DISHONEST APPROACHES TO PUBLIC HEALTH

As the intense public curiosity about swine flu makes plain, it's
easy to become fascinated to the point of obsession with new
diseases. Michel Kazatchkine knows that feeling well. As an
immunologist in Paris in 1983, he treated patients returning from
Africa with unexplained symptoms. By 1985, he had opened an AIDS clinic.

"For a physician, a new disease, it's a very strange feeling. Of
course it comes as a threat, and then you want to understand. There's
nothing that is more frustrating for a physician than not
understanding, because not understanding means not helping. The first
years, the '80s, were years of total frustration, of death."

These days, he has new frustrations. He is now the executive director
of the Global Fund to Fight AIDS, TB and Malaria. Today, he's
frustrated because the Global Fund is facing a funding shortfall of
more than $4 billion.

He's also frustrated because so many people -- including Prime
Minister Stephen Harper and Pope Benedict XVI -- continue to ignore
the evidence about how AIDS is spread and how it can be prevented.

Kazatchkine made his first official visit to Canada in April. He met
with Canada's international co-operation minister, Bev Oda, who used
the occasion to make a saccharine statement about Canada's
contributions to the Global Fund. "I am proud that this government
continues to be a worldwide leader in the effort to combat widespread
and deadly diseases," the minister said.

Canada was, as Oda said, "instrumental" in the creation of the Global
Fund in 2002. The fund is one of the most effective tools ever
created for combatting infectious disease. It's evidence-based:
projects that will work get funded, and projects that won't, don't.

Canada likes supporting the advancement of medical science in noble
causes. Except when it doesn't.

Oda didn't mention that a few days before their meeting, Kazatchkine
made international headlines when he called for the decriminalization
of drug use, and said governments should encourage harm-reduction
strategies for intravenous-drug users.

"A repressive way of dealing with drug users is a way of facilitating
the spread of the (AIDS) epidemic," Kazatchkine told The Observer.
Then he said the same thing to an international conference in
Bangkok. And then he came to Canada.

I doubt anyone knows the AIDS epidemic more intimately than
Kazatchkine, who has spent the last quarter-century fighting it. If
he says drug laws are facilitating the spread of AIDS, we should
listen to him. (He emphasizes that he's talking about decriminalizing
use, not trafficking.) If he says harm-reduction works, we should
listen to him.

So what did this Canadian government, which is so proud of its
connection to the Global Fund, do right after Kazatchkine's visit? It
sent its lawyers to Vancouver to fight to shut down the
safe-injection site there.

"I've heard about the controversies that I must say I wouldn't have
expected to occur in a country like yours," Kazatchkine told me. "I
find it very frustrating and disappointing that, after so many years,
the area of HIV prevention where the most compelling evidence on
efficacy is, is still a matter of debate and resistance."

He is similarly baffled by the recent statements by Pope Benedict
XVI, criticizing the distribution of condoms in Africa. "I think it's
an absolute scandal to say such things, and particularly scandalous
to have those declarations while he was flying to Africa, and to
Cameroon, which is a country I know well. It is a country with a
generalized epidemic, and I cannot understand that any type of
ideological thinking should prevail over reducing harm and having
public health, the health of the people, as the number one priority."

It's heartbreaking to watch political and religious leaders squander
the opportunities provided by 25 years of hard work on the AIDS
front. There has never been a better chance to halt the spread of HIV
than right now. After the difficult years of the 1980s, solutions
began to appear in the mid-1990s. Drugs were available, and an
international consensus developed about the need for widescale
treatment and prevention. But then, for several years, the effort
stalled again.

It has only been in the last few years, since the creation of the
Global Fund and other creative initiatives, that there's been real
reason for hope and even excitement. More than four million people in
the developing world are now receiving antiretroviral treatment, two
million of them through programs supported by the Global Fund. The
life expectancy of an HIV-positive person has skyrocketed, making it
likely that a 20-year-old Canadian on antiretroviral treatment will
live into his or her 60s. Unless that HIV-positive person is an
intravenous-drug user, which reduces the life expectancy of a person
on antiretroviral treatment by about 12 years. And as Kazatchkine
points out, drug users might not start antiretrovirals in the first
place, because they're hiding from the system.

Canada's government cannot in good conscience continue to
congratulate itself on fighting AIDS, so long as it refuses to hold a
frank conversation about its drug laws.