Received: by alpheratz.cpm.aca.mmu.ac.uk id OAA07927 (8.6.9/5.3[ref pg@gmsl.co.uk] for cpm.aca.mmu.ac.uk from fmb-majordomo@mmu.ac.uk); Wed, 16 Feb 2000 14:59:53 GMT Subject: FWD: Botswana comes to grips with AIDS Date: Wed, 16 Feb 2000 09:58:20 -0500 x-sender: wsmith1@camail2.harvard.edu x-mailer: Claris Emailer 2.0v3, Claritas est veritas From: "Wade T.Smith" <wade_smith@harvard.edu> To: "memetics list" <memetics@mmu.ac.uk> Content-Type: text/plain; charset="iso-8859-1" Content-transfer-encoding: quoted-printable Message-ID: <20000216150418.AAA13769@camail2.harvard.edu@[128.103.125.215]> Sender: fmb-majordomo@mmu.ac.uk Precedence: bulk Reply-To: memetics@mmu.ac.uk
You know, the hell with suicides-after-radio-program studies- such
white-bread eurocentric academic puff-pastry elitism as they are- right
now in several regions of Africa there is a strong memetic component to
ignoring and spreading death- all mixed up in machismo and social class
and the identity of women and men- and a lot of Latin America and other
enclaves of such misogyny and autocracy are ready and able to stand in
the same pose.
Here is a real laboratory of a devastating memetic stance, (although this
article spends very little time on the 'whys' of HIV transmission), and a
real laboratory of real denial in the face of this stance.
_______________________
Botswana comes to grips with AIDS
By Richard A. Knox, Globe Staff, 2/15/2000
In some regions of the southern African nation of Botswana, half of all
pregnant women carry the human immunodeficiency virus. So health
officials were disheartened recently when most women refused drug
treatment known to minimize the transmission of HIV to their unborn
babies.
''We felt it was something most women would welcome,'' said Dr. Howard
Moffat, one of Botswana's leading physicians. ''But fewer than 50 percent
of women actually accept the offer.''
The reasons are complex, Moffat said last week in a telephone interview.
But one is an overwhelming fatalism.
''Since they themselves are infected and their lifespan is going to be
quite restricted - and they don't know who is going to care for their
children - there is a feeling amongst some women that, `We might as well
both go together,''' Moffat said.
Their attitude is understandable. Botswana shares with nearby Zimbabwe
and Malawi the distinction of having the world's highest AIDS-virus
infection rates - about one adult in every four. But only about 200
people in a population of 1.5 million have access to the kinds of
antiviral drugs that are extending lives in wealthy nations.
Despair about that inequity, as much as the virus itself, is the target
of a state-of-the-art virology laboratory that will be dedicated today in
Gabarone, Botswana's capital, with the pomp of a brass band, choirs, and
speeches by dignitaries from Botswana and Harvard University.
The facility is being launched with a $4.9 million AIDS grant from
Bristol-Myers Squibb Co., among the first of a $100 million grant to
Botswana and four other hard-hit African countries.
One hundred million dollars is just a drop in the ocean of AIDS-related
needs in Africa - and only one-tenth of 1 percent of Bristol-Myers
Squibb's revenues over the five-year grant period. But AIDS experts in
Botswana and Boston say the new lab has a significance beyond its dollar
value. African-based HIV science, they say, is a necessary antidote to
the ''what's-the-use?'' attitude that afflicts Botswanian mothers-to-be.
In this sense, the Gabarone virology lab is the vanguard of a gargantuan
effort, just beginning, to bring AIDS drugs for prevention and treatment
- and ultimately an effective AIDS vaccine, researchers hope - to ground
zero of the world AIDS pandemic.
For starters, the new lab will greatly expand Botswana's ability to
determine who, and how many, are HIV-infected. Most of them currently
don't know, but as effective drugs become available against HIV and
associated infections, especially tuberculosis, it will be vital to find
out who is infected. The nation's main blood bank can run 100 to 200 HIV
blood tests a month. With the new lab, ''we can run those in a day,''
says Dr. Richard Marlink, director of the Harvard AIDS Institute, which
is collaborating with Botswanian scientists on the project.
The new facility would have little significance, however, if its purpose
was merely to diagnose HIV infection. Far more important, the lab is the
first in the world built specifically to investigate an HIV subtype known
as 1C, or clade C - the type now responsible, Harvard scientists say, for
more than half the world's AIDS-virus infections.
''In just the past few years, subtype C has spread like wildfire
throughout southern Africa, up East Africa to the horn and on to India,''
Marlink says. ''It infects more individuals worldwide than all the other
HIV subtypes put together.''
For such an important scourge, amazingly little is known about HIV-1C,
for the simple reason that nearly all AIDS research until now has
focussed on HIV-1B, the subtype responsible for nearly all the infections
in North America and Europe.
Why has clade C spread so fast in East Africa, apparently out-competing
other HIV subtypes already established there? No one knows, and little
research is being done to find out.
Does HIV-1C respond to treatments the same way as subtype B? Will its
apparently revved-up mutation rate produce drug-evading resistance more
quickly? Scientists have just started trying to find out.
Perhaps most important in the long run, will vaccines being developed
against the HIV-1B prevalent in the northern hemisphere work against
clade C, the scourge of the south? Public health officials will never
know if scientists don't learn how different the clade C virus is,
immunologically speaking.
Dr. Max Essex, a Harvard AIDS researcher scheduled to speak at today's
lab dedication, is convinced that the clade C virus is more easily
transmitted from mother to child and through heterosexual intercourse
than other HIV subtypes. He thinks it may also be more virulent, leading
to more rapid disease progression and death.
''The epidemic of HIV-1C that is blazing across southern Africa today is
infecting a much larger fraction of local populations than are other
subtypes in other regions,'' Essex says. ''Its prevalence and its rapid
spread suggest its greater potential for causing larger epidemics than
any other HIV the world has experienced before.''
Not all scientists agree with Essex and Marlink that clade C is more
transmissable and more virulent, although no one can explain why the 1C
virus has supplanted other strains in parts of Africa and India. Women
infected with 1C in Zambia, where clade C predominates, transmitted it
heterosexually even when they had lower blood levels of the virus than
men who transmitted the virus to women, according to a paper presented
last month at a San Francisco AIDS conference.
Researchers at the same conference found 1C virus in about four percent
of a group of about 200 foreign-born individuals with HIV infection in
New York City. Sara Beatrice of the New York City Health Department and
her colleagues said public health officials and physicians ''should be
aware of the growing genetic diversity of HIV-1 in this country,'' if
only because tests to determine the amount of HIV-1B in patients' blood
may not be accurate among those infected with non-B virus types.
So far no one has apparently documented transmission of the 1C subtype
from foreign carriers to others outside regions where the virus is
endemic, leaving open the question of whether 1C has started to
infiltrate US or other populations. As the 20-year-old AIDS epidemic has
shown, however, international borders are porous to viruses and other
infectious organisms.
But even if HIV-1C poses no new and urgent threat to northern-hemisphere
societies, its overwhelming predominance in the world's most
AIDS-affected regions is reason enough to focus more resources on
understanding the 1C virus, researchers say.
''It seems to mutate much more quickly than other subtypes, so there is a
greater chance there will be natural resistance to drugs,'' Moffat says.
Botswana offers a scientific blank slate to begin studies of 1C's
resistance to drugs, he adds, ''because so few people here have had
treatment.''
This story ran on page E02 of the Boston Globe on 2/15/2000. © Copyright
2000 Globe Newspaper Company.
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