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BRIAN
DEER: THE VAXGEN EXPERIMENT Page 2
At first
glance, Thailand is a strange location to carry out
medical trials. The CIA rates the country as merely
an "emergent democracy"; the last military
coup was only eight years ago; and there were Bangkok
riots in 1992, when 91 died or went
"missing". Corruption is de rigeueur, while
police are accused by Amnesty International of
"extra-judicial killings". Much of its
profile relies on sex: first with young women and
later with children.
Since
the coup, however, quick cheap, experiments on the
Thai population have been added to the country's
attractions. Dozens of projects are currently in
progress, run by foreign pharmaceutical companies and
sponsored by the CDC and WHO. With an estimated
800,000 Thais infected with HIV, Aids is the big one,
with tests of drugs, immune-system stimulants, and
top of the list Francis's AidsVax trial.
It
makes sense to test products where the risk of Aids
is greatest, but my attention was drawn to potential
problems during a conference in a Bangkok hotel. The
topic was Aids vaccines. Francis spoke. And a doctor
pointed out that some volunteers in an AZT trial were
mothers from remote hill tribes. "They come
across the border from Burma." he said.
"They don't speak Thai, so there is the question
of whether they can understand enough to give
informed consent."
The
question was brushed aside ("They keep coming
back.") and might not have meant much if I
hadn't also met an activist from the northern town of
Chiang Mai. Despite grilling 11 people who swallowed
tablets daily, he complained that he couldn't
discover even the name of the product or the
pharmaceutical company involved. This man was a
former heroin user, so I asked him where VaxGen was
recruiting. "Go to Khlong Toei," he said.
"By Port Authority Building. That's where
they'll get people for the trial."
Khlong
Toei is a slum; a sewage-stinking wasteland; a
cauldron of disease and drug use. The better-off live
in concrete hutches, with wire-fenced windows and
balconies. Next down in the social scale are
wooden-shack coops on plots of flood-prone ground.
Then there are kennels: festering shantytown alleys
of plank, sheet-iron and debris sheds. The
"streets" are dim corridors, with boardwalk
floors, cluttered with children and dogs. At night
frail figures shuffle around, suffering from Aids,
tuberculosis or both.
Thailand
was once praised for anti-HIV efforts in disease hot
zones such as this. But evidence suggests that since
the 1992 coup priorities have changed. In 1992, a
health minister complained that talk about the virus
had "seriously affected tourism". And now,
official figures show that Aids prevention has been
slashed by one third against comparable public health
programmes.
The
biggest cuts have been in initiatives aimed
specifically at drug misusers. "There used to be
a project for clean needles in the early 90s, but now
it's gone" a spokeswoman for a Khlong Toei
charity, the Duang Prateep Foundation, told me. A
health department official said the same thing. His
time-frame: "about seven years ago".
Targeted education, known to be most effective, has
also been axed, he said.
Nobody
could explain the thinking, but the effect on the
junkies can be measured. Blood tests reveal that HIV
prevalence peaked among female prostitutes in 1993 -
when 30% were positive - and has since fallen back to
21%. Among rent boys, prevalence peaked in the
following year at 18%, and is now half that figure.
But prevalence among heroin-injectors has leapt from
31% in 1994 to a staggering 47% now.
Were
these changes evidence that the government were
allowing the junkies to be put at greater risk to
make them useful for experiments? (Health department
officials told me that if AidsVax is marketed, they
expect a billion-dollar manufacturing plant.) I
couldn't find out. People wouldn't talk when I raised
such contentious concerns. Even Bangkok's Medicines
Sans Frontieres staff went silent when asked about
the trial.
Francis
is convinced that nothing is amiss, and his
collaborators voice no worries. "All have
assured me that this has been done ethically,"
he told me, when eventually we met. "We are
going out of our way not to increase the
vulnerability of an already vulnerable
population." The trial was conducted in
Thailand, he said, for scientific reasons. Different
parts of the world are linked with different HIV
subtypes, with their myriad subsidiary strains. B
subtype strains, for instance, are most common in
North America, Europe and Australasia; A, C and D in
Africa. In Thailand, there's a mix of B and E strains
and, for technical reasons to do with E strains, the
company argues that success is more likely there
"than anywhere else in the world."
But
there are aspects of the project which suggest that
the junkies may be involved in an unusual way. A
parallel trial among gay men at American clinics is
having problems finding and keeping volunteers, due
to scepticism towards the venture. But at Kachit's
clinics the programme has features which may help to
avoid these snags. The junkies get methadone, an oral
heroin substitute, plus $10 expenses for each of up
to 17 visits. The risk is the appearance of offering
drugs and money as inducements to this desperate
group.
There's
also a feature of the experiment's design that seems
self-contradictory. If the methadone liquid got
people off injecting heroin, the volunteers' risk of
infection would slump and they would be of little use
to the vaccine trial. In fact, documents drawn up
with the CDC and WHO show that that 7% of clinic
users are expected to become HIV-infected each year.
So, despite the oral methadone, they keep injecting
heroin. They may even buy it with VaxGen's money and
have an increased risk of getting Aids.
The
logic of the trial creates a dilemma for Francis. The
moral uncertainties about using junkies as guinea
pigs might be offset by humanity's greater needs. But
there would need to be plausible scientific grounds
to think that AidsVax might work. And on that the
VaxGen experiment is open to even greater doubts.
*****
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