Grabbing a monster by the tail
Posted by Henry Bauer on 2010/02/02
The monster is HIV/AIDS. The thoughtless action has been to wage ceaseless propaganda that everyone should be tested, even as a positive test is said to mean stigma, lifelong disability, and an early death. Some consequences are coming home to roost in South Africa:
“The national health department and the Treatment Action Campaign (TAC) have added their voices to condemning the use of HIV home testing kits, saying they are risky to use at home and their accuracy cannot be guaranteed. This follows a warning from the SA Medical Association (Sama), which cautioned that home testing for HIV could leave people devastated. . . . TAC general secretary Vuyiseka Dubula warned against the use of the kits. Suicides could result if people tested at home and got a positive result. . . . ‘When doing an HIV test it’s very important to know why you are doing it, and to have a proper support system’” (“South Africa: HIV Home Tests – More Warnings”).
Doesn’t it seem rather odd, that someone who keeps urging everyone to get tested then implies or insists that they need some other reason for being tested than that everyone is being urged to get tested?
Perhaps there’s a subliminal awareness that the tests are often misleading?
“Dubula also questioned the accuracy of home testing kits, saying there was no confirmation. ‘All HIV tests must be confirmed. The worry with self-testing is that it’s not always possible to confirm the results. Some people may not be able to afford to buy a second kit to confirm their results,’ she said, urging people to get free tests at public health facilities.”
But there’s no such thing as a confirming HIV test, according to “Laboratory detection of human retroviral infection” by Stanley H. Weiss and Elliott P. Cowan, Chapter 8 in AIDS and Other Manifestations of HIV Infection, ed. Gary P. Wormser, 4th ed. (2004). None of the tests are capable of establishing the presence of HIV infection; all results should be expressed as probabilities; so-called “confirmatory” tests are actually only supplemental tests, to be used only as additional adjuncts to clinical observation and medical histories. “Each individual assay has its own associated special characteristics and is not interchangeable with other assays, even within a given class of test” (p. 148). “In the absence of gold standards, the true sensitivity and specificity for the detection of HIV antibodies remain somewhat imprecise” (p. 150).
The truly monstrous fact is that the public hears constantly about confirmatory tests and the 99%+ sensitivity and specificity of HIV testing at the same time as the expert technical literature emphasizes that such a high “accuracy” still means that in low-risk groups the probability of false positives may be 5 out of 6 and that no test or sequence of tests can prove infection (“’HIV’ tests are self-fulfilling prophecies”, 10 May 2009).
When public policies are based on ignorance, this is the sort of mess that ensues. On the one hand, the policy makers are told that “rapid testing may assist in facilitating the diagnosis of HIV infection, improving HIV testing capabilities in facilities without access to laboratories”; on the other hand it’s recognized that “There was also the danger of misinterpretation of the results of the home test kit . . . . Professor Peter Eagles, chairman of the Medical Control Council . . . said consumers needed to ensure the product was of a good quality, and registered in its country of origin.”
How, one might logically ask, should the typical “consumer” in Africa distinguish advertisements by makers of the home-test kits from other propaganda they are subjected to? But perhaps above all, consider the implications of the assertion that “rapid testing”, notoriously unreliable in itself, can assist with “diagnosis of HIV infection”, when Weiss & Cowan go to great pains to describe the lengthy, elaborate procedures required to diagnose infection in ways that do not rely exclusively on test results.
There is a similar disconnect between the incessant propaganda to distribute antiretroviral drugs in Africa and the considered views of the treatment experts that antiretroviral treatment requires constant careful monitoring, frequent laboratory testing, the likelihood of needing to change treatments at intervals, the elaborate procedures like “resistance testing” to choose the right treatment regimens in the first place:
” Multiple studies have demonstrated that better outcomes are achieved in HIV-infected outpatients cared for by a clinician with HIV expertise [1-6], which reflects the complexity of HIV infection and its treatment. Thus, appropriate training and experience, as well as ongoing continuing medical education (CME), are important components for optimal care. Primary care providers without HIV experience, such as those who provide service in rural or underserved areas, should identify experts in the region who will provide consultation when needed” (NIH Treatment Guidelines, 1 December 2009, p. 3).
It seems more than likely that good nutrition and vitamins and mineral supplements would do far more good in Africa than the liberal distribution of toxic antiretroviral drugs in absence of nearly enough experienced physicians to ensure that treatment is changed or discontinued at the first sign of toxic side-effects.
This entry was posted on 2010/02/02 at 4:13 pm and is filed under Alternative AIDS treatments, antiretroviral drugs, experts, HIV skepticism, HIV tests. Tagged: HIV home-test kits, psychological harm from HIV tests, Treatment Action Campaign, universal HIV testing, Vuyiseka Dubula. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.