Newsday’s Laurie Garrett Shares Experiences on HIV Spread in Developing CountriesLaurie Garrett, author of Betrayal of Trust: The Collapse of Global Public Health and a Newsday reporter, yesterday at the American Medical Association's National Leadership Conference outlined two main reasons why she believes AIDS is spreading rapidly in less developed regions: the power imbalance between men and women in African and Asian countries and "adolescent alienation" in the former Soviet Union, which has led to a large-scale intravenous drug use problem in the region. Garrett described the social and family dynamics she observed during a trip to sub-Saharan Africa. Typically, married men become infected with HIV by having "many" sexual partners and then "bring HIV into the household" and infect their wives, who may then give birth to HIV-positive children. But because the husband is usually the first within the family to become infected, he typically develops symptoms of AIDS first, and the family will spend all their "available resources" on treating the husband. When the husband dies, the wife and children are left "penniless," and some African social customs do not allow a widowed wife to inherit her husband's property, leaving the family with no resources. Garrett also noted that women in many African societies are unable to protect themselves against HIV because they cannot dictate the "terms of sexual intercourse." According to Garrett, if women request the use of a condom, they may be beaten by their husbands, who may think they are trying to interfere with procreation, which is "socially mandatory" as a "sign of manhood." To assuage this problem, Garrett urged that a "stealth" vaginal microbicide be developed to prevent HIV transmission in these communities. In her conversations with women in Africa, she found that women would be willing to use a tasteless, odorless vaginal microbicide that works as an HIV prevention method but not as a contraceptive. However, Garrett expressed doubt that pharmaceutical companies would take on this initiative, because they "can't imagine it would turn a profit" in developing countries.
Drug Use in Eastern Europe
Garrett also traveled to Siberia and the former Soviet Union to observe the drug problem among Eastern European adolescents, which exists "on a scale [Garrett] never personally witnessed anywhere else in the world." Not only do the youths share needles among numerous drug users, but the drugs themselves are often "crude[ly]" manufactured using human blood as an emulsifier, Garrett said. Distribution of sterile, autodestruct syringes on a "massive scale" could help control the spread of HIV through IV drug use in Eastern Europe. However, like vaginal microbicides, Garrett doubts that such a public health initiative would come to fruition, not because of obstacles associated with cost and money, but because needle distribution "politics" stand in the way. Garrett predicted that within four years, AIDS will have "eclipsed" the Black Death of the 14th century and the 1918 influenza epidemic as the "single greatest pandemic to ever have afflicted humanity" (Meredith Weiner, Kaiser Daily HIV/AIDS Report, 3/6).