- The Washington Times - Wednesday, May 14, 2003

A person suspected of having SARS refuses to be tested for the disease and, instead, files a lawsuit claiming that government-mandated screening is a violation of his constitutional right to privacy and the Fourth Amendment’s prohibition against unreasonable search and seizures. Then SARS activists — afraid of being “treated like lepers” — hold up Food and Drug Administration approval of a private home SARS testing kit on the same grounds and because of objections that home tests didn’t have face-to-face counseling. They also threaten to seize the patent of any company that develops a SARS drug or vaccine and give it to any generic company to ensure “access.” Guess how far SARS would spread in the face of such obstacles?

Now, replace SARS with HIV, and you get an idea of why we may have a chance to control the spread of SARS and HIV will never be contained. Chalk it up to post-September 11 thinking about terrorism, bioweapons and the vulnerability of borders perhaps, but SARS is regarded as a clear public health crisis — and nothing else. But our approach to fighting SARS could be the exception, not the rule. This is why the incidence continues to climb here and — with greater speed — in Africa, and parts of Asia.

SARS and HIV are the same in one respect: You can test positive but not show symptoms. That means the only way to control it is through testing, screening and education. But for years, the AIDS community fought implementation of such simple public health measures or what one epidemiologist in Beijing calls Disease Control 101.

That is because then and now, the HIV crisis is defined as a political and legal battle, a civil rights movement instead of a public health crisis. Twenty years ago, HIV activists had good reason to worry that an effort to contain HIV would also be used to discriminate against gay men. Fortunately, America responded aggressively to outright discrimination by disease.

Yet, the activist community still opposes proactive screening and detection despite the significant benefits early intervention can provide. Though antiretroviral therapy can reduce mother- to- infant transmission of HIV by up to 90 percent, the HIV Law Project and ACLU are still suing to prevent mandatory testing of all women giving birth on privacy grounds.

AIDS groups even opposed widespread private and voluntarytesting. For 10 years, many AIDS service groups lobbied the FDA and Congress against the approval of a home HIV test kit. They argued that HIV testing through in-home collection not linked to in-person face-to-face pre- and post- test counseling was ineffective and dangerous. (Many of these same groups would stand to lose federal dollars if the people who came into their clinics for counseling decided to test themselves at home.)

Yet, as one HIV group, Project Inform, noted, “according to the Centers for Disease Control, less than 15 percent of adults in the United States have been tested for HIV … statistics show that if HIV-testing through in-home access were available, there are people who may utilize this option who would not otherwise test through existing mechanisms.”

In China, SARS is spreading in large part because its government is continuing to underreport its incidence and is seeking to manage it as a political problem, not as a medical disaster in the making. That viewpoint still dominates the approach to controlling the spread of HIV globally. Activists continue to insist on a treatment model that requires the purchase of vast quantities of HIV drugs from generic firms, blaming patent protected drugs for the spread of the disease. But, here, too, the principal goal is victory in a glorious struggle against drug companies, not a triumph over a deadly disease.

The $15 million Global Aids Bill signed by President Bush does fund prevention measures — including mandatory testing of mothers with HIV, condoms, abstinence and religious-based education. Even with this measure, the world is putting the horse before the cart. Most of the money in the bill will still be spent on buying drugs.

It is an approach that will continue to cost lives. In 2001, Nigeria — on the advice of activists — purchased generic anti-AIDS drugs. The World Bank, the U.S. Agency for International Development and the Gates Foundation, among others, donated more than $150 million to help with distribution.

Two years later, only about 800 people have been treated, and the tons of drugs in the government stockpile will expire in less than six months. The Nigerian Directorate of the National Programme to Fight AIDS concluded that Nigeria’s woeful health infrastructure was the real reason for the failure.

In contrast, Uganda and Thailand have introduced programs that target high-risk populations through mandatory testing, abstinence and condom use that have more effectively reduced the spread of HIV and led, most importantly, to a rapid decline in HIV infection rates among young adults.

The fight against HIV was and is different. It was first a civil rights and cultural movement. Now, it has become a crusade against global capitalism. In seeking to squelch the sequelae of SARS, we are avoiding the mistakes we are making in our approach to HIV. Just this week, the Bill and Melinda Gates Foundation released a report concluding that way too little money and effort was being spent on preventing HIV in Africa instead of treating it. Now they tell us.

Robert Goldberg is director of the Manhattan Institute’s Center for Medical Progress.


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