NYT Times: Drugs Stop AIDS. Take Your Medicine.

[There are some problematic assertions that McNeil makes in this article. One is that HIV+ people who choose to not begin treatment are "selfish" and/or "self-destructive." There are many reasons that a person may have to forestall treatment that wouldn't include either of those negative characterizations. Another troubling idea is that people with HIV are somehow incapable of safer sex practices. In fact, most people who know they are HIV+ do practice safer sex. More unsafe sex happens when people do not know their status. There are a number of other problems with this, see what you think - Mapping Pathways]

via New York Times, by Donal G. McNeil Jr.

There is now, for the first time, hard clinical evidence of an effect that AIDS doctors have suspected for years: If you are H.I.V.-positive, being on antiretroviral drugs will probably save not only your life, but also the lives of your sexual partners.

This month, a randomized clinical trial — the gold standard in medical research — showed that the drugs lowered the chances of infecting a partner by 96 percent.

This is good news for the infected and their lovers. But it is a moral dilemma for doctors whose infected patients do not want to start taking drugs immediately, usually because they do not yet feel sick and have heard exaggerated rumors about side effects.

What does a responsible doctor do with a patient who is sexually active and teeming with a fatal and incurable virus? Advise him to use condoms and trust him to act decently? Beg?

Behind each doctor — whose primary duty is to one patient — there is a government public health bureaucracy, whose duty is to protect the whole country. The epidemic has been killing Americans for 30 years now.

Whose rights should be paramount? Those of the patient? Or those of his healthy spouse — or boyfriend, or date, or hookup, or client, or rape victim, or incest target?

This debate has been going on since AIDS began, and has always been inextricably mixed with the circumstances of its birth: it was a sexually transmitted disease that emerged among gay men in the middle of the sexual revolution and the new gay rights movement. AIDS still carries a huge stigma and provokes hatred wildly out of proportion with the fact that it is simply a new virus. (Neither SARS nor H1N1 were called “God’s wrath.”)

But the fact that there is a new form of prophylaxis reopens old questions.

Several AIDS clinicians interviewed for this article said the idea of forcing treatment onto a patient was repulsive to them.

“It was unthinkable when we had this debate in the early 1980s, and it’s unthinkable in 2011,” said Dr. Myron S. Cohen of the University of North Carolina, who led the study that found the 96 percent protection rate. During a long discussion, he called the idea “medieval” and “a violation of civil rights.”

Read the rest.


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