Diary Prequel Package — page 22

to less than 10 countries before then)? Do we really know how much of that failure is due to insufficient monetary support, how much to infrastructural failure and how much to the DOTs model, itself, in varying cultural and political settings? - which HAART combos are least likely to lead to multiple drug resistance, or cross resist- ance and how that compares with the cheap combos proposed by CIPLA and MSF, etc? - what key factors have, for the last decade, prevented distribution of the Essential Drugs lists in most African countries? (Hint: it aint got crap to do with the cost of the drugs, prices set by manufacturers or WHO policies. It has everything to do with corruption, black markets, Russian mob, bad roads, lack of ship off-loading capacity at ports, warehousing in high heat, etc etc.) - WHY AFRICA? OK, I'm asking a rhetorical question here. But if global distribution of HAART makes sense for ssAfrica, why not also for Vietnam? Ukraine? Cambodia? Russia? Estonia? Is it a question of a certain cut-off, such as "societies with greater than 10% HIV+ rates?" Or 5%? Who has the right to make that decision? What are the moral issues here? Do white doctors from America and Europe get to choose which HIV poor populations on earth get to have freebie drugs? Does WHO decide? MSF? YOU?????? (If I were an AIDS doc in Bombay or Kiev right now I would be mighty pissed off....). - If, indeed, Senegal, Uganda, Thailand and Brazil have not only lowered their mass HIV rates, but sustained lowered levels, what worked? (From my observations in Uganda I would say the lowering was transient, and it is now resurging in much of the country. It was not sustained. Senegal never did have a high rate: why? All of west Africa has lower rates....why? Many believe it has little to do with prevention programs or drug access, and everything to do with male/female power balance issues and female access to the cash economy.) Jon Mann for ages had a mantra: if a prevention effort works, why? and why isn't it immediately replicated elsewhere? - Why were all the questions raised in opposition to phase 3 vaccine trials not raised for largescale HAART? Remember when NIAID decided to can Phase 3 vaccine studies? The reasons were not so much about the likelihood the vaccines would work (nobody thought they would), but concerns that people who received the vaccines would then put themselves and their partners at higher risk, based on the assumption that they were at least somewhat protected. That was shouted from the rafters, and continues to be a huge issue. NIH and CDC have spent loads of money trying to figure out how to counsel vaccine volunteers, what to say about safe sex, etc. It has been an ENORMOUS concern in the vaccine arena --- well in advance of actually having a product worth testing. But with HAART? Bupkiss. Nada. Zilcho. This seems a glaring contradiction bordering on mass hypocrisy.