Anti-retroviral drugs 'help reduce' HIV transmission by kpo

I... They encouraged couples to have sex where one half of the couple was infected with AIDs and one wasn't?

I'm grateful it turned out well, but that... That sounds like suicide to me. Especially considering how they didn't know in advance how it would turn out. o.0

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Friday, May 13, 2011 7:37 PM

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)

Quote:
HIV-positive patients were split into two groups. In one, individuals were immediately given a course of anti-retroviral drugs.

The other group only received the treatment when their white blood cell count fell.

Both were given counselling on safe sex practices, free condoms and treatment for sexually transmitted infections.

Among those immediately starting anti-retroviral therapy there was only one case of transmission between partners.

In the other group there were 27 HIV transmissions.

I don't see in the article where anyone "encouraged" HIV-positive patients to have sex with non-HIV-infected people. HIV-infected people were treated, although with different regimens and procedures, and were told about safe sex practices, given condoms, etc. Some undoubtedly DID go out and have unsafe sex, and researchers tried to track the results.

At least, that's how I read it.

And it doesn't look like it necessarily "worked out", either - 27 cases of HIV infection were passed on by those NOT treated with anti-retrovirals. It worked out far better for those who WERE treated, though.

ETA: Sadly, though, here's the number one reason why it likely won't make much difference, at least in Africa:

Quote:
... it would cost more than ten billion dollars to provide drugs to the ten million people worldwide who are currently not receiving medication for HIV.

"Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservatives." - John Stuart Mill

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Saturday, May 14, 2011 4:27 AM

It was mostly the first paragraph that threw me.

Quote:
The United States National Institutes of Health sampled 1,763 couples in which one partner was infected by HIV.

So it sounds to me like they administered anti-retrovirus medication to the HIV positive or full-blown AIDs part of the couple, and then checked to see if their HIV-negative partners later became HIV positive.

I can't fault the results, but the whole thing seems very irresponsible.

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Saturday, May 14, 2011 9:20 AM

Sometimes you own the libs. Sometimes, the libs own you.

Quote:
Originally posted by Bytemite:
It was mostly the first paragraph that threw me.

Quote:
The United States National Institutes of Health sampled 1,763 couples in which one partner was infected by HIV.

So it sounds to me like they administered anti-retrovirus medication to the HIV positive or full-blown AIDs part of the couple, and then checked to see if their HIV-negative partners later became HIV positive.

I can't fault the results, but the whole thing seems very irresponsible.

Why? All of the people were given safe sex advice. And no one was encouraged to have sex: that's something you can trust people do without encouragement (even HIV-infected people). The results were just measured for the two different cases - immediate versus delayed treatment.

It's not personal. It's just war.

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Saturday, May 14, 2011 9:23 AM

Um, because 27 people came down with HIV while participating in the study.

Seems to me that people coming down with HIV, I dunno, that's something you want to prevent, isn't it?

"We gave them safe sex advice then washed our hands" doesn't cut it with me.

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Saturday, May 14, 2011 9:31 AM

Sometimes you own the libs. Sometimes, the libs own you.

Quote:
Um, because 27 people came down with HIV while participating in the study.

Seems to me that people coming down with HIV, I dunno, that's something you want to prevent, isn't it?

Yes, but they did nothing to encourage or facilitate it; how could they have prevented it?

Husbands and wives are going to have sex with each other, even if there's a HIV risk to manage.

It's not personal. It's just war.

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Saturday, May 14, 2011 11:44 AM

Quote:
Yes, but they did nothing to encourage or facilitate it

Study. About sexual transmission of HIV rates while on anti-retrovirus medication.

Seriously. No one else sees a problem here?

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Saturday, May 14, 2011 6:19 PM

I see a problem *IF* they gave one group anti-retroviral drugs and then said "Go at it - you're good!"; I see a problem *IF* they purposely withheld the drugs from another group and then told them to have unprotected sex.

If, however, they gave drugs to one group and not to another, and warned both groups about the dangers of having unsafe sex, and said, "You shouldn't do this, but if you do, can we study what happens afterward?", then I don't have a giant problem with it.

If you're studying a group of people who are going to behave a certain way, and one group you let do what they will without intervention, and the other, you try something which you have no idea whether it will work or not, then are you purposely putting one group in danger?

And what happens when someone comes up with an AIDS vaccine? How do you test it? Doesn't it, at some point, involve a bit of a "leap of faith", so to speak, in that you're going to give it to someone and they're going to have sex with people with full-blown AIDS to see what happens?

It's not an easy subject, but I think you're perhaps seeing malicious intent where there may not be any.

Do I have a problem with it? In one sense, yes; in another - letting people use their free will to do what they will - I can kinda see that being worth studying.

"Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservatives." - John Stuart Mill

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Saturday, May 14, 2011 6:37 PM

I'm not seeing malicious intent, I'm seeing irresponsibility that gives me pause, as well as a definition of ethics that is foreign to me but seemingly founded in that whole "greater good" thing I tend to take issue with.

There are rhesus monkeys, you know, that develop HIV without the deadly and drastic effects seen in humans. While it's also troubling to me to cause infection in an innocent creature, I have to rate an infection that never manifests symptoms as a better option than a risk that might lead to eventual death.

One group they did NOT give medication. I understand that was a control group for a scientific study, but on the other hand, they withheld medication.

Doctors are supposed to do no harm, and advise patients on the path of less possible harm. Advising them on a path that could lead to deadly infection... Even for science?

No matter how I look at this, no matter what interpretation of the study is presented (and I admit from the new article we aren't given nearly enough information to clearly understand what was done), I can't help but find it objectionable.

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Sunday, May 15, 2011 2:31 AM

Sometimes you own the libs. Sometimes, the libs own you.

Quote:
One group they did NOT give medication. I understand that was a control group for a scientific study, but on the other hand, they withheld medication.

Ok, this temporary withholding does throw up a bit of an ethical dilemma. But remember they didn't know that withholding drugs would increase transmission rates - that's what the study was trying to find out. They had suspicions, and scientific curiosity, and not a lot else. Maybe for all they knew withholding the drugs temporarily would've decreased the transmission rate, and done those particular test subjects a favour? I don't know a great deal about how anti-retrovirals work, do you?

ETA:

Another point about the ethics of the study, from the article:

"It was abandoned four years early as the trial was so successful."

It's not personal. It's just war.

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Sunday, May 15, 2011 2:48 AM

Keep the Shiny side up

Quote:
Originally posted by Bytemite:
One group they did NOT give medication. I understand that was a control group for a scientific study, but on the other hand, they withheld medication.

Doctors are supposed to do no harm, and advise patients on the path of less possible harm. Advising them on a path that could lead to deadly infection... Even for science?

No matter how I look at this, no matter what interpretation of the study is presented (and I admit from the new article we aren't given nearly enough information to clearly understand what was done), I can't help but find it objectionable.

Pretty much any clinical trial is gonna use the same methodology: Give part of the group the new - and hopefully more effective - treatment, and give the other either nothing or the existing treatment. Now, it could be that the new drug/treatment/therapy will reduce the incidence of the disease. It could also either have no effect or have, despite the developer's best efforts, negative side effects that cause more health problems than it cures. So it could be that the folks getting no treatment end up in better shape.

Then again, you have to figure that the folks who volunteer for these tests know that there's a risk either way, and are still willing to go ahead, for whatever reason. Could be that they figure that if the tests are successful they'll eventually benefit from the new drug, even if they're in the control group for the test.

"Keep the Shiny side up"

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Sunday, May 15, 2011 2:57 AM

Sometimes you own the libs. Sometimes, the libs own you.

Quote:
ETA: Sadly, though, here's the number one reason why it likely won't make much difference, at least in Africa:

Quote:

--------------------------------------------------------------------------------
... it would cost more than ten billion dollars to provide drugs to the ten million people worldwide who are currently not receiving medication for HIV.
--------------------------------------------------------------------------------

I disagree, I think knowing that HIV medicines keep people alive AND prevent it spreading is a powerful argument for increased funding. It gives an economic incentive to spend money on this NOW, and then much less on it in the future.

It's important to know that keeping people alive on HIV medicines is not self-defeating in some respects, in that it gives infected people more time to pass on the virus. Instead the HIV medicines prevent transmission, so their effect is doubly positive.

It's not personal. It's just war.

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Sunday, May 15, 2011 5:01 AM

It's different from the studies you're describing because it's already known that anti-retrovirus medication has some life saving effects against the disease, and, in my understanding, even prevents the HIV from developing into full-blown AIDs (which as I've said is deadly (eventually)).

Delaying medical treatment of the HIV... I don't have words. The transmission thing seems to be a side benefit of the retrovirus medication, it's fine that they found it, but there's a number of things about this study that just seems wrong to me. There is absolutely NO other way they could have tested for this?

The fact that a number of partners developed HIV during the study is also in my mind condemnable. And terminating the study early? How do we know that the retrovirus medication doesn't merely delay transmission, not outright prevent? What happens if transmission rates actually go up because couples believe they are safe so long as the HIV-infected partner is on medication?

And I confess to thinking there's some irresponsibility on the part of the couples involved here in regards to each other as well too. The whole thing does seem suicidal still to me. They risk infecting their partner, any children they might have. Hard choices? How can anyone make the choice to endanger people they care about? This must be some sort of moral code and belief system that is beyond my comprehension, where romantic and sexual connection is placed even above the prospect of death. If so, then what about activity where there is absolutely no risk of transmission, such as mutual voyeurism? If they want children, why not fertility clinics to help grow and implant embryos with their shared genetics but no HIV? It could become a charity thing over in Africa.

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Sunday, May 15, 2011 10:07 AM

Keep the Shiny side up

Quote:
Originally posted by Bytemite:
What happens if transmission rates actually go up because couples believe they are safe so long as the HIV-infected partner is on medication?

Without doing tests like these, there's no way to find that out. Catch-22.

Also, once again, the folk in the test are volunteers who know going in they are either getting the medication or not. It's not like someone is doing this to them without their knowledge or consent.

"Keep the Shiny side up"

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Sunday, May 15, 2011 10:15 AM

That's entirely dependent on if they used a placebo or not, which is common in studies like these. I'm not even sure how you can have a control group without a placebo, because theoretically people should act differently if they know they're on medication or not.

But if it was a placebo...

And if they didn't have a placebo, how did they rule out different behaviour under conditions for comparison? Did they compensate for it? How? In the manner they advised either group? Either way, it's wrong, just wrong.

And no, this isn't the only way. I just mentioned other options that are out there. This isn't a catch-22 at all.

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Sunday, May 15, 2011 5:13 PM

Keep the Shiny side up

Quote:
Originally posted by Bytemite:
Either way, it's wrong, just wrong.

You still fail to address the fact that the folk in this study knew going in that there were risks, and selflessly decided to go ahead. They were willing to take that risk to give other folks a better chance at a good life.

As you noted, if they'd given everyone the anti-retroviral drugs they could very well have later found that this lead to behaviors that actually increased the spread of HIV. Would that be better?

"Keep the Shiny side up"

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Sunday, May 15, 2011 5:17 PM

No, which is why I stand by my previous statement of "wrong, just wrong." It feels like even if the study had a useful outcome there's no justifying the kind of risk involved. Not the doctors performing the study, not the people who are about to be infected, or the people who are infected. It's irresponsible all around.

There's a difference between selfless and suicidal, and I should know.

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Monday, May 16, 2011 1:55 AM

Keep the Shiny side up

Quote:
Originally posted by Bytemite:
No, which is why I stand by my previous statement of "wrong, just wrong." It feels like even if the study had a useful outcome there's no justifying the kind of risk involved. Not the doctors performing the study, not the people who are about to be infected, or the people who are infected. It's irresponsible all around.

There's a difference between selfless and suicidal, and I should know.

So we should give everyone the anti-retrovial drugs, and if it causes an increase in HIV due to modified behavior or other factors that's just too bad? That seems to be what you're proposing.

"Keep the Shiny side up"

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Monday, May 16, 2011 2:25 AM

Byte, it sounds to me almost as if you're treading very dangerously close to the "let's control everybody's every action" line of thinking here.

People in the study - both groups - were given every opportunity and assistance (condoms) AND instruction to have safe sex. Some likely DID do so; some did not. I highly doubt ANY of them were told that they were going to be completely safe if they DIDN'T use safe-sex practices, because such would be medically inaccurate and quite dangerous.

How exactly would you propose ENFORCING safe sex practices on a group of people?

If these people entered into a study with informed consent - knowing their partners had HIV, knowing they were testing a drug with no indication of any kind of efficacy, knowing that there was a high risk of HIV transmission from unsafe sexual activity with an HIV+ partner - and they went ahead and had unsafe sex anyway, then why is it the doctors' fault for studying the outcomes?

If I want to test a new anti-emphysema drug on a group of smokers, am I responsible for every smoker who doesn't get the drug and later gets emphysema? We already KNOW that smoking is a leading cause of that disease; should we not try to study it, or abstain from helping, and simply let people get the disease?

"Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservatives." - John Stuart Mill

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Monday, May 16, 2011 3:57 AM

I'm not saying enforce anything, I'm saying they're being unforgivably and horrifically irresponsible to the point where it clashes with my own sense of morality. Big difference.

I'm allowed to call out people when I think they're behaving in a dangerously reckless manner. I'm also allowed to call out science if I think it's behaving in a dangerously reckless manner.

Quote:
then why is it the doctors' fault for studying the outcomes?

Because it's almost enabling the spread of AIDs. Very borderline grey area.

Quote:
If I want to test a new anti-emphysema drug on a group of smokers, am I responsible for every smoker who doesn't get the drug and later gets emphysema?

This is kind of a bad example, because it's a rare thing that people choose to get AIDs. Some people are born with it, some get it from their mothers when infants, some get it because of simple ignorance, and sometimes rape. I find it dubious we can compare an addiction to nicotine to people willfully and knowingly taking risks that could give them AIDs. Some people are addicted to sex, true, but for people who aren't the decision still comes across to me as complete insanity.

But in your given case, while the patients do have some responsibility for the actions they've taken (those that aren't addicted, anyway), the doctors didn't exactly help them, either. They didn't do their jobs. So I think we have to ask ourselves which is more important, the research, or the health of the people involved? Perhaps research should become flexible enough and with enough follow-up with patients that if doctors see a patient in either group progressing in a bad way, they can be taken out of the study and placed on potentially life saving medication. Instead, we seem locked into a course, dismissing the responsibility that doctors have for people by saying that "well, the patients knew the risks."

I find that unacceptable. And if the researchers and doctors KNEW they were withholding valuable medicines that might have prevented serious disease or illness, I might even consider it criminal.

Quote:
We already KNOW that smoking is a leading cause of that disease; should we not try to study it, or abstain from helping, and simply let people get the disease?

This is a contradictory point to the one you already made. Not giving known beneficial medicine is by definition abstaining from helping, and allowing people to get the disease. If you mean that it is potentially limiting the medical field by not doing the research to determine the benefits of a medicine, that's also not applicable to this case, as we already knew the medicines in question were helpful, we just didn't know they were also a preventative.

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Monday, May 16, 2011 4:14 AM

Quote:
So we should give everyone the anti-retrovial drugs, and if it causes an increase in HIV due to modified behavior or other factors that's just too bad? That seems to be what you're proposing.

If you can't argue with me without twisting my stance into something abhorrent, then I don't have much cause to stick around.

Before this study, we wouldn't have known that the medication is a preventative, therefore of course we wouldn't let modified behaviour increase the spread of aids through increased prescription. Now after the study, of course we shouldn't do that either, because all medicines have side effects and a person shouldn't take them unless they have good reason. Similarly there's also the problem that we don't know about the preventative rate on the drugs, and anything less than 100% is automatically risky for use in that manner.

If the takeaway doctors get from this is "let's prescribe this stuff to everyone so everyone can have sex indiscriminately!" then clearly society has become so idiotic there may be no salvaging it.

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Monday, May 16, 2011 6:59 AM

Keep the Shiny side up

Quote:
Originally posted by Bytemite:
If you can't argue with me without twisting my stance into something abhorrent, then I don't have much cause to stick around.

Sorry, but reading what you've written, that seems to be your stance: that we should give all HIV positive folks anti-retroviral drugs, since it would be immoral to withhold them, and only find out if HIV transmission increases or decreases through studies of infection rates in the general population of HIV/non-HIV couples.

If that's not what you're saying, then please clarify.

"Keep the Shiny side up"

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Monday, May 16, 2011 7:35 AM

Hmm. Guess I misunderstood. I thought you were saying that my position was that we should give everyone the anti-retrovirus meds, both HIV positive and negative, and have them go at it.

Well, you know, the idea for this study had to come from somewhere, yeah? Probably they were looking over existing data, noticed a trend, then came up with the study to test it. Then it turned out the trend was scientifically significant.

I'm not against medical studies, and informing patients of risk is an appropriate action. But I think sometimes that there should be some weight given to what kind of risk and how much risk and how to mitigate risk in the design of a study or experiment. I'm wondering if they could have accomplished the same thing using cell cultures. Maybe they already did. I don't know.

But 27 people coming down with HIV while they were working with doctors and researchers just doesn't seem right to me. And I admit the concept that there are people who would be willing to take the risk of infection is one that boggles me still.

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Monday, May 16, 2011 7:52 AM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

"... the concept that there are people who would be willing to take the risk of infection ..."

Sometimes it's a control thing - the HIV-negative person has it demanded of them as the price of the relationship. Maybe it's framed as subservience, or trust, or compassion. I've seen these kind of head games played out in relationships where people basically don't like themselves enough to demand something healthy.

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Monday, May 16, 2011 8:07 AM

Yeah, I think that's why I might be so uncomfortable with that aspect. I can't reconcile "caring relationship" with "willful infection." The only alternative I can think of is that the HIV-negative person wants to be infected so they can "go through it together" and "show solidarity" or something, but that still doesn't make sense.

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Monday, May 16, 2011 8:13 AM

Quote:
Originally posted by Bytemite:
Quote:
So we should give everyone the anti-retrovial drugs, and if it causes an increase in HIV due to modified behavior or other factors that's just too bad? That seems to be what you're proposing.

If you can't argue with me without twisting my stance into something abhorrent, then I don't have much cause to stick around.

Before this study, we wouldn't have known that the medication is a preventative, therefore of course we wouldn't let modified behaviour increase the spread of aids through increased prescription. Now after the study, of course we shouldn't do that either, because all medicines have side effects and a person shouldn't take them unless they have good reason. Similarly there's also the problem that we don't know about the preventative rate on the drugs, and anything less than 100% is automatically risky for use in that manner.

If the takeaway doctors get from this is "let's prescribe this stuff to everyone so everyone can have sex indiscriminately!" then clearly society has become so idiotic there may be no salvaging it.

Now we're getting somewhere! Yes, I'm in agreement with you on this.

The takeaway for the scientists seems to be a course of action they can now recommend (or "prescribe", if you'll allow me to use that phrase in a punny fashion...): "You shouldn't be having sex with anyone who is HIV-negative, ever, but IF YOU DO, please be safe, and please use these anti-retrovirals whether you're going to have sex or not, because they can not only prolong your life, but just MIGHT reduce the risk that you infect someone else. REDUCE the risk. Not remove."

By the way, I have a hard time believing there are more than a very few people in this country who didn't know the risks of smoking before they started. They started, and they assumed the risks. And many of them keep smoking, even after they've killed loved ones with their second-hand smoke!

"Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservatives." - John Stuart Mill

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Monday, May 16, 2011 8:17 AM

I'm willing to accept that. Still can't fathom the HIV negative folks who willingly do it, but I'm willing to allow some human behaviour may just always be a mystery for me.

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Monday, May 16, 2011 8:57 AM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

To keep on my train of thought --- I think the dynamic - the HIV-negative having sex with the HIV-positive - is intrinsic to the relationship of the two. (As an example, one previously HIV-negative man I know 'sero-converted' after getting into a relationship with an HIV-positive man who claimed he just needed to be fully loved and accepted despite his HIV-positive status. If you really loved me you would ...)

I think what this study shows is the impersonally protective effect of the drugs, despite relational dynamics.

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Monday, May 16, 2011 12:24 PM

Quote:
Originally posted by 1kiki:
To keep on my train of thought --- I think the dynamic - the HIV-negative having sex with the HIV-positive - is intrinsic to the relationship of the two. (As an example, one previously HIV-negative man I know 'sero-converted' after getting into a relationship with an HIV-positive man who claimed he just needed to be fully loved and accepted despite his HIV-positive status. If you really loved me you would ...)

I think what this study shows is the impersonally protective effect of the drugs, despite relational dynamics.

Quote:
Posted by Bytemite:

I'm willing to accept that. Still can't fathom the HIV negative folks who willingly do it, but I'm willing to allow some human behaviour may just always be a mystery for me.

Yes, indeed. And the whole, "If you loved me..." argument. Yikes. What about "If you really loved ME, you wouldn't ever want me to have HIV!"?

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Monday, May 16, 2011 1:39 PM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

The particular man I'm thinking of had a mother who was literally sexually sadistic to him from a young age. OTOH she really favored the daughter, treated her like a princess. This man grew up desperate for love, and was taught by mommie dearest that the measure of TRUE love (and thus the chance to be loved) was willingness to sacrifice your interests for the other. With that situation in mind, I can see how someone could end up like that. Not that I think it's healthy, but I see that played out in his present life.

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Monday, May 16, 2011 2:58 PM

I understand, Kiki - I've known a few women who were content to let their men beat on them, because "it shows that he really cares about me". Never could understand the reasoning, but I understand that it happens.

"Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservatives." - John Stuart Mill

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Monday, May 16, 2011 7:00 PM

RIONAEIRE

Beir bua agus beannacht

Hey Byte.
I can understand that you are feeling that this study is weird. I mean, I know what you mean about wondering why someone without HIV would choose to rut with someone who has it. I'm pretty sure though that all the couples that were part of the study had been together since before the study began, so they'd already made the choice to be in said relationship and they were probably already rutting. So they signed up for the study, hopefully knowing what it entailed, these things are usually closely monitored, concent papers signed etc. so study participants know what they're getting into. Then some were given the medicine and some weren't, but, with the study or without the study, I'm pretty sure that all the couples were having sex anyways. Why is a whole nother issue.
If I fell in love with a man with HIV we'd have to learn ways to enjoy each other's company sexually without fluid sharing, it might not be the most ideal situation, but it can be done.

"A completely coherant River means writers don't deliver" KatTaya

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Sunday, June 5, 2011 8:35 AM