Editorial V

Virological Time Bomb

Nations typically deal with the African AIDS epidemic like such: throw money at it, get some good publicity for your dedicated philanthropy, and ignore the fundamental causes. While foreign aid may not be solving the problem, surely it helps. Doesn’t it?

It seems the unmonitored and irresponsible application of antiretroviral treatments is creating new drug-resistant strains of HIV (Financial Times). This development is especially alarming at a time when the economic crisis will surely curtail the development of new treatments to combat HIV, particularly new strains.

At the risk of being an alarmist, understand that this is more than just a humanitarian concern. Should this negligence continue, there exists the realistic possibility of a resistant strain making its way over here. We already learned with the SARS outbreak of 2002-2003, when the disease spread to 37 countries from Guangdong province in China, just how easily viruses could travel in globalized world.

Whether or not this problem will be addressed in a significant way remains to be seen. Countries doling out aid do not want to hear that their efforts are counter-productive. Just to reiterate, no one advocates cutting aid off. After all, “it's better to be alive with drug-resistant virus than dead with drug-sensitive virus.” As one doctor counters however, “resistance is an entirely predictable end-point. If it starts to spin out of control, it's going to be difficult to get a handle on."

This is a problem of state-capacity. Effective monitoring is a laborious undertaking, certainly more arduous than the unregulated allotment of treatment, some of it in bastardized forms. Recommended solutions for this growing problem include:

a) “tougher international scrutiny of plants that produce HIV medicines and an assurance for countries buying them that quality is consistent.”
b) “innovative medical (programs) to boost drug adherence in poor countries.”
c) “a shift in the treatments used…a switch directly to make current second-line therapies into the first-line option.”

One other point, about a separate matter: In Veracruz, Mexico, where HIV/AIDS mortality rates are the highest of anywhere in the country, sex education is advocated as a combative tool by many of the local outreach programs. Unfortunately, ideological opponents of sex-ed have made sure this weapon against AIDS remains shelved in the arsenal. If ever there was a time to be practical about these matters, it is now.

Below is a fascinating presentation on the formation of resistant HIV strains.