Read. Enjoy. Remember never to e-mail your colleagues when you’ve had a few. Even if they have done the inexcusable and removed the indefinite article from the last line of your restaurant review. A taste:

2) I will now explain why your error is even more shit than it looks. You see, i was making a joke. I do that sometimes. I have set up the street as “sexually-charged”. I have described the shenanigans across the road at G.A.Y.. I have used the word ‘gaily’ as a gentle nudge. And “looking for a nosh” has a secondary meaning of looking for a blowjob. Not specifically gay, for this is soho, and there are plenty of girls there who take money for noshing boys. “looking for nosh” does not have that ambiguity. the joke is gone. I only wrote that sodding paragraph to make that joke. And you’ve fucking stripped it out like a pissed Irish plasterer restoring a renaissance fresco and thinking jesus looks shit with a bear so plastering over it. You might as well have removed the whole paragraph. I mean, fucking christ, don’t you read the copy?

Thanks to rival newspaper The Guardian for washing The Times’s dirty subbing in public. And to Sophie Campbell for the tip.

Activists have done a spectacular job in slapping down the price of antiretroviral drugs in the last five years. They’ve rallied big names like Bill Clinton and marshalled huge funders like the Global Fund. Even US-funded PEPFAR, once laughingly known as Purchasing Expensive Pharmaceuticals from American Retailers, is spending money on cheap generic drugs. All the while, Big Pharma has warned that eroding profit margins by pushing prices too low will discourage new investment in research.

Roche has been careful not to make a direct connection between low prices for HIV-related drugs and their decision to stop research in the area, even off the record. And there are good reasons for the decision — they were not a huge player in HIV in the first place; less that 5% o HIV related drug sales are from Roche. Many of their drugs are designed to help people only after other, more common treatments fail. And one of their most effective products is unpopular because it has to be injected rather than swallowed.

Is Roche’s announcement a shot across the bows of advocacy for cheaper drugs? “Stop eroding the profits we want, or we’ll stop inventing the drugs you need?” It’s hard to say, but I am amazed that the question is not ringing loudly around the blogosphere. I support the achievements of groups that have fought to bring down drug prices with every fibre of my body. And I certainly find it hard to feel sorry for an industry that spends far more on marketing than it does on research, and that consistently makes its shareholders richer. But is there a point when we have to start discussing how much is enough when we press commercial firms to lower prices?

One solution to the return-on-investment dilemma of is of course to provide more public funding for the development of drugs that meet the needs of poor people and poor countries. There’s been a fair bit of progress in finding public funding for vaccine research, so it’s especially depressing that yet another vaccine trial has been canceled because researchers think it’s unlikely to produce good news.

Thanks to Juan Ramirez.

Researchers looking at data from a large group of American servicemen have found that a genetic mutation which made people of African descent less susceptible to a now-extinct form of malaria also makes them more likely to contract HIV. That’s the bad news. The good news is that African-Americans with the mutation survive longer with HIV if they do get infected.

The paper is very dense, full of sentences like this:

“As there is extensive linkage desequilibrium around the DARC locus, we cannot exclude with certainty the possibility that the effects ascribed to the -46C/C genotype might be attributable to some other polymorphism(s)/genes in the LD near DARC”

But it’s been magicked into comprehensibility by Nicholas Wade, writing in the New York Times. Wade’s account of the research, a model of clear science writing, translates the DARCS and -46C/Cs into passages like this:

“The Texas-London research team is not certain how lack of the receptor promotes H.I.V. infection, but Dr. Ahuja said the red blood cells acted like a sponge for CCL5. Because CCL5 is known to obstruct multiplication of the virus, having lots of the hormone in the bloodstream may prevent infection. Conversely, people whose blood cannot soak up the hormone could be more vulnerable.”

While the people whose blood contributed to the study were all Americans, the paper suggests that the genetic modification is likely to occur also in the African populations with whom the African-Americans share ancestors. And it may explain some of the high HIV prevalence in sub-Saharan Africa. Of course HIV is distributed unevenly throughout the continent and even within particular countries; it would be interesting to map the distribution of the genetic variation.

What I love best about this is discussion of Chart Junk that it prompted at Presentation Zen. Read. Go ahead, read. Then tell me if you think the discussion is po-faced or tongue in cheek? And how come nobody picked up on Environmental Graffiti’s true wickedness, the Misleading Headline. As a resident of Ireland who has also spent time in Shanghai, I can tell you that having sex costs exactly the same in both places. Having safe sex, though; aah, that’s a different matter….

Thanks to Peter at Apt for the tip.

Most of the money will be spent on drugs to keep people with HIV alive. This is necessary, and wonderful for the individuals who are getting the drugs. But it does mean that there will be more people with HIV. It also means there are more people who can pass it on. Granted, HIV treatment reduces the amount of virus in body fluids, and makes it more difficult to pass on. It also prevents AIDS, sickness and death. So it makes the consequences of HIV less visible. The evidence suggests that this in turn makes uninfected people more careless about who they have sex with, and sloppy about using condoms. And that in turn makes them more likely to have unprotected sex with someone who is infected but not yet on treatment. Newly-infected people are both most likely to be highly infectious and least likely to be on treatment. Indeed most still count themselves among the uninfected. So while treatment decreases the likelihood of infection for individuals on meds, it can increase new HIV infections across a whole population.

That’s what seems to be happening among gay men in countries where access to treatment is near-perfect: in Britain, the Netherlands, Canada, the United States and Australia, new HIV infections among gay men are rising. The effect of rising risk behaviour weighs more than the effect of lower viral loads. In Africa, it’s likely to be worse. Crappy health and transport systems and erratic incomes may mean people have difficulty getting the drugs they need when they need them. Other STIs are high too, and both of those things can send viral loads bouncing all over the place, even for those on treatment.

Of course we need to get antiretrovirals to as many people in need as possible. But if we want that to remain plausible and affordable, we have to stop people getting newly infected, too. The only developing country that’s managed to prevent new infections while putting everyone in need on meds is Brazil. The country invests very heavily in needle exchanges for drug injectors, in promoting condoms to young people, and in good health services for sex workers. So will PEPFAR copy this shining example? Uhhh, no. There’s US$ 50 billion on the table, but not a cent for clean needles for injectors. Not a cent for sensible prevention programmes in the sex trade. A full half of the prevention money (some five billion dollars in all) must be spent telling kids to cross their legs, even though we know that abstinence programmes don’t work. (If people allocating PEPFAR money in countries want to throw less than half of their prevention money into this black hole, they have to make a special report to Congress.)

There’s still a little bit of negotiating to do on the bill because the versions passed by the House and the Senate are different. (This means that the understandable jubilation over the end of the HIV travel ban may just be premature.) But if all the current amendments stick, the US tax payer may well be financing the growth of the HIV epidemic.

For a blow-by-blow account of the Senate debate, read Scott Swensen’s account.

Condoms lead to death, apparently. Since one in 10 adults in Dar is infected with HIV, you might think it more likely that unprotected sex leads to death. But perhaps to the Catholic fundamentalist who put up the posters, passing on a fatal virus is preferable to the sin of using contraception.

At the time, I wrote that “The Condoms = Death campaign … marks a shift in rhetoric from anti-abortion to anti-contraception among a small but vocal core of conservatives in the United States. Unless something is done about it very soon, that shift is going to be imposed on millions of women and men across the globe.”

It now looks like the first victims might be women on the home front. Under new regulations proposed by the US Department of Health and Human Services (pdf), many popular forms of hormonal and indeed mechanical contraception can be re-defined as abortion. And the legislation allows people who work in tax-funded clinics to refuse to provide those contraceptive services if it offends their delicate religious sensibilities. So much for separation of church and state.

Essentially, Conservative Christians, who’ve spent decades perfecting the use of the anti-abortion hot-button, are beginning to conflate contraception with abortion in much the same way as they’ve conflated prostitution with human trafficking. They don’t try to hide it: Human Life International, the Virginia-based Catholic organisation which is responsible for the Tanzanian posters, declares “We exist…to fight the evils of abortion, contraception, sex education and family breakdown”.

If this becomes entrenched in the States, it will certainly get exported around the globe. The AIDS funding legislation before Congress already prohibits the use of HIV prevention money to support contraception for infected women. We’re willing to give a pregnant women expensive antiretrovirals to prevent her passing HIV on to her infant, but we can’t give her cheap contraceptives if she’d rather avoid being pregnant in the first place.

It’s shocking and completely irrational. Though perhaps they’re just following the lead of the World Health Organisation. When I was last on a WHO contract the health plan wouldn’t pay for contraception, but it would pick up the tab for an abortion. Ho hum.

For more details on the US legislation, see Amie Newman and Cristina Page.

Here’s some of what I say: Over three decades of fertility and sexual behaviour surveys have recorded distinct differences in patterns of sexual networking around the world. Broadly, men and women in parts of sub-Saharan Africa are more likely to have a small number of steady partners at any one time; in other regions, people often have a lot more partners over a life time, but usually just one at a time (sex in nets versus sex in strings, I call it). HIV spreads more efficiently through sex in nets, and that in large part explains why two thirds of people with HIV live in Africa.

Those are facts. Not opinion, certainly not an expression of any judgement about the inherent superiority of any behaviour or moral code. But some people have suggested that simply stating those facts plays into the hands of people who believe that sex is bad and more sex is worse, and who use that judgement to light bonfires of hatred upon which whole races get burned. One such person is ZSUZSANNA, of the Faithful World Baptist Church (Doctrinal statement: “We believe that homosexuality is a sin and an abomination which God punishes with the death penalty”.)

“I would link to her blog to prove I am telling the truth, but I won’t because I thought the woman was inappropriate, vulgar, and a psycho.” says ZSUZSANNA of a stranger who had the audacity to conceive a child by in-vitro fertilisation. I feel exactly the same way about ZSUZSANNA, but I will link to her vitriolic blog, so that you can see I’m not making it up. Choice quote:

Maybe instead of handing out condoms like candy, these people should be taught not to live like animals and sleep with everyone and everything that moves. Statistics have proven over and over that distributing condoms RAISES the incidence of STDs. This is due to the fact that people will fornicate more because they feel safe…

Let’s leave aside this good Christian soul’s inability to interpret data (one she shares with a Bush-appointed former Secretary of Education, Bill Bennet.) How many of “these people” has she spoken to? Is she prepared to write off the millions of chuch-goers of Africa as “animals” just because of differences in the way sexual partnerships are structured?

In addressing HIV, I still believe it important to state the facts and address them appropriately. But if anything I say reinforces this kind of blind prejudice, I would be sincerely sorry.

I was alerted to this rant by Lazygal.

One of the Stubborns, South Carolina’s Jim DeMint, specifically “criticized the bill’s “mission creep” into other development activities,” according to CQ Today. His solution? He’s going to offer amendments to the PEPFAR bill that relate to biofuels, oil, gas and abortions in China.

Makes sense, I guess. At least none of those are development issues.