AIDS testing - Nir Kafri - 30.11.2011
AIDS testing at a clinic of the Israel AIDS Task Force in Tel Aviv, Jan. 15, 2008. Photo by Nir Kafri
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Adam Glassman
Drawing by Adam Glassman, reading 'lifesaver' on display at Dizengoff Center in Tel Aviv for International AIDS Day. Photo by Adam Glassman

Tomorrow is International AIDS day. Thirty years ago, in 1981, when Dr. Michael Gottlieb began working at the University of California Los Angeles Medical Center, the young doctor could not have imagined that within six months he would identify the first five patients with a disease later known as AIDS. Acquired Immune Deficiency Syndrome quickly became an international epidemic and the disease has changed the world. Sixty million people have been infected, and 30 million of them have died.

The first AIDS medication, AZT, hit the market in 1987. Twenty years later, a combination of drugs, called a cocktail, was used to defeat the disease. Over the last decade, drugs so effective that patients achieve near normal life expectancy with a high quality of life have been available.

HIV carriers today can give birth to children who are disease-free, they can work and even serve in the armed forces, and they may enter the U.S. (One of Barack Obama's first steps as U.S. president was to remove the ban on entry for HIV carriers ).

Nevertheless, while the Western world makes vast strides forward, Israel is still treading water and in fact lagging behind.

Individually tailored drugs needed

One of medicine's aspirations is individually tailored treatment, which insures consistent use, safety and a high rate of effectiveness. While in other areas, doctors may merely dream of this, in the AIDS field today there are genetic screenings and drugs which can make the dream come true. Such treatment is of the utmost importance, because a lack of adherence to treatment protocol is highly dangerous, as it is likely to cause the virus to become drug-resistant. In order for patients to stick to their regimens, the treatment must be tolerable, and not cause difficult side effects.

Since each patient responds differently to drugs, individually tailored treatment reduces side effects to a minimum.

The age of patients has been declining in recent years. Some of them are 22 or younger, and some carriers have been identified during army service. They will need drug treatment for many years. Yet, while other developed countries have begun using the new, more effective and safer drugs, in Israel they are not included in the first line of drugs covered by health insurance, following cutbacks in health funding.

In order to receive a new drug, the patient must first try an old one, suffer the side effects or discover that the virus has developed immunity to the drug, and only then receive the new one, which, if he had received it in the first place, would have saved him much suffering.

One of my friends, a doctor, was forced to cope with the cocktail's side effects for a month, after he was jabbed by an HIV carrier's needle. The immediate side effects include nausea, gas, diarrhea and difficulty concentrating, and long term effects such as metabolic disturbances, increase in lipids and malfunctions of the liver and kidneys.

One of the most disturbing effects is lipodystrophy, the degeneration of fatty tissues on the face, buttocks and limbs and their migration to the back and stomach. The phenomenon creates an aesthetic problem, as well as deficiencies in resistance to insulin and blood lipids which increase the danger of heart attacks and other circulatory system diseases.

The U.S. Food and Drug Administration recently approved use of the new drug Tesamorelin to treat the problem of stomach fat, which improves the quality of life and apparently leads to a decrease in heart disease as well.

The stigma remains

If all this wasn't enough, while in the Western world, AIDS stepped out of the closet a long time ago, in Israel it is still a disease that many suffer in private. The stigma has hardly lifted and many carriers prefer to avoid exposure.

In France three months ago, a dentist who refused to treat an AIDS patient was brought to trial. In Israel many dentists, like many other doctors, refuse to treat carriers and there is no one to bring them to court.

Today it is clear that early detection increases the chances of slowing the epidemic, and so health departments the world over encourage AIDS testing. In Israel, however, many difficulties block the way. Recent research shows that early location of carriers and early treatment with antiretroviral drugs prevents 96 percent of the spread of the infection. All over the world the approach of treatment as prevention is being developed and is likely to save many from the disease.

Even if it is relatively expensive, it prevents more infections and therefore justifies itself in terms of effectiveness. Israel refuses to institute such a policy.

In addition, while the rest of the world (including poor countries ) encourage pregnant women to have an AIDS test as government policy, our government is blind. The declared policy in Israel is that there is no need to test women who do not belong to a high-risk group. And so, every year in Israel five children are born HIV carriers whose infection could easily have been prevented.

While until three years ago it was possible to say that Israel stood at the forefront of science and treatment, I am sorry to say today that this is no longer true. And since AIDS patients in Israel are anonymous, they will not go out into the streets and won't erect protest tents. It is our obligation as human beings, as a country, to change this policy. As Nelson Mandela said, our approach to AIDS reflects who we are as people.

The writer is chairman of the Israeli Association for AIDS Medicine and director of the AIDS and sexually transmitted disease clinic at the Sheba Medical Center.