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Frerichs, R.R. Asian Crisis -- HIV Testing Issues,  Frustrations and Conduct.

SEA-AIDS Network, January 21, 1999.

Posted in response to:

SEA-AIDS, January 20, 1999

From Rachel Sacks, New York

I find it ironic that even as SEA-AIDS list members are discussing the dire consequences of the Asian financial crisis on HIV prevention and AIDS care programmes in Asia, Dr. Frerichs still chooses to ignore all logic and expound upon the glories of widespread HIV testing.

It is now two years since Dr. Frerichs first shared this viewpoint with us from his SEA-AIDS soap box -- to which he commutes from Los Angeles, USA. It is also one year and a half since he stood at a podium during the 4th ICAAP in Manila, at the satellite session on AIDS in India, and displayed his complete ignorance about the testing already being done there and its effects on the epidemic. The audience at that session literally silenced him; and participants on this email list often remind him of the simple realities in their countries and localities.

     Confronting HIV in India (Oct. 26, 1997 Slide Talk)

Dr. Frerichs contributes so often, that I just KNOW in advance what he'll say. I know it never changes, so I've never experienced even the most remote urge to respond to him -- until today, when the juxtaposition of his submission with the others was just too striking to ignore...... I have just a simple comment.

In the real world of India, Thailand, the Pacific, and all the countries in between, there is a choice to be made should we spend the few "development dollars" that still float around Asia on mass testing programmes? Or should we spend them on care for those we already know to be infected, and mass prevention for those who may or may not be HIV positive as yet?

That's it. It's a simple choice.

So, go ahead spend all that money on testing, and satisfy academics and researchers who itch to find new populations to test their drugs on (yes, I know there are other reasons to test, but let's keep the illustration as simple as the principle is). With the advent of the Asian financial crisis, even the few positive folks who HAD access to the existing drugs can't afford to keep up their treatments -- so we can all imagine what'll happen with the next batch of new protease inhibitors or antiretrovirals they decide to test over there....And, remember even AZT is only available while you're pregnant.

But go on --help us establish reliable Asian baselines, and from those statistics, we can develop perfect theoretical programmes, and on and on. But please don't expect to have any money left over to actually HELP all of those people who test positive in your mass testing programmes. And never mind those who know they're positive already.

There will be no money left. Period. So if you think that's the only way to make the case for funneling more development money into the region, think a little harder. By the time the bureaucracies get working on those new statistics, no one will be around to receive the benefits of those new and perfect programmes.

This tirade is intended to note that the "human rights issues," which Dr. Frerichs so hates to discuss, are more simple than he seems to be capable of even imagining. And by the way -- I, too, am writing from the US -- but I did bother to spend a few years in Asia before getting on my soapbox.

Whew. I've been waiting two years for that.

Rachel Sacks, MPH

Co-director of Community Outreach

and Education

Body Positive of New York

R.R. Frerichs Posting

Frustration. HIV seems to bring this out in people, as exemplified by Ms. Sacks in today's posting. Is the villain the virus, or is it people who disagree with conventional logic? It is difficult to insult a microbe, since biologic agents have only survival in mind, considering ways to move from one person to another. It is far easier to criticize people, but the consequences may be un intentioned or unexpected. Instead of giving voice to the intellect -- challenging assumptions about testing or no testing, treatment for pregnant women or no treatment, partner notification or no partner notification -- frustrations over perceived slights or wayward views affect the mind and logic becomes the loser.

On January 10th, SEA-AIDS presented a guide for contributing to postings. The author of this helpful item mentions early in his narration:

"This document is not intended to teach you how to use Usenet. Instead, it is a guide to using it politely, effectively and efficiently. Communication by computer is new to almost everybody, and there are certain aspects that can make it a frustrating experience until you get used to them. This document should help you avoid the worst traps."

It then goes on to describe the traps that some may fall into, letting their fingers fly when pause and thoughtful reflection would have been the more appropriate response.

Rather than becoming irritated with a fellow traveler, I would encourage Ms. Sacks to use her experience in Asia to share with us specific solutions to the many problems we have been discussing. It may ease her mind to know that I have not spent all my time in Los Angeles, but rather for the past thirty years have been involved with international work in Latin America, Africa and Asia. In Asia I have worked most extensively in Bangladesh, Myanmar, Thailand, Vietnam, the Philippines, Indonesia and most recently, Mongolia.  Each of these countries have had to face varying levels of HIV, offering challenges to their health care and social systems. It is countries such as these that are the focus of SEA-AIDS, and is where our attention should lie, not in castigating messengers or those who offer dissent from common themes. 

With that said, I encourage Ms. Sacks and others who feel similar irritations to come on board, relate her experiences and move forward in a positive and productive manner. We all would benefit.