Working v/s bloviating

The biggest story out of the 18th International AIDS Conference that concluded last week in Vienna was the finding by a South African research team that a vaginal microbicide using tenofovir actually worked to prevent HIV infection.

Tenofovir is one of the drugs people who already have HIV take to suppress viral replication. Scientists have thought that it and other antiretrovirals might also be able to block the initial infection, but the study done by the Durban-based Centre for the AIDS Programme of Research in South Africa (CAPRISA) was the first to find statistical evidence that it actually does.

[Full disclosure]: CAPRISA is affiliated with Columbia University as am I.

Women who used the gel vaginally at least 80 percent of the time before they had sex were found to be half as likely to acquire HIV infection than those who did not use it at all. That’s far from ideal but nonetheless a major breakthrough in a field where all the biomedical magic bullets have failed miserably.

Most of the people still slogging away in the AIDS field celebrated the research finding. But as never fails, some ultra-left purist whose ideology is far more important than mere facts promptly assailed the study for showing ‘callousness and disrespect for black lives’.

A writer named Andile Mngxitama held forth in The Sowetan that testing the gel on one thousand black women (‘used as lab rats and discarded’) in a depressed area was tantamount to ‘medical genocide’ performed on the weak and vulnerable, a sort of Tuskegee Syphilis Study redux.

The level of ignorance in the Sowetan article is lamentable given people’s readiness to believe the worst when it comes to medical research. But the shameful performance by former South African president Thabo Mbeki—who single-handedly held up HIV treatments for millions of his countrymen and women because of crackpot pseudo-scientific fantasies—should have alerted us to the dangers of this kind of posturing.

In fact, the female participants in the study were extensively counseled on HIV prevention, informed that the gel was not proven to be effective and guaranteed full medical treatment if they became HIV-positive during the trial.

In a stinging rebuttal the respected South Africa advocacy group TAC (Treatment Action Campaign) lit into Mngxitama for ‘distorting facts, taking an opinion on something he knows little about, and making statements that will cause life-threatening confusion’, all ‘under the guise of black consciousness’. Unfortunately, the TAC reply is not posted on the Web, but I will gladly forward it to anyone interested.

Just one detail will provide an ample idea of the sloppy reporting and demagoguery behind the Sowetan article. Mngxitama said 60% of the trial participants eventually became HIV-infected; the actual figure is 11%—in a country where prevalence rates in some areas run over 30% of all sexually active adults.

Efficacy trials for a communicable disease like HIV do face ethical dilemmas because the only way to demonstrate that something works is to establish treatment and the placebo groups and wait to observe how many people acquire the infection. Since we know that a percentage of people will not follow medical advice and expose themselves to risk, trials that are large enough will provide the evidence sought.

The alternative is to do no research and accept that some things can never be studied—an option often chosen when the ethical issues are insurmountable. For example, one can no longer study new HIV medicines against a untreated group because we now know that treatment works. But primary HIV prevention is different.

For reporters interested in learning something, CAPRISA had developed an extensive media kit of fact sheets, videos, PowerPoints and all the rest of it, along with making themselves available for interviews. But writers cannot be forced to do their homework especially if they have pre-set agendas and can’t be bothered with facts.

It is noteworthy that the study achieved a 95% retention rate, which is remarkable for research anywhere. That might be related to the years of medical care being provided in these same settings, which naturally led people to cooperate with the research staff and believe in the process.

Actually tackling a grave social ill like AIDS requires years of quiet dedication and steady work. It doesn’t provide an immediate, facile reward like penning a denunciation in the name of the downtrodden.