First, a note of caution: Normally, my posts are about life in Thailand, interesting news articles, random thoughts of the day, pictures from traveling far and wide. I try not to be political or post about things that are super controversial. But, it's World AIDS Day, so here are (some) of my opinions and experiences as life as an HIV researcher.
In honor of World AIDS Day 2010, I thought I'd share some of the interesting (and disturbing) reactions from people when I tell them what I do. As you know, I am an ASPH/CDC global health fellow working with the HIV Research Branch with the Thai Ministry of Public Health - U.S. Centers for Disease Control and Prevention in Nonthaburi, Thailand. The branch is currently conducting studies among injection drug users (IDUs) and men who have sex with men (MSM). I work with the group studying behaviors and HIV among MSM in Bangkok. This, however, is quite a mouthful and I tend to summarize by saying I work in HIV research. So with this in mind, the reactions:
- "I hope you're not one of those people who think HIV is just in gay men." No, I'm not. Anyone CAN get infected with HIV. In Thailand, however, if you are a man who has sex with another man, you're much more likely to have HIV or to get HIV then if you're someone else. I'm not judging... I'm just saying, based on surveillance and monitoring the HIV epidemic in Thailand, this is true. This doesn't mean that MSM should be treated differently or unfairly. It actually means that, as a public health professional, I think Thailand should develop programs to prevent HIV in MSM and I think Thailand should provide support to people who have HIV. And, they are starting to. And, based on their 100% condom program, they might have success. I certainly hope so.
- "Hmm, should I wear a condom?" Well, yes. Using condoms consistently and correctly is one of the most effective ways at preventing HIV infection. But, really, I'm not a counselor, nor do I appreciate having this conversation on an airplane. (Actually, the question I got from my plane seat neighbor was more disturbing.) There are some other ways to prevent HIV that are currently being researched that are looking more promising:
- Microbicides - see the CAPRISA 004 study - They demonstrated that a microbicide used by women in South Africa can decrease HIV transmission by up to 40%.
- PrEP (Pre-Exposure Prophylaxis) - see the iPrEX study results - They demonstrated that a drug combination (Tenofovir and emtriciticine) used daily can decrease HIV transmission by about 40% (and almost 80% in those who were very adherent) in men who have sex with men in Peru, Ecuador, Brazil, United States, South Africa, and Thailand.
- HIV vaccine - see the Thailand Vaccine Study - This was the first study that showed a vaccine had any effect in preventing HIV infections.
- Blank stare. "Oh that's interesting." Averted eyes. Quickly change the conversation... These people tend to be, shall we say, more conservative than others. Sometimes, they think HIV is a disease that bad people get and that people who get HIV deserve to get it. In my opinion, that's bogus. No one deserves to get a life-threatening illness. What if I said your children deserve to get diabetes because they eat too much over-processed sugars. Both can be life-threatening illnesses that require life-long treatment. Diabetes isn't heavily politicized though and people with diabetes are rarely stigmatized. Diabetes programs aren't limited by politicians in providing evidence-based prevention and treatment programs. No one says, "Hey, I think we should pay for people who have diabetes to get insulin because I don't like needles." But it happens quite frequently in HIV programs. Here are just a few examples:
- Programs must spend a significant portion of their budget on abstinence education. Yes, I agree, abstinence is a great way of preventing the spread of HIV. But, it doesn't work by itself. Here's a pretty comprehensive review.
- Programs cannot set up clean-needle programs for drug injectors. Look, I understand the train-of-thought: Take away access to needles and drug injectors can't inject so they can't do drugs so they can't get HIV. But that doesn't work either. Providing clean needles doesn't make injectors use drugs more often, but it can link they with treatment programs, education, and improved awareness. More information
- Programs are limited in how they can promote condoms. There are a few lines of thinking that limit condom-promotion: 1) Condoms are a form of birth-control, which is prohibited by the Catholic church; 2) Condoms lead to promiscuity because if young people have condoms, they will have sex earlier or more often. I'm not going to address the first point (except by linking you to this article by the BBC on the Pontiff's latest remarks of condom use). The second point, however, is a bit absurd. It's along the same lines as the opposition to giving girls the HPV vaccine - if we give them the vaccine, they'll have sex earlier or more often. Really? Do you really thinking giving a girl a vaccine that can prevent a disease they may or may not get in 40 or more years will really prevent her from having sex now? Do you really think not giving a boy a condom now will prevent him from having sex now? Will all those thoughts of potential pregnancy (9 months from now) or potential for sexually transmitted diseases (which may or may not effect his health a few days to a few years from now) will prevent that? I think you're probably deluding yourself. Young people will have sex, regardless of the information or tools you provide them. So why not provide them with the best education and the best tools to prevent harmful consequences? Anyway, that's what I think.
And finally, some news from other sources on World AIDS Day 2010:
Nice post Ksmcca. Thanks for all the info and sharing your experience :-)
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