Half measures: Why pills and technology aren’t enough

Examining the latest developments in HIV-related research, leading international HIV/AIDS experts attended the 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia in July. They explored how scientific advances can inform the global response to HIV/AIDS and opened the conference with the World Health Organization (WHO)’s 50 new recommendations on biomedical approaches to HIV infection, including recommendations on HIV testing, using antiretroviral medications for prevention, linking individuals to HIV care and treatment services, initiating and maintaining antiretroviral therapy (ART) and monitoring treatment. While their recommendations suggested progress towards more effective prevention and treatment generally, they did not focus on any specific population. This is a problem because, while they’re making technology generally applicable, they’re not looking at the needs of specific populations and working from there to identify the particular solutions needed. Although the solutions include biotechnologies, biotechnologies are not a general answer because solutions lie in the particular not the general. This is echoed in the calls for personalised medicine and even (in molecular biotechnology) personalised medications.


Medicine works by creating solutions that work for a specific individual, as opposed to public health which works as a “one size fits all” solution for populations. Physicians and biotech often confuse the two, putting the cart before the horse by making biotech lead health-services. Biotech should be there to support health-services, not the other way round. Biotech products can never be the solution for everyone because they do not address individual people and contexts. This is a problem that needs to be addressed because while the vested interests of commercialism look to impose their perspectives on health-services, their raison-d’être is to make money first, without a view to helping individuals in the long-run.


This biotech-based approach is what drives the specification of treatment-standards without reference to the necessary service-standards. We know how to treat an HIV infection, but we clearly don’t know how to treat a person with HIV. That’s why the transmission-rates continue to rise as do the illnesses that come alongside HIV, including Hepatitis C, depression, and so on.


Because of this, we are doing a project into the standards of services, led by researcher Luke Sleiter from New York. The project’s aim is to show how services can be more effective by providing standards for the treatment of the patient, not just the infection. The data show that treating the infection is not enough – as with Hepatitis C, where up to a quarter of people who are cleared of the infection become reinfected in some clinics, because basic mental, social and behavioural issues have not been addressed.


I am working closely with Luke as communications intern to launch a ‘Patient Voice’ campaign whereby the patient feels empowered and participates in their treatment program by voicing their individual needs. This also relates to the ‘Rights and Responsibilities’ research at the Tuke which is building upon a new framework that enables rights and responsibilities equally. This is key to the effectiveness of health services provided.


The WHO conveyed to the IAS conference that their guidelines include expanding the use of ART medications from treatment of the infection to prevention of the infection. However, they lacked any guidance as to how and if at all to treat the behavioural, social and mental health of people with HIV, and given that HIV is a pandemic driven by behaviour, this is short-sighted.


At the recent ‘HIV at 30’ conference at Cumberland Lodge, Chairman of the Tuke Institute Dr Rupert Whitaker mentioned the necessity for comprehensive and integrated services. This again refers to individual needs and social, mental, behavioural as well as physical health-services which are essential for helping a person get well in the sense of the WHO definition of health which states: ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’


Rupert Whitaker commented on the subject recently, asking this vital question: “As patients, we have been assured by physicians that medication is all we need in response to serious sexual infections, such as HIV. However, pills are clearly not enough to solve the problems of infectious epidemics, we should routinely include behavioural medicine in health-services, because HIV is about behaviours like sex and drug-use” While pills fix the infection short-term, the patient might not have actively changed behaviour, and this can often be unnoticed for long periods of time while it is assumed by the physician that the patient is recovering and is acting in his health’s best interests. It isn’t until it is specifically requested, or offered upon observation, that the need for behavioural medicine and real change comes into the equation. This is fundamentally wrong; because there is the possibility that a large extent of patients who suffer with mental, social and behavioural issues alongside their physical illness go unnoticed, and therefore unhelped.


The rise of pills and biotechnologies as the sole answer to human needs and infections is dehumanising and, while the intentions of these are mostly good, they’re only part of the solution to better health because they don’t incorporate the human element and treatment that so many people require. By ‘human element’ I mean the involvement of mental, social and behavioural treatment that keeps a person healthy all-round, and not just physically.


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