The HIV Pandemic: Local and Global Implications

"It should be recognized that an integrated approach is needed; no single intervention operating in isolation is likely to have a significant impact on HIV incidence in a population. What works today may not work tomorrow." - Strathdee et al (page 67)

Editors: Eduard J. Beck, Nicholas Mays, Alan W. Whiteside, José M. Zuniga

I found this week's readings absolutely fascinating. It was dry and mostly based on facts, figures and statistics, but it was information I needed to know and had never encountered before. This was a change from Treichler's theory based text but also a natural next step. The knowledge I gained from last week's readings allowed me to critically evaluate the implications of the information presented in The HIV Pandemic: Local and Global Implications.

For example, I noticed that the text engaged with women as a group only as they related to the topic of mother to child transmission of the disease, which is a trend Treichler mentioned in her text. But while most of the section was focused on treatment of men who have sex with men, it was very good at acknowledging other groups and highlighting the differences in treatment options that exist within different populations both within a country and in other countries in the world.

What especially interested me in this text was the first chapter on prevention programs. Strathdee et al. outline three levels of intervention in the chapter: individual, group and community. While reading the section I began to consider how these intervention methods might apply to my group of interest, black women. The authors describe why each level may or may not be affective within a particular population. They conclude that community level interventions are the most effective based on studies involving men who have sex with men. While reading the descriptions of the different methods I found myself thinking that the community level would also be the most effective with black women in Canada because of the challenges of sustainability of the other two because of costs and the pressure on resources. Given the programs that currently exist in Ontario that target black women as a group, I have to conclude that others have agreed with me as they are primarily community level initiatives.

Other elements of the text were quite challenging to get through. Parts of it felt as if I had been transported to a university level chemistry course except that I didn't have any of the pre-requisites. I found myself pausing often to look up terms and information on the behaviour and replication of viruses. This is particularly true of the section on antiretroviral treatment and care of HIV. While complicated, the chapter does give a through explanation of how these drugs work and why they are affective in a North American context.

The section is also successful at providing a basic understanding of the many complexities of treatment. Not only are the drugs themselves hard to pronounce and they way they work harder to understand without a degree in science, but the efficacy of these treatments and their availability vary by country and level of development. The reading makes it very clear that access to certain regimens and treatment and prevention methods vary depending on the ability of a society or group within a society to afford them. This is especially relevant when it comes to my particular group of interest, because this is a very diverse group with varying levels of access to care and treatment. That being said, the fact that they are in Canada puts their treatment options far above many similar populations in other parts of the world.

The reading also makes it clear that while there has been a lot of development in treatment of HIV since it was first discovered, treatment of the virus is an ongoing and sometimes arduous process. Joep MA Lang in his chapter on antiretroviral treatments, first explains the many treatment options and how they works and describes how successful they have been. He adds a very important caveat though, which is that antiretrovirals have to be taken throughout life on strict schedule to avoid drug resistance in the virus. This lifelong treatment also leads to chronic toxicity over time with effects that may lead to disfigurement.

When I first became interested in this topic I saw a movie that chronicled the experience of four women in toronto living with HIV or AIDS. Each of them showed their daily regimen of drugs, the image of the one woman who was not taking her pills regularly and had developed full blown AIDS has remained with me. She was virtually emaciated and constantly ill from her disease and the illnesses that come along with it. She eventually died. I think the reason the film and this woman come to mind when I'm reading a very factual text on HIV/AIDS and treatment methods is to remind me that this disease is not about test subjects and chemistry--it is, at the end of it all, about the lives of people.

I learned a lot reading this text, things that I need to know and understand as I move forward with this course and my project. Treatment of this disease is a very complex process, that becomes even more complex as it targets specific groups or societies. But the most important thing I learned is that while HIV/AIDS has a lot to do with chemistry and biology (and that is where an eventual cure will stem from) I can't forget that it is a disease that is also entirely human and social.