All voices not heard at Aids conference
July 23, 2004
Source: The Nation
The 15th International Aids Conference in Bangkok had the noble theme, “Access For All”. According to the conference promoters: “We will ensure that all voices, all experiences and all concerns are represented.”
Unfortunately the truth falls short of the hype. All voices were not represented, and access for was not granted.
Let’s take the issue of HIV testing. In the US, most of Europe and Australia, a person is not considered HIV infected until a minimum of two criteria have been satisfied - testing positive first to a screening test, which is usually an ELISA test, and then to a confirmatory test, which is almost always the Western Blot.
In the US, in fact, if the ELISA is positive, it is usually repeated, then if positive again the Western Blot is run.
And if that’s positive, the US Centres for Disease Control (CDC) recommends that the entire set of tests be run again, on a new blood sample, to reduce the chances that the tests could be reacting to one of the over 70 common conditions that are documented to cause false positives.
In Thailand, on the other hand, people are routinely pronounced HIV positive based on only two screening tests: two ELISAs or an ELISA and a GPA. The mores specific Western Blot is used only if the two screening tests disagree. This has many problems. The ELISA and similar tests were developed to be supersensitive, as a means of screening blood donations. This means they are more likely to be falsely reactive to almost any condition that causes antibody proliferation in the blood.
These conditions can be as common as the common cold, flu, herpes, pregnancy or past pregnancy, drug abuse, numerous viral and bacterial infections and many others. Moreover, according to Dr Praphan Phanuphak, an Aids specialist at Chulalongkorn University, in Thailand both tests are usually run on the same single blood sample, which means that if there is some condition causing a false positive, nobody is bothering to wait for the condition to clear and then get a second sample to be sure before declaring the unfortunate person positive.
The US CDC, in its role as Aids advisor to the Thai government is not raising its voice in objection to what is a dubious and very cavalier procedure for branding Thai people HIV positive
Why is there one HIV positivity standard for westerners, and a different, more lax one, for Thais? The answer generally given is that the Western Blot (WB) test is too expensive for poorer countries. But, according to Dr. Phanuphak, the WB costs only about US$30 (Bt1200) in Bangkok. So, while the AIDS establishment wants to ensure “access for all” to highly toxic AIDS drugs which, even in Thailand, cost hundreds to thousands of dollars a year, per person, they are not willing to provide access for all to a $30 test that could acquit Thai people of being HIV positive in the first place.
In a study conducted in Russia, 30,000 people tested positive on the ELISA. Of these, only 66 could be confirmed by a positive Western Blot. (Voevodin, A. 1992, HIV screening in Russia, Lancet) In a study published in the New England Journal of Medicine in 1988, 60 to 70 per cent of twice-positive ELISAs were not confirmed by Western Blot (Burke, et al). In a study published in the Journal of the American Medical Association, 30 to 80per cent of twice positive ELISAs were not positive on the Western Blot. (Sloand et al, 1991).
Medical literature has many studies that have reached similar conclusions.
In Thailand where the Western Blot is used, It is generally only used as a “tiebreaker” if the two screening tests disagree. But even then, the test is evaluated differently in Thailand than it is in the West.
According to Dr Wiwat Rojanapithayakorn of UNAids, only two of the 10 bands (which are supposed to represent HIV proteins) on the Western Blot test must be reactive to the person’s blood in Thailand in order to declare a person positive. In the US, generally three or more bands are needed. In France and Australia, usually four bands must react before a person is called positive. Whether called positive based on two screening tests, or on a Western Blot, a HIV positive Thai person could conceivably emigrate to the West and become HIV negative.
As a group of scientists from the University of Western Australia, Eleni Papadopulos-Eleopulos, Dr Valendar Turner, Dr David Causer and Dr John M Papadimitriou, concluded: “Many HIV positive Thais would not be HIV positive in the West.”
No Aids expert has ever provided any logical justification for these differing HIV positivity standards.
Since the countries that pronounce people positive without a Western Blot (in Africa, even without any test at all) are generally developing countries, one suspects that HIV positivity is politically, not medically defined.
As testing positive ruins a person’s life, one must ask, who decided that Western lives are more valuable than those of Thais or Africans? Under whose influence have these dubious testing procedures been implemented, and why has nobody in a position of responsibility challenged them?
Testing positive for HIV antibodies produces staggering psychological stress and turmoil in a person, which by itself is proven to suppress the immune system and make a person more likely to get sick.
It is well documented that many people commit suicide shortly after being declared HIV positive. Nobody should be branded with the stigma “positive”and have their lives crushed on relaxed criteria that would not be allowed in richer countries.
Marcel Girodia
Special to the nation
