Tuesday, July 05, 2005

US Foreign AIDS Policy

The New York Times recently reported on the two sides of American AIDS policy.

In the battle against AIDS, the Bush administration is both savior and scoundrel. Washington is the single largest financier of AIDS programs in poor countries. But the administration uses its muscle to extinguish necessary and successful programs it finds politically objectionable, and to carry out ineffective ideological crusades...

The Times article describes how the US recently approved Indian-made generic nevirapine and efavirenz, two antiviral cocktail components. This move will make the drugs available to millions more. But at the same time the Bush Administration is asking UN-AIDS to drop all references to needle exchange programs from its documents.

Now, free needle exchange for IV drug users is a controversial topic, and it's not necessarily intuitive that it would be effective. But the preponderance of clinical evidence indicates that it reduces drug injection rates, reduces needle and syringe sharing, and reduces AIDS spread.

Needle exchange programs are among the best tools we have for fighting AIDS in populations with high IV drug use; the Bush Administration should continue to support these programs. But I wouldn't put money against the Administration letting ideology get in the way of evidence-based public health policy.


At 9:42 PM, Blogger J. James Mooney said...

What do you say to the arguement that says, "I don't what to pay for someone elses drug problem?"

At 12:27 AM, Blogger fmodo said...

A good point, and a few responses:

-We're each already paying for the price of the HIV epidemic through
1. Cost shifting in the US (HIV Positive patients who come to hospitals without insurance force the hospitals to shift the cost to insured pts by raising all charges across the board), and
2. The Federal and UN security and aid budgets internationally (the cost of the epidemic in Africa requires considerable expenditure to preserve the peace, since HIV selectively decimates the economically active young adult population, creating an environment suited for strife)
Any effective preventive measure can decrease these existing, significant costs.

-Also, remember that HIV/AIDS is spread vertically--mother to child. The cost to society of taking care of HIV positive orphans, once their parent(s) die is enormous.

-To those who believe that simply on principle they do not want their money going to support a drug addiction, I would answer that needle exchange is not a support--these folks can find enough needles on their own to inject themselves, just not enough to avoid sharing them--it is a type of harm reduction. If one still feels uncomfortable I would ask whether the principle is based on the idea that involvement in NEPs would be tacit approval and eventually end up promoting addiction (which has not been found in research but is a potentially provable or disprovable proposition) or if there's a moral objection apart from the consequences to patients, to which an ethicist or minister could perhaps speak with more authority than I can. But I can think of no convincing deontological arguments against NEPs.

The price of syringes/needles is miniscule compared to the cost of HIV medications. But though I think that the economic, political and security arguments are compelling, I think the moral argument is this: IV drug abusers made a mistake, but once addicted are no longer rationally chosing to remain addicted. They are simply biologically dependant, and it takes a lot of time and work to conquer an addiction--ask any smoker.

In the meantime, whether they're making a good faith effort to quit or not, it's in everyone's interest that each addict not become another link in the chain of HIV transmission.


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