The coincidence of the reports on our first H1N1 related death and the guy who came out with respect to his HIV, gave me cause to think about how the world treats these two pandemics.
It is becoming increasingly clear that the mortality related to H1N1 is nowhere as high as was initially estimated. A recent article in Eurosurveillance by two New Zealand public heath experts reviewed the methods for estimating the case fatality ratios (CFRs) for the H1N1 flu and concluded that the current methods overestimated the CFRs. They present possible alternative methods, which despite their limitations, all produce much lower CFRs (0.06% - 0.0004%) compared to the original estimates of 0.4%.
By contrast also, the HIV CFR has an almost surreal air to it. Nobody talks about HIV related deaths in the same way as for H1N1. For example, a heart attack patient with positive H1N1 would be an H1N1 related death, but an HIV patient dying of a heart attack would not be a HIV related death. Even so, the very crude estimates of HIV CFR is in a totally different ball park from H1N1. In 2007 WHO reported a global incidence of 33 million cases of HIV. Over the same period 2 million AIDS deaths were reported. This allows us to make a very rough estimate that HIV related deaths could be at least 6%, 10 x the worst estimated CFR for H1N1.
Yet we run around panic stricken, whacking at the H1N1 flu with fancy words like containment, mitigation - quarantines, contact tracing etc etc.....while treating HIV almost with kid gloves.
The word that epidemiologists use for this is - 'exceptionalism'.
HIV is probably one of the most destructive pandemics in human history. Since 1981 when it was first discovered it has been estimated to have killed 25 million world wide. Yet we are afraid to manage it in the same scientifically rational way we manage all other epidemics. Activists and lobbyists have managed to persuade the global community that to do otherwise is a human rights offense.
So we have been powerless to deal with this pandemic in the correct way.
But things seem to be swinging away from that falsehood as people come to terms with the destructive nature of the pandemic. In 2007, the US CDC and and WHO/UNAIDS finally got the courage to recommend that testing for HIV be part of routine clinical testing. This is 26 years too late if you ask me.....but at least it is now being done.
Singapore followed suit with Changi General Hospital taking the lead. Senior Minister of State Ministry of Foreign Affairs, Dr Balaji, reported (Nov 2008), "... Changi General Hospital was the first hospital in Singapore to pilot voluntary opt-out HIV screening for inpatients just under a year ago. They have shown that it can be done. More than 3,000 of their patients have been screened so far, and around 50 have been found to be HIV-positive. The Ministry of Health has asked other acute hospitals to implement a similar opt-out HIV screening programme for their adult inpatients, and it should be in place in all public sector hospitals by the end of the year. Private hospitals should also study how they can implement opt out testing as this becomes the standard of care."
Let's do away with exceptionalism once and for all, and deal with a pandemic the way pandemics ought to be dealt with. Scientifically, rationally and truthfully.
Read "Changing the Paradigm for HIV Testing — The End of Exceptionalism" in the New England Journal of Medicine.
5 years ago