STDs and HIV

Rachel Kelley
Post for 10/14

Reading about these two studies made me think a lot about experimental design. I knew before that there is a lot to consider when designing an experiment (i.e. controls, privacy issues, sample composition, etc.), but I had not thought about what a logistical feat that these large studies truly are! I can't imagine what kind of organization and planning it must have required to implement the mass testing and treatments of the Rakai study or the concerted follow-up and continuous treatment of the Mwanza study. On top of that, all of the resources (testing materials, antibiotics, etc) needed to be paid for and distributed.

I was a little disturbed by the policy in the Rakai study that failed to treat syphilis-infected individuals. It is true that such individuals were referred to another clinic, but it seems to me that it would have been more ethical for the study to treat them. Certainly the decision is complex because of finite resources of the study as well as their desire not to intervene in the control group. That being said, the study DID have the ability to treat syphilis infections, and the referrals were not as effective at treating infection. I think it is an injustice to allow people to suffer when there is an available means to alleviate that suffering. I much prefer the methods of the Mwanza study because they preserve and even strengthen the healthcare provider - patient relationship and justly treat all who are found to be sick. It also seems that the continuous support of the health care providers is a more effective intervention anyway.

The article that compared the two studies posed some interesting questions and recommendations in its concluding paragraphs. I would be curious to know if any of those questions/recommendations have been addressed in the nine years since it was published. Is there now a better way to treat HSV-2? Is there a better way to screen symptomless women for STDs?