The AIDS vaccine

News that trials of an HIV vaccine have produced encouraging results offer a small glimmer of hope that the AIDS epidemic may eventually be brought under control. But any optimism should be tempered immediately with some sobering statistics. Every day, according to UN estimates, 7,500 become infected by HIV worldwide, four out of five of them under the age of 25; 33 million people are currently living with the disease and a child dies from AIDS every ninety seconds. In 2007 at least 2 million people died from the disease, including a staggering 330,000 children. These dreadful numbers will not improve any time soon.

The Thailand vaccine was created from the mixture of two earlier vaccines which had failed to make any headway against the disease. Using synthetic versions of the HIV gene and the bird virus ‘canarypox’ to prime the human immune system, the new vaccine was not expected to fare any better. But, after six years of testing in which more than 8,000 people were inoculated, while a control group of equal size received a placebo, 51 of the first group contracted HIV, as compared to 74 of the second – a reduction of 31 per cent. (Both groups were given condoms and safe sex advice throughout the experiment.)

Researchers for an AIDS vaccine are understandably encouraged by this outcome, but even the most optimistic concede that there are no prospects of a smallpox-style vaccine being developed for at least several years. Even if there were, the truth is that AIDS would still continue to spread and claim lives needlessly, because the transmission of the virus is not simply a medical problem, it spreads along the fault lines of global poverty just as if it were a social problem instead of a virus. The most startling evidence of this is the statistic that three out of every four deaths from AIDS deaths, currently occur in sub-Saharan Africa. The new vaccine will do nothing to change this. Furthermore, the two subtypes of the AIDS virus (B, E) used to develop the Thailand vaccine were based on strains of the virus that are commonly found in Asia and Europe. Subtype C – the strain which is ravaging Africa – may not be conducive to the production of vaccines. Even if it were, by the time a similar trial could be completed, several million more Africans will have died. This unconscionable neglect reflects the depressingly low priority which the problems of Africa are accorded in the rest of the world, not just in political, economic and military terms, but also the search for new medicines.

Closer to home, every West Indian should be alarmed by the fact that AIDS has become the leading cause of death among Caribbean adults. Our region now has a rate of new infections that is the highest in the world after sub-Saharan Africa. This, too, is not simply a medical crisis. An article in the current Atlantic Monthly argues that a “major factor in the region’s susceptibility to the epidemic is its pervasive atmosphere of homophobia, which makes education and outreach efforts nearly impossible. Jamaica [with a]  32 per cent HIV infection rate among gay men, offers a case study in how anti-gay attitudes have helped spread and intensify the epidemic’s impact.” These attitudes reportedly include a reluctance among young Jamaicans even to say something as trivial as ‘Come back here,’ because they might be “implying that you’re ‘coming in the back,’ which is how gay men have sex.”

While Jamaica’s youth busy themselves with such absurd niceties, AIDS has cut a swathe through the country’s heavily closeted gay community. The absence of open discussion has also led to enormous social pressure to conform. Consequently a significant number of Jamaican homosexuals have masked their sexual inclinations by pretending to be ‘straight’ – some even going to the extent of getting married. This has increased infection rates and created a dangerous, largely unexamined link between the gay and straight communities. Jamaica’s fanatical homophobia can therefore no longer be seen simply as a cultural quirk, it is an anachronism which is costing lives. Elsewhere in the Caribbean, with, perhaps, the partial exception of Trinidad, old fashioned ideas about human sexuality need to change quickly if public awareness campaigns are to be effective.

The AIDS crisis cannot be solved by medicine alone. It requires social, political and cultural maturity – especially a willingness to deal with the reality of sexual life, prostitution, and drug use – and information campaigns that deal frankly with the most likely forms of transmission. At current rates of infection, a successful vaccine, whenever developed, will come too late to stop millions of avoidable deaths. Only our own concerted action can prevent those. In Guyana, and throughout the Caribbean, it is time that we faced this reality.