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Professor Gordon T. Stewart
Emeritus Professor of Public Health, Glasgow University

ABOUT HIV-AIDS on 24th September, 2010.

Soon after AIDS was first diagnosed in 1981 in communities of promiscuous homosexual men in CA and NYC, the CDC classified it descriptively as a Gay-related immune deficiency GRID. This description sufficed to monitor the fast track of cases in these two states until, in 1982, AIDS was pronounced without reason to be affect to women though it was not until 1985 that validated cases in women were registered, even in CA. However, by that time the papers by Montagnier, Gallo and their colleagues had been accepted as proof that AIDS was cause by a retrovirus HIV which was universally infectious by heterosexual and perinatal transmission universally. This was never proven scientifically but remained as an inviolate assumption which WHO, UN AIDS and health authorities accepted internationally and without exception through 2007 for surveillance, clinical diagnosis, prevention and treatment, in parallel with an presumption that it was incurable and eventually fatal unless suppressive antiviral drugs were prescribed forever under varying schedules and with many changes and options. It was presumed also that AIDS would never be prevented except by a vaccine, unavailable then and now. In 2008, Professor Montagnier and Dr Barre-Sinoussi of the Pasteur team in Paris were awarded a Nobel Prize for their discovery of HIV as the universal single, necessary and sufficient cause of AIDS everywhere. However, in accepting this award, Montagnier conceded the importance of biological and other co-factors in the pathogenesis of active infection, and used these as reasons for a new and wider base for management of HIV/AIDS.

There are good scientific reasons for accepting his new approach but, by definition, it reduces to nil the claim that HIV is the unique cause.The underlying reality, well recognised in gay communities and scientific insiders, but not acknowledged by orthodox medicine or health authorities, is that diagnosis by tests for HIV is surrogate and liable to be fallacious because they are, along with some other tests of immune activation, non-specific markers of persisting infectious or other pathological changes indicative of damage to natural immunity. This is why, in backward communities and countries, positive tests overlap with malaria, tuberculosis, malnutrition, recurring diarrhoeas along with neglect of children and gross abuses of women. Because of this, 30-40% of these populations are at risk of AIDS compared with rates of 0.01 to 0.1% in the low risk populations of developed countries. This difference is now explicitly admitted in the USA where some large black-hispanic minorities now show HIV levels exceeding those of the original white homosexual groups. Since everyone with HIV including immigrants are eligible, exceptionally, for unconditional treatment and lifelong support, the nightmare of unaffordable costs finally forced health authorities to plan cuts in 2009 of $170 million. Projections by an expert group at Johns Hopkins University in Baltimore of five outcome scenarios found that current trends could raise the prevalence of HIV to 38% and cost expenditure of an “Additional $128 to 237 billion in medical care”. By the same tolen, it is finally admitted that, even if annual new infections are somehow stabilised over the nest ten years at 55,400, prevalance of HIV would increase by 29% mainly because of continuing transmission in the resident population of homosexual men. Other studies, not only in the USA have shown, that this is now accompanied by increases in bisexual and other parasexual behaviours. Paradoxically, the Hopkins scenarios all conclude that, to date, preventive programmes have already “Averted more than 350,000 infections and saved more than $125 billion in medical costs”.

In European countries, where the prevalence of HIV and AIDS in resident populations is one-tenth or less than that of the USA, the medical and financial arithmetic is on far lower scale but in some countries the overlap with transmission of hepatitis and other AID-defining infections by needle-sharing drug users, extensions of high-risk promiscuity, commercial sex, new patterns of high-risk behaviour and uncontrolled immigration are raising new challenges for prevention which limit and often negate medical interventions: if an eligible candidate vaccine was available, who should receive it, when and how often, and how would scientists, manufacturers and users cope with a virus which apparently begins to mutate as soon as it is given?

Socially, the problem is complicated by problems of relationships, child care, mandatory welfare, fiscal support and – in the UK, for example – the fact that name-based, geographic, duplicate and partner notifications are not permitted and almost everything is optional except that a child can be taken away from parents who decline testing.

The special report by the US CDC is aimed at homosexual men, bisexual couples and drug users because in all of them the problem is not HIV or any other single, impersonal agent. It is their personal prefence for a sexually promiscuous homosexual life style and behaviour, life style and contacts. Whenever they recognised and avoided or desist from this, as many with homosexual preferences did, their suffering and that of their intimate contacts lessened or ceased, and the communities in which they lived were spared the problems and public costs, which were always unjustifiable and are now unaffordable, of their behaviours. This has been increasingly obvious since 1985, but was obscured by professional and political pressures and deceptions which soon prohibited disclosure and led to impasse of reasoning. It might now be possible to begin to clear this, at least in developed countries. In developing countries, the onset of diseases registrable as AIDS was later in a pattern which was fundamentally different, but equally or more in need of independent attention.