HIV and medical justice. (Your Letters).

Publication: Mothering

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COPYRIGHT 2002 Mothering Magazine

I rarely have been so disturbed by articles as I was by Mothering's on HIV and pregnancy ("Safe and Sound Underground" and "Molecular Miscarriage," September-October 2001). Had you limited the argument to protecting any individual's right to decide if and when to take medical advice, I would have applauded. Those cases of women being coerced to take antiviral drugs are appalling and are not the mainstream opinion in the HIV world, which is that all testing and treatment must be voluntary. Unfortunately, you then grafted onto this important truth all kinds of pseudoscience and misinformation.

Please allow me to address these issues. The main risk factor for the disease in the world is heterosexual sex (and the lack of basic human rights). The disease is without symptoms for many years. Most people with HIV die if not treated. The antibody test is accurate when confirmed with further tests, and the viral load test is very accurate.

The idea that AIDS is not caused by HIV is debunked by 99 percent of the world's best scientists. The syndrome of AIDS, with its panoply of opportunistic infections and cancers, is unique to those who test positive for the virus and in no other disease. The viral genome is well characterized and its evolution well described by scientists here at Los Alamos.

Combination anti-HIV therapy, not the single therapy with AZT to which you keep referring, has dramatically reduced the death rate from AIDS over the past five years--strange indeed if it did this without its target, HIV, being the cause of the disease. Here at our center in Santa Fe the death rate was one per week for many years. Last year, with a much larger numbers of clients, we had three deaths. This year, we have had three deaths so far, all in people who declined to take drugs--their choice, and we cared for them to the end. You are right in saying that these drugs have potentially serious toxicities. Usually, together we can find a combination that the person can live with and that controls the virus. Taking the drugs every day is a difficult challenge.

You are also right in saying that the average rate of transmission from mother to baby is around 25 percent. With modern combination therapy, this is reduced virtually to zero (<1 percent). Some babies with HIV survive; most do not. To advocate, as you seem to, that it is not worth treating all pregnancies to save one in four babies is outrageous. Yes, it's a mother's right to say no, but to characterize the advice to treat as medical fascism is trendy silliness and gravely irresponsible.

Breastfeeding in the developing world in women who are HIV positive is associated in most studies, as you say, with a transmission rate of 15 percent per year. Formula feeding without access to clean water is associated with such increased risks of diarrheal diseases that it's hard to know what to recommend. Here in the US, with breastmilk banks and clean water, it is better to be safe and not breastfeed, hard though it is to make such a statement after all these years of advocating breastfeeding.

You might want to come to our center and talk to the brave women with HIV...

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