by five’ initiative, the aim to get three million people on antiretroviral treatment (ART) by the year 2005? It took longer than expected. And six years later, the figure is still a long way from being doubled, at about five million.

One of the reasons why less than one third of the estimated 15 million people in need of ART receive it is because they are so incredibly expensive. Clinton makes a big thing of mentioning her husband’s foundation, which has orchestrated very well publicized ‘reductions’ in drug prices. But those reductions were from levels unaffordable anywhere to levels unaffordable in the countries where the majority of HIV positive people live.

In fact, countries with high HIV prevalence are not even able to guarantee an adequate supply of drugs to those on treatment, often only 20-25% of those in need. Many countries regularly run out of testing kits and other supplies. And as for anything beyond pharmaceuticals, because they are a profitable business, forget it. People without enough food or clean water are often more likely to to get HIV drugs than any other form of treatment. So they die of all sorts of things, just not headline diseases.

Combining these interventions, even by including many others, will have little impact on the worst epidemics until non-sexual drivers of the virus have been identified, investigated and eliminated. But Clinton made no mention of things like unsafe healthcare or cosmetic services. And why would she? Mention of such matters is not politbureau approved.

Far from ushering in a HIV-free generation, the big players in the HIV industry have been keeping things ticking over nicely for years, and reaping ever-increasing profits. Given Clinton’s remarks (and her husband’s machinations), this is likely to continue for the foreseeable.