THE POLITICAL ECONOMY OF AIDS Part 1

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http://www.redflagsweekly.com/features/2004_feb17_1.html

 

 

THE POLITICAL ECONOMY OF AIDS Part 1

 

The Central Villain Is Not A Virus. It Is Poverty. And The Critical Cure Is Not

Medicine. It is Justice.

 

by Brian K. Murphy

 

Schmalhausen's Law is a general principle that organisms in unusual or extreme

conditions, at the boundary of their tolerance for any one aspect of their life

conditions, are extremely sensitive to stressors in all aspects of their life

conditions. Thus malnutrition inhibits the immune system and makes people more

vulnerable to infection. Pesticide poisoning can prevent absorption of vitamin

A, and this in turn reduces the T-cells and macrophages that are part of the

body's defences. Diabetes makes bacterial infections more dangerous. Diarrhoea

can make it easier for pollutants to pass through the lining of the gut, while

any sexually transmitted diseases that irritate the reproductive tract

facilitate the entry of HIV. Social and emotional stress and anxiety reduce

immune capacity. Poor people are often afflicted by multiple insult, allowing

even more ailments to accumulate. Therefore any struggle against poverty and

racism and abuse based on gender is also a public health issue,

and the health of a community has to be looked at not only disease by disease

but also as a whole. Vulnerability itself becomes an object of study.

 

The single-minded reliance on chemical therapies leaves us vulnerable. A

whole-system strategy for confronting infectious disease has to be much broader

than traditional medical and public health efforts. Health is determined in a

much larger arena that includes land use, demography, pollution and waste

disposal, wildlife and agriculture, poverty and inequality.

 

~ Richard Levins, John Rock Professor, Harvard School of Public Health

 

 

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No health issue has so galvanized the world and public attention as has the

acquired immune deficiency syndrome (AIDS). The acquired immune deficiency

syndrome is a condition in which a person's immune system is severely

compromised and left vulnerable to a broad range of infections and diseases that

debilitate and can lead to death. It is a medical construct that captures many

disease phenomena in one basket for purposes of investigation, diagnosis and

treatment. Within this complex syndrome there are many factors. It is my view

that no one factor - including the various viruses associated with

immunodeficiency - is alone sufficient to bring on the onset of chronic acute

immune deficiency. The most determinant predictors of immune suppression and

associated disease, in the north and the south, are factors directly related to

social and economic status or to medical treatment itself. And increasingly,

front line workers in the " fight " against acute immune deficiency are asking

that

resources be prioritized in the area of basic health promotion.

 

Closely read, the in-house literature of the international health institutions

and multilateral development agencies explains all of this. Acquired immune

deficiency syndrome is multifactoral, and social factors predominate. Yet there

has been a tendency to obscure these fundamental understandings for fear of

" confusing " people, undermining prevention programs, and eroding political

support for program funding and continued investment in pharmacological

research. Extensive resources are available for those who develop their programs

within the conventional medical framework, and most programs and public

education campaigns are built uncritically on the " HIV/AIDS " metaphor and image.

It is far easier to mobilize support to fight disease than to fight poverty and

injustice.

 

Those advocating a comprehensive and balanced approach in health programming and

public education do not insist that poverty is the sole cause of extreme and

chronic immune suppression, nor that viruses and microbes can be declared with

certainty to have absolutely no role. Indeed, most resist precisely the notion

that what is called AIDS is a single phenomenon or that it has a sole and

solitary cause. They do say that the factors and conditions that lead to such

immune suppression are dominant among poor populations, that the poor are the

most vulnerable, and that it is on poverty and its roots that we should focus. A

virus is a convenient and simple " target " to rationalize medical responses, but

it also obscures other factors that would focus responses on long-term social

and economic transformation of the conditions that make people vulnerable to the

diseases that take advantage of chronic immune deficiency. The role of medicine

- that is drugs - in resolving the crisis can only

be very limited, and there is controversy about the actual effects, negative

and positive, of pharmaceutical approaches.

 

Such a fundamental re-thinking inevitably entails confronting vested interests

and conventional wisdom, and provokes differences of opinion within legitimate

communities of concern, including among AIDS activists. However, nothing less is

sufficient if we are to help those susceptible to chronic acute immunodeficiency

and associated life-threatening diseases, especially the poor and indigent in

our own communities, and in the poorest countries of the South. And nothing less

is sufficient if we are to protect AIDS " suspects " - those considered, on the

basis of gender, race, origin, sexual-orientation or class, to be at high-risk

for infection and transmission - from the excesses that arise when fear,

ignorance and prejudice over-ride individual rights.

 

The issue is justice. The primary factors in the development of chronic acute

immune deficiency are largely social and political, rather than biological. The

measures that could effectively prevent or remediate such immunodeficiency are

neither expensive nor complicated. The pharmacological treatments - none of

which are sufficiently effective, and all of which are toxic and dangerous - are

both expensive and complicated. Neither prevention nor treatment are available

to those most at risk. They are certainly not available among the most marginal

populations in the Global South and will never be accessible to them on any

meaningful scale. And to the limited extent that pharmaceuticals do become

available, it will be at the expense of investments in community health and

social transformation that, in the final analysis, are the most effective

responses to the phenomena presently attributed to AIDS.

 

Acknowledging the debate

 

 

Over ten years ago, the evidence concerning the conventional interpretation of

HIV and AIDS was extensively reviewed and documented by Dr. Robert Scott

Root-Bernstein, a MacArthur Foundation " genius " award winner and a professor of

physiology in the Department of Biology at the State University of Michigan in

East Lansing, Michigan, in his landmark text , Rethinking Aids: The Tragic Cost

of Premature Consensus .

 

Root-Bernstein, who is a clinical researcher in the field of immunology, carried

out an exhaustive survey of the scientific literature on HIV and AIDS. He

demonstrates that the evidence for a primary and exclusive causative role for

HIV in the development of acute immunodeficiency is weak and tenuous, although -

along with most health activists who seek a moderation in the extreme medical

model and pharmacological approach to AIDS - he does not dismiss entirely the

role of HIV as one of many possible secondary co-factors in a synergistic model

of the AIDS condition. He explains why this is a subject of great controversy in

the corridors of science, and why the controversy is systematically

misrepresented - or simply ignored - in the mainstream media. And as an insider

of the medical-scientific establishment he explains in direct and critical terms

why this tragedy of bad science and misinformation has unfolded for so long. In

the intervening years, the gaps in the science have only

widened, in spite of the continued interventions of researchers and scholars

such as Root-Bernstein.

 

At the heart of the matter are an extensive list of proven non-viral causes of

immuno-suppression, many of them treatment-related (such as chronic antibiotic

use, or blood transfusions), or social/health factors (such as malnutrition,

unsafe sexual practices, and stress), as well as endemic diseases and

environmental factors.

 

Can we imagine the political impact if world-wide cumulative statistics for such

diseases as hepatitis, malaria, tuberculosis, or simple malnutrition, each of

which take millions of victims annually, were kept and widely reported

cumulatively over 20 years in the way that has been done -uniquely - with AIDS?

Although these figures do not get the same public attention, WHO reports that

well over 20% of the Earth's more than five billion people are sick or

malnourished at a given time, with the ten leading maladies being: Hepatitis B,

2 billion; Tuberculosis, 1.7 billion (WHO estimated in 2003 that almost 33% of

the human population passively carried the TB bacillus, although only about 2-3

million are stricken at any one time); Anemia, 1.5 billion; Hookworm

(ancylostomiasis), 700-900 million; Roundworm (ascariasis), 700 million;

Diarrheal diseases (amoebiasis and giardiasis), 680 million; Whipworm

(trichuriasis), 500 million; Malaria, 270 million; Iodine deficiency, 200

million; and

Schistosomiasis (parasitic infection), 200 million. Obviously many of these

maladies are suffered concurrently by hundreds of millions of people worldwide,

most in the Global South, and many such as TB are increasing yearly.

 

Every one of these most-common inflictions are also among the most serious

factors leading to the development of chronic life-threatening immunodeficiency.

And every one is more prevalent and active than HIV. When suffered in

combination with chronic malnutrition and its vitamin deficiencies (particularly

vitamins A, B6, B12, as well as thiamin, riboflavin, nicotinamide and carotene),

critical immunosuppression is inevitable and, if not remedied, so are the

opportunistic infections that lead to death.

 

 

 

 

 

 

 

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