Kevin De Cock, the World Health Organization’s director of HIV/AIDS programs, spoke at the opening of the HIV/AIDS Implementers’ Meeting on Wednesday. Delegates are still talking about it. He made one dramatic warning: Some people, “no matter how unfairly,’’ may draw comparisons between AIDS treatment in the developing world today and the infamous Tuskegee study in which researchers failed to appropriately treat syphilis among poor, mostly illiterate African-Americans between 1932 and 1972.
Here’s a short interview with De Cock:
Q: What’s been most important so far at this conference?
KD: The big themes so far that have dominated have been the financial downturn and the implications for HIV financing. I thought Steff Bartozzi made a very good presentation today. What I hope personally would come out of this meeting is a widespread acceptance that we need the science to be sorted out, that the big scientific questions are addressed so that decisions are made based on evidence.
Q: What are those big scientific questions?
KD: There are obviously a lot of questions in the realm of biomedical prevention: the role of microbicides, the role of pre-exposure prophylaxis, and a bigger question of treatment for prevention. In the treatment arena, the biggest question is how early to start treatment and with what drugs? I do think we need to move toward trying to find rational regimens and get to one, or a few, regimens worldwide. So that someone in the United States would get the same drugs as someone in Namibia.
Q: Why did you raise the Tuskegee study in your speech?
KD: Firstly, let me emphasize that Tuskegee happened just in the US, while the question here is global. What happened in Tuskegee was that science progressed and made medical developments available, but a particular underprivileged community not only was neglected but allowed to continue under a previous practice that was outmoded and suboptimal.
That’s what we are facing today in a way if we don’t ensure global medical practice remains consistant through the world, and that includes the question of when to start treatment (for AIDS patients.)
We are in a position where science could tell us what is the best answer to this question: When is the best time to start antiretroviral treatment? It is unethical not to get that right answer. When you don’t know the answer, you do a randomized control trial. It is not good ethics not to do it.
There is more at stake in the South than in the North. In the industrialized world, people argue, the rate of (adverse) events at high CD4 counts is so low, the question is not that pressing. In the South, it’s more pressing, especially with the high incidence of TB. Do you really think in Southern Africa that we could get on top of TB epidemic any other way than not starting way earlier in treatment? I would argue we would not.
If we suddenly really had data — that you not only need to treat however many million now, but you need to treat three times as many, that would be a challenge. But that’s not a reason not to get the answer.