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Research on HIV prevention gel put black lives at risk

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benguela
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« on: August 03, 2010, 18:39:03 PM »

In this world there are the scientifically illiterate inciting racial hatred and the literate
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Faerie
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« Reply #1 on: August 04, 2010, 09:34:25 AM »

Yes, unfortunate is'nt it.

education, education, education....

We'll have to drag them kicking and screaming into the century of the fruitbat - to misquote Pratchet, but to do so, one will have to adress the ignorant in positions of power first - such as this journalist, instead of educating and uplifting his readers, he managed to assert his own and their ignorance which will only be passed on to the next generation.....

My domestic help - part of my family for the last 15 years - contracted HIV some 4 years ago, she found out when she fell pregnant, together, we seeked help and she took her meds religiously, baby was born clean, and she's with us still, healthy as a horse and eating my snack cupboard clean - her brother on the other hand, was diagnosed some 18 months ago and we saw him into the ground last week-end. His logic - it was the white man's disease and the meds would kill him sooner. Well, as far as education goes, at least my domestic speaks up as an example to her family, and her three children learnt from this, and hopefully, their children will in turn be educated enough by them to understand the difference.

*sigh* these things upset me.
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Mandarb
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« Reply #2 on: August 04, 2010, 15:44:43 PM »

FFS. Are we back in the 1950s now? Experimenting on the poor because they have little choice?
I read about this in passing, and I was wondering how do they control for this kind of trial. It's disgusting. The same for the circumcision trial a while back.

* Mandarb tries to go and find original trial doc.
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Mandarb
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« Reply #3 on: August 04, 2010, 15:53:00 PM »

Heh, slash me works here. Cheesy

Found this:
Quote
In his column published in the Sowetan on 27 July 2010 (“Research on HIV prevention gel put black lives at risk”), Andile Mngxitama viciously attacks South African researchers who recently announced a huge breakthrough in the development of a microbicide, a gel that they hope women will be able to use to reduce their risk of being infected with HIV from sex.  Under the guise of black consciousness he distorts facts, takes an opinion on something he knows little about, and makes statements that will cause life-threatening confusion.  Steve Biko would never have written in this way.

Mr Mngxitama is wrong on every count.  Let me set out the facts.

The trial he refers to is known as CAPRISA 004.  It is the first trial ever to establish that a microbicide reduces the risk of women contracting HIV from sex.  Until the trial results were made public, no-one knew if such a gel would offer any protection.  Earlier studies had only shown that it was safe to use.  Now the scientific world has evidence on the basis of which many women – especially black women – may be protected from HIV infection in the future.

The trial did not put black lives at risk.  All the women who participated were extensively counselled about HIV prevention.  In fact there is evidence that simply participating in a trial reduces the risk of HIV infection.  But it is also known that even in trial settings, where participants are freely provided with condoms, lubricant and ongoing HIV counselling, some degree of unsafe sex continues.  As a result, after 2½ years, 11% of trial participants – and not the 60% Mr Mngxitama claims – contracted HIV.

Mr Mngxitama asks why the study was not conducted on urban white middle class women.  The answer is simple.  There is a high prevalence of HIV among black women because of the combination of poverty, sexual and social inequality and illiteracy.  It would have been impossible to conduct this study amongst a population that has a relatively low HIV prevalence.  The trial participants were chosen because they are part of communities that have been hit particularly hard by HIV.

The reality is that many women in South Africa have unsafe sex, often because they are unable to get their male sexual partners to wear condoms.  They are fully able to make choices for themselves, but all too often their male partners impose their bad choices on them.  It is these women who are most in need of female-controlled prevention tools such as a microbicide.

Mr Mngitxama protests that “none of the women knew who was protected and who wasn’t.”  But a key principle of clinical research is that the only scientifically acceptable way to do determine if a new medicine works is by randomly dividing the trial participants into two.  The first group is given the test product.  The second group is given what is called a “placebo”, something which looks, feels and smells exactly like the product being tested, but without the trial ingredient (medicine) – in this case the antiretroviral (ARV) medicine tenofovir.

So, all women got gels, but only half of them got gels containing the drug.  However each participant was fully counselled about the trial and understood that:

(a)    There was a 50% chance they had been given the gel (and a 50% chance that they had been given the placebo);
(b)    There was no evidence that the gel worked; and
(c)    Even if the gel worked, it would not be 100% effective – meaning that condoms should also be used consistently and correctly.

Without any evidence, Mr Mngxitama patronisingly suggests that informed consent is “tricky” for vulnerable women.  Echoing former President Thabo Mbeki he attacks orthodox science and accuses those who have conducted trials of male circumcision and microbicide gels of “medical science genocide” and of treating blacks “as one would treat an animal”.

I could go on and on, but I won’t.  But let me list two more of Mr Mngxitama’s long list of errors and misleading suggestions:

•    The women who tested HIV positive were not “used as lab rats and discarded” – they were all directed into care.  As and when necessary, they will be able to access ARV treatment.
•    New prevention technologies are not being targeted at blacks, but rather at all people at high risk of infection.  For example, a trial that is currently taking place in Cape Town amongst men who have sex with men is designed to establish whether a daily dose of two ARV medicines can reduce the risk of HIV infection.  Many of those participating in the trial are white and middle class.

Finally, there is a good reason why those concerned with medical ethics have not raised their voices about the trial – it was conducted ethically.  The researchers have advanced the struggle against the pandemic in South Africa and beyond.  They are African scientists advancing African knowledge from African universities. They are deserving of our praise, not uninformed and dangerous attacks.
 


http://www.tac.org.za/community/node/2920

I have more respect for the TAC than for a columnist.
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Hermes
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« Reply #4 on: August 04, 2010, 16:07:42 PM »

Found this:
A link to this appeared in benguela's OP.   Not a problem, no harm done.
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Peter Grant
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« Reply #5 on: August 04, 2010, 19:04:35 PM »

Andile Mngxitama is an idiot. People are being infected and dying of AIDS whether they participate in trials or not. Should we stop doing research and just sit back and watch more people die?
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BoogieMonster
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« Reply #6 on: August 06, 2010, 10:18:08 AM »

It's one of the "immoral" consequences of all clinical trials. This happens in rich countries to rich people too. In a cancer trial where people can die from not getting the experimental medicine, you still have a 50% chance of just getting a placebo. Is that acceptable? The question becomes the age-old one of "the interests of a few against the interests of millions". The cold hard truth is, this is the only way to get cold hard numbers to prove that something works.
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Mefiante
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« Reply #7 on: August 06, 2010, 11:32:31 AM »

True enough as far as it goes, but there’s a flipside too – actually, a few of them.  (I’m deliberately ignoring that “immoral” is in quotes.)  The treatment under trial may not work at all and/or even produce serious side effects.  These aspects are largely unknown, which is why the trial is being conducted in the first place.  Trial participants are always comprehensively informed of the risks, potential or actual, as well as their chances of receiving the placebo vs. the treatment (which need not be 50:50 because the test and the control groups don’t have to be the same size).  The participants are selected from a suitable pool but they are neither forced into nor excluded from taking part against their will; they are free to opt in or out, based on the information they have been provided with.  The legal term is “informed consent.”  Clearly, participants who opt out also have a zero probability of receiving the treatment being tested in their immediate future.  There is also a slowly growing trend towards evaluating the efficacy of new treatments against that of existing ones, rather than against a proper placebo, especially in the case of treatments for serious diseases and syndromes.

'Luthon64
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BoogieMonster
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« Reply #8 on: August 06, 2010, 14:47:23 PM »

The "immoral" is in quotes because it is subjective, not because I'm inferring a certain meaning. That's all.
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Peter Grant
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« Reply #9 on: August 06, 2010, 20:36:19 PM »

This is the first HIV prevention lube developed so far right?
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Peter Grant
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« Reply #10 on: August 06, 2010, 22:30:18 PM »

OK, not a lube. Read something about application every twelve hours, that's either really impressive or I misunderstood something. It would be way cooler if they could just put it in KY jelly.
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Mandarb
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« Reply #11 on: August 10, 2010, 08:33:03 AM »

Takes foot out of month. Sorry, should have read the OP properly.
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