Test Them & Drug Them: New Plan to Halt Spread of AIDS

by Heidi Stevenson

22 February 2010

The war against AIDS may start causing a lot of collateral damage in the military lingo sense—dead people. A trial is about to start in South Africa to see if HIV/AIDS rates can be cut back by testing everyone and handing out drugs to each person who tests positive. The idea isn't to save the lives of those testing positive, but to limit their ability to spread the disease.

The logic goes like this: People with AIDS often continue to have sexual intercourse. The drugs given for AIDS treatment lower the body's viral load to 1/10,000 the predrug level. This drastically limits the likelihood of HIV transmission through sexual intercourse. Therefore, rather than try to get people to avoid sex or use condoms, just give them AIDS drugs and there will be far less chance of transmission to others.

The idea is heralded by Brian Williams, an epidemiologist at WHO (World Health Organization, an agency of the United Nations). He said:

The concentration of the virus drops 10,000 times [with AIDS drugs]...This probably translates into a 25-fold reduction in infectiousness. But if you did this it would be enough essentially to stop transmission.

Demonstrating his statistical approach to problems, Williams stated:

Each person with HIV infects, on average, one person every one or two years. Since people with HIV, and without treatment, live for an average of 10 years after infection, each person with HIV infects about five to 10 people. Treating people with ART within about one year of becoming infected would reduce transmission by about 10 times. Each person with HIV would infect, on average, less than one other person and the epidemic would die out.

Does the Plan Make Sense?

Where's the documentation to support the plan? It's all based on theory. Brian Williams thinks it would be a good idea to test 'em and drug 'em. What we have to go on, though, is nothing more than his theory⁽¹⁾.

Williams is only now starting to get trials done, yet he's already running around giving speeches about how wonderful his plan is before there's one whit of proof that it might work. Since his reputation and career will be based on the results, how likely is it that the trials' results will be unbiased—especially in light of his grandstanding? That is not the methodology of a true scientist. One might also question whether his goal is really the public's health. He is, after all, hyping a plan for which he has no proof of effectiveness.

Williams figures that such a program could cut the number of new AIDS cases to a twentieth of the current numbers in 10 years, and eliminate AIDS in 40 years. Nice goal, if it can work. The problem is that none of the negative factors that could impact on the results has been taken into account.

Possible Problems With the Plan

Most obvious is that cutting the number of reinfections to a twentieth is not stopping transmission, so the disease would still continue, though possibly with fewer people becoming infected. As the head of policy at the UK HIV charity, the Terrence Higgins Trust, Lisa Power said:

We need to be clear; these proposals would very much slow the spread of HIV in areas with generalised epidemics such as sub-Saharan Africa, but they will not stop it by themselves.

HIV is believed to be a rapidly mutating virus, so one must wonder whether aggressive treatment with drugs might result in a more virulent drug-resistant form developing.

The AIDS tests are notoriously inaccurate. They produce a huge number of false positives—likely 2 false positives for every 1 genuine positive. These tests would be done on a mass basis, ultimately with the idea that everyone, without exception, would be tested on regular basis, probably annually. This could result in three times the number of people who actually have HIV/AIDS being given the drugs...

...and these drugs are nasty. They are particularly hard on the liver. Symptoms of the liver being compromised result in pain and, ultimately, death. The drugs commonly cause many unpleasant symptoms, such as nausea, diarrhea, headaches, loss of interest in food, insomnia, vomiting, pain, and neuropathy. These symptoms are indicative of the body's attempts to be rid of a toxic substance or, as in the case of neuropathy, are the direct result of damage.

Add to the drugs' toxic effects how frequently they must be taken and the sheer number of pills that must be taken. It's no wonder that patient compliance is notoriously low.

The ongoing stress these drugs put on the liver is likely to shorten life spans. So, in the eagerness to save lives, it seems likely that many people, who would otherwise have lived normal lifespans, will instead be condemned to much briefer and more miserable lives from the drugs. It's likely that, for every person who actually has AIDS, two would die much sooner from the pain of liver disease.

There is a presumption that all people who have been infected with HIV will necessarily develop AIDS, but this has not been shown. The drugs are highly toxic. People who might otherwise remain symptom-free could succomb to AIDS as a result of the treatment.

AIDS drugs damage the immune system. A person taking the drugs after a false-positive diagnosis would suffer from an impaired immune system, making it more likely to contract HIV/AIDS from an infected person, in spite of the lower viral load. That unfortunate person would also be less able to contend with the infection because of the immune system damage.

The Moral-Ethical Element

Would people be forced to take their drugs? Would they be monitored with smart pills?

Does society have the right to punish people who normally pose no harm to anyone else for not taking drugs? What if the drugs are causing distress? Does society have the right to force people to take drugs that make them ill? Does society have the right to force people to take drugs that might shorten their lives?

Does society have the right to force people to be tested for AIDS?

Who Pays and Who Profits?

Brian Williams and WHO are apparently assuming that governments would pay for the testing and drugs—no small expense. That, of course, means that you and I would foot the bill. And who would profit? That's a no-brainer: Big Pharma, of course.

AIDS drugs are already big sellers. A plan to test everyone and give drugs to anyone who tests positive would turn them into blockbusters. One must wonder if the real brains behind this test 'em and drug 'em concept is actually Big Pharma. It's interesting to note that pharmaceutical giants Pfizer and GSK (GlaxoSmithKline) recently joined in a new venture, ViiV Healthcare, to research new AIDS drugs. Do they know something we don't?

It seems unlikely that mass testing for HIV/AIDS and mass drugging of those diagnosed positive would eliminate AIDS. There are so many issues that aren't being addressed, one must question whether the plan would succeed in actual application. There is good reason to suspect that the plan would harm the health of huge numbers of people. The moral and ethical concerns have obviously not been addressed. Add to those concerns that there is one obvious beneficiary of the plan: Big Pharma.

Test 'em and drug 'em is a bad idea.

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