10/14 Reading

The Mwanza, Tanzania and Rakai, Uganda trials were interesting to examine in the scope of the high HIV-1 incidence in Sub-Saharan Africa. Even though some people may see the results of these trials to be contradictory of each other, I strongly agree with Grosskurth et al in that the different results reflect the many different factors surrounding the disease in each of the tested areas. Some of the important baseline factors that might have given rise to the differences such as disease maturity are very significant because the results, might point to the fact that different control and treatment measures need to be used when dealing with HIV-1 in relation to STDs. I believe the important message of these trials and of Grosskurth is that we cannot generalize: what applies to STDs and their influence on HIV-1 transmission and vice versa in one area does not have to necessarily apply to another place because there are several epidemiological, virological, behavioral and environmental differences. Another important point was that policy makers should not necessarily depend on one study to implement action; they must explore many and understand that differences and contradictory information is inevitable. With this insight, they can be more aware and conscious of the decisions they make. One issue I had with these experiments is with the comparison communities. Granted, it is already difficult as it is to do research on humans without breaching ethical and moral decorum. With that in mind, I would still question the ethics in maintaining a certain group without treatment intervention just for the sake of having a control group to compare against a variable group. Even though, as the authors informed us, the comparison communities were eventually given treatment at the end of the 2 years or the 10 months, in that duration several hundred people might have died or gotten infected who might have otherwise not have gotten infected. I realize that control groups are paramount to scientific research but I guess I only point this out to open discussion on what exactly can be done or not done as in this case and still be called ethical.
The Illife reading was very interesting to me because it basically disected national and international involvement in the AIDS epidemic in Africa in a different light. A point I thought was very interesting that he brought it is the idea of how the methods used to approach the epidemic in Europe and the US should have not been used to approach it in Sub-Saharan African because it was not concentrated in certain minorities like homosexuals and iv drug users. This point kind of recalls, the key point that Grosskurth was portraying when saying that the two studies did not contradict each other: there is no one general method of approach. The key is to take into consideration what is going on in a specific place and deal with it in a manner specific only to the area, obviously drawing in relevant information from other approaches. In this light, in the West and the WHO's efforts to fight the epidemic, there is a chance that it might have been propagated to spread even more. Interesting...