Saturday, May 30, 2009

Reiki and the Roman Catholic Church - my response

Whether or not you accept Reiki as a viable, beneficial practice, is not the point in what I say here. The point is that the position that the Roman Catholic Church [RCC] has taken is based on misinformation and put forward as dogma. As well, this action deprives many of comfort and possible healing at some level.

I think it is prudent to answer the RCC statement on Reiki as was done by The International Center for Reiki Training without challenge and aggression as in the reply appearing in the previous post. The RCC is a big organization and carries a lot of influence even though its credibility is being severely stretched by its egregious statements and behaviour.

I think it is time to point out a few things and to stop pussy footing around just because the RCC is what it is. If the the RCC bishops had done their homework and research on Reiki, its origins and proven scientific benefits, they might not have made such a statement. As I show below, the RCC goes directly against scientific proof and knowledge when it chooses to.

There is no logic in their thinking on Reiki or they would ban all medical procedures and therapeutic processes that were originated by a non RCC believer. Yet, such processes and procedures are used widely without thought as to the procedure’s origins. They are also inconsistent as they do not target Therapeutic Touch which is secular in origin but also based somewhat on energy transfer concepts

In the world of HIV prevention, the pope most recently made his second statement that I am aware of, about condom use on his March, 2009, second visit to Africa. He again stated categorically that condoms do not work and allow the HIV virus to pass though the latex. I recently read a published blog ( letter from an 18 year high school student in the USA who alleged that she was taught the same thing in her USA RCC highschool and asked advice on how to handle this when it was clearly in opposition to oft verified science.

The RCC would rather maintain ”purity” of doctrine on contraception which as far as I know is not commanded anywhere in the Bible, instead of listening to the direct injunctions to aid the poor and the suffering. By this attempt at “doctrinal purity” it condemns people to death. In my direct and forthright world, willfully stating that while knowing death and suffering is the result is considered evil, and with the pope s level of worldwide influence, it is even more so. This issue on Reiki is another instance illustrating that the RCC will do what it wishes.

Friday, May 29, 2009

Reiki and the Roman Catholic Church

Reiki [ ray-kie] teachings claim that there is an inexhaustible, universal "life force" spiritual energy that can be used to induce a healing effect. Believers say that anyone can gain access to this energy by means of an attunement process carried out by a Reiki Master.

Reiki is described by adherents as a
holistic therapy which brings about healing on physical, mental, emotional and spiritual levels. The belief is that the energy will flow through the practitioner's hands whenever the hands are placed on, or held near a potential recipient, who can be clothed. Some teachings stress the importance of the practitioner's intention or presence in this process, while others claim that the energy is drawn by the recipient's injury to activate or enhance the natural healing processes.

It is seen by the medical community as similar to therapeutic touch and conveying similar benefits. Like therapeutic touch, it is not accepted by everyone since both prractices transcend the physical in some way.

The following is adapted from the Blog of Rev. Carol E. Parrish, PhD. Dean, Sancta Sophia Seminary, Tahlequah, Oklahoma, USA (

You may or may not be aware of the stir caused by the Catholic bishops by sending out a letter condemning the use of Reiki. Reiki is called “Buddhist,” etc. and inappropriate for Christians to either give or receive.

I think we should all become aware of the facts and as individuals seeking to serve others, we need to be aware that pettiness is not the property of anyone alone, but that when we get into religiosity, splitting hairs gains emphasis.

My brief response to the behaviour and actions of the Roman Catholic Church in this and other actions will be in the next post, as this one is already too long!

An official response from the International Center for Reiki Training follows.

A Response to the Bishops’ Statement on Reiki by William Lee Rand

On March 25, 2009, U.S. Catholic bishops issued a statement advising Catholic hospitals, health care facilities, and Catholic chaplains not to support the use of Reiki sessions. The statement was issued by The Committee on Doctrine, United States Conference of Catholic Bishops and titled: “
Guidelines for Evaluating Reiki as Alternative Therapy.”

The statement was based on research the committee had done over a period of several months involving information found on the Internet and in Reiki books. Based on these sources, they concluded that Reiki came from Buddhist texts and has a religious basis; that Reiki healing energy is directed by human thought and will; that Reiki is not validated by scientific studies and has no scientific explanation, and that Reiki is not accepted by the medical community.

When considering the value of the bishops’ statement, it’s important to note the sources they accessed. Much of their research came from information published on Internet Web sites. Overall, the Internet isn’t a good source of factual information because there is no requirement that information published there be checked or approved for accuracy. Anyone can set up a Web site and publish anything they wish. What often happens is that authors of sites copy from each other, so if inaccurate information is published on one site, it can easily spread to many sites across the Internet. If one makes use of the Internet for research, one must use a developed set of selection criteria that limits one to only the most respected and reputable Web sites. Otherwise, one runs the risk of accepting rumor and misinformation as fact.

This is especially true for Reiki Web sites. Reiki information has been riddled with inaccurate ideas from the beginning of its practice in the West. Many Reiki practitioners, teachers and authors fail to check the accuracy of the information they base their teaching and writing on, and this has had a detrimental effect on the quality of information published both on the Internet and in Reiki books.
The best information on Reiki comes from those who have researched the history and practice of Reiki professionally by conducting research in Japan, reading original documents, and interviewing members of the founding Reiki organization in Japan. If the bishops who wrote the statement on Reiki had interviewed several of these experts, they would have realized that much of the published information on Reiki is inaccurate, and they would have had accurate, verifiable information on which to base their conclusions.

Origin of Reiki
One of the stories told by Mrs. Takata about the origin of Reiki indicates that the founder, Mikao Usui discovered the secret of Reiki in Buddhist texts.1 This story has been repeated over and over in Reiki classes, on Internet Web sites and in many Reiki books. Yet we know this isn’t true. For many years, Mrs. Takata was the only source of information about Reiki for those in the West, and most practitioners accepted her statements without question. Language, cultural, and organizational barriers in Japan made research difficult for those who wanted to learn more about the origins and practice of Reiki. It wasn’t until the end of the 90’s that a few researchers were able to make breakthroughs.

Researchers, including Toshitaka Mochizuki, Hiroshi Doi and Frank Arjava Petter, made contact with the original Reiki organization, discovered Mikao Usui’s grave, translated the story of Reiki inscribed on his memorial stone, and uncovered an original document written by Mikao Usui about the nature of Reiki. These sources indicate that Mikao Usui wasn’t seeking to discover a method of healing, but that the ability to heal came to him spontaneously during a spiritual experience on a sacred mountain. Furthermore, in his Reiki Ryoho Hikkei (Reiki Healing Art Handbook), Mikao Usui states: “My Usui Reiki Ryoho (healing art) is original, never before explored, and incomparable in the world.” These facts indicate that Reiki couldn’t have come from Buddhist texts, nor could it be connected to any religion or belief system. In addition, Japanese Reiki Masters who have knowledge of Buddhism have indicated that they can find nothing from Buddhism in the practice of Reiki and that Reiki is religiously neutral.2

The Nature of Reiki Healing
One of the first things I noticed after I took my first Reiki class and began to practice Reiki is that Reiki healing energy directs itself. I was unable to direct it with my mind or will and realized this wasn’t necessary as Reiki had its own form of guidance that was superior to my own. This experience has been verified by other professional Reiki practitioners and forms the basis of one of the important keys to using Reiki: If you want Reiki to provide the best healing experience, it’s necessary for the practitioner to set their own desire, will and ego aside, and allow the Reiki energy to guide itself.

Scientific Explanation for Reiki
There is a scientific explanation for Reiki that is based on scientific studies and factual information. This explanation has been presented as a testable hypothesis by James Oschman, Ph.D.
Dr. Oschman is a scientist with a conventional background who became interested in the practice of energy medicine. Through research, he discovered a number of important scientific studies that point to a scientific basis for energy medicine based on the laws of physics and biology. These findings are discussed in an interview, “
Science and the Human Energy Field,” published in the Winter 2002 issue of Reiki News Magazine.The electrical currents that run through every part of the human body provide the basis for Dr. Oschman’s hypothesis. These currents are present in the nervous system, organs, and cells of the body. For instance, the electrical signals that trigger the heartbeat travel throughout all the tissues of the body and can be detected anywhere on the body.
Ampere’s law indicates that when an electrical current flows through a conductor, an electromagnetic field is produced that reflects the nature of the current that created it. Tests with scientific instruments indicate that electromagnetic fields exist around the body and around each of the organs of the body, including the brain, heart, kidneys, liver, stomach, etc. The heart has the strongest field, which has been measured at a distance of 15 feet from the body.

The fields around each of the organs pulse at different frequencies and stay within a specific frequency range when they are healthy, but move out of this range when they are unhealthy. The hands of healers produce pulsing electromagnetic fields when they are in the process of healing, whereas the hands of non-healer do not produce these fields. When a healer places his or her hands on or near a person in need of healing, the electromagnetic field of the healer’s hands sweeps through a range of frequencies based on the needs of the part of the body being treated. Faraday’s law indicates that one electromagnetic field can induce currents into a nearby conductor and through this process, induce a similar field around it. In this way, a healer induces a healthy electromagnetic field around an unhealthy organ, thus inducing a healthy state in the organ. A detailed explanation of this hypothesis, including descriptions of the scientific studies, diagrams, and references is presented in the interview mentioned above.

Acceptance by the Medical Community
Although Reiki is not universally accepted within the medical community, many medical professionals, hospitals, and healthcare facilities recognize its benefits and accept it as an adjunct therapy. In Holistic Nursing, A Handbook for Practice, Chapter 2 “Scope and Standards of Practice,” the American Holistic Nursing Association (AHNA) lists Reiki as an accepted form of treatment.3 In addition, according to the American Hospital Association, in 2007 Reiki was offered as a standard part of patient care in 15% or over 800 hospitals across the US.4 Doctors have recommended Reiki to their patients for amelioration of various health-related conditions. Surgeons make use of Reiki practitioners prior to, during, and following surgery. As an example, Dr. Mehmet Oz, one of the most respected cardiovascular surgeons in the US, uses Reiki during open-heart surgeries and heart transplants. According to Dr. Oz, “Reiki has become a sought-after healing art among patients and mainstream medical professionals.”5

Ethical Implications
To refuse Reiki treatment to patients that request it creates an ethical issue. According to the
AHNA statement in response to the bishops’ statement, the practice of holistic nursing is not subject to regulation by the Catholic church and it would be an ethical violation for a member of the AHNA to withhold Reiki treatment from a patient who requests it; this includes those working in Catholic hospitals.

Scientific Studies
There are a number of reputable scientific studies that provide evidence that Reiki is therapeutic. These studies can be found by using one of the professional medical databases such as PubMed or Cochrane Collection.6 Studies meeting medical and scientific standards are usually published in peer-reviewed journals. There are over 20 such studies on the therapeutic value of Reiki. A review of some of these studies, “An Integrative Review of Reiki Touch Therapy Research” by Anne Vitale, Ph. D., can be found at While the Reiki studies conducted to date are preliminary in nature, they do provide support for additional studies.
One well-designed Reiki study is “Autonomic Nervous-System-Changes During Reiki Treatment: A Preliminary Study.”7 Forty-five subjects were assigned randomly to three groups. One group received no treatment, another received Reiki treatment by experienced Reiki practitioners, and the third group received sham treatment by a person with no Reiki training who used the same hand positions as those receiving real Reiki.

Measurements were made of heart rate, cardiac vagal tone, blood pressure, cardiac sensitivity to baroreflex, and breathing. Heart rate and diastolic blood pressure decreased significantly for those receiving Reiki, but not for those receiving sham Reiki, or no treatment. This study indicates that the body does respond to Reiki energy and that this response isn’t purely psychological. It also indicates a potential therapeutic effect for Reiki.

“Reiki Improves Heart Rate Homeostasis in Laboratory Rats”8 is another valuable study. The value of using animals in this type of study is that they are not affected by belief or skepticism regarding Reiki. In addition, highly accurate telemetric implants were used to transmit the biometric data. White noise was used to increase the heart rate of three implanted laboratory rats. The rats were treated by a Reiki practitioner and by a sham Reiki practitioner prior to being exposed to white noise and after exposure. The procedure involved the practitioner directing their hands toward the caged rat at a distance of four feet. The rats that received Reiki experienced a significant reduction in heart rate, both before having their heart rates elevated by white noise and after, whereas those treated with sham Reiki did not. This is one of the most rigorous Reiki studies to date and demonstrates that Reiki reduces the heart rate in both stressed and unstressed animals and promotes homeostasis, both of which promote healthy heart function.

Reiki is practiced by followers of many religious traditions. Although some practitioners integrate Reiki into their existing religious beliefs, Reiki is not a religion, doctrine, or dogma. Reiki is grounded in the principle of compassionate action, which is common to all religious traditions. While each religion has the right to create its own rules, it’s within the nature of human dignity and free will for each person to decide which path to follow and what activities are appropriate for them.

1 Paul David Mitchell, The Blue Book, revised edition for The Reiki Alliance (Coeur d’Alene, Idaho: 1985), page 13.
2 Personal communication with Japanese Reiki practitioners Hiroshi Doi and Hyakuten Inamoto.
3 page 56.
4 and
6 PubMed is the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature. The Cochrane Collection provides access to a collection of databases, which focus on the effects of health care and evidence based medical practice.
7 Nicole Makay, M.Sc., Stig Hansen, Ph.D., and Oona McFarlane, M.A., The Journal of Alternative and Complementary Medicine, Volume 10, Number 6, 2004, pp. 1077–1081. This study is also discussed in “The Science of Reiki” by Nicole Mackay, Reiki News Magazine (Summer 2005).
8 Ann Linda Baldwin, Ph.D, Christina Wagers, and Gary E. Schwartz, Ph.D., The Journal of Alternative and Complementary Medicine, Volume 14, Number 4, 2008, pp. 417–422.William Lee Rand is president of the International Center for Reiki Training and executive editor of the Reiki News Magazine. He has studied with five Reiki teachers, including two from Japan, and has made three trips to Japan to research the history and nature of Reiki. Rand has practiced Reiki since 1981 and has taught full time for 20 years.

Sunday, May 24, 2009


The pictures in this post are from my favourite local walk every May and early June.

On approaching the area, I can smell the heady aroma of the flowers and soil from half a kilometre away and then as I draw near, the riot of colours feeds in visual delight: the azaleas, rhododendrons, hanky tree, bluebells, lilacs, buttercups, lily of the valley, hosta of many kinds, tulip tree, Chilean rhubarb and others that I do not know.

I am posting them today when my Mother would have turned 97. She made her transition November 30, 2007. She loved walking and never stopped being awed by the beauty all around her. She would take it all in and say, full of wonder; ”It’s so beautiful.” Here’s to you, Mom.

Medicins Sans Frontieres / Doctors Without Borders

Yesterday, I was fortunate to be at a pre-conference session of the Quality of End of Life Care Coalition that featured a former president of Medicins Sans Frontieres é Doctors without Borders; Dr. James Orbinski. He was President of the International Council of Médecins Sans Frontières at the time the organization received the 1999 Nobel Peace Prize. James Orbinski also is the co-founder and Chair of the Board of Directors of Dignitas International, a medical humanitarian organization working with communities to dramatically increase access to life-saving treatment and prevention in areas overwhelmed by HIV/AIDS. He is an Associate Professor of Medicine at the University of Toronto.

He had many interesting stories from his work over the years in Africa, specifically Rwanda during the genocide of 1994 and Malawi over many years working in the area of HIV.

He talked about a world of 6.8 billion people where 3.8 billion people live on $US2 per day or less. And it is now being upset even more as we experience crises of finance, fuel, food, and climate. He talked about the hallmark of equality being that people in similar situations are being treated similarly and how much we need to do to achieve that

He talked about Malawi, a country where the life expectancy is 36 compared with ours approaching 80 – more than two times as high. As we experience in Canada, HIV is moving to being a chronic but treatable disease but Anti Retroviral Therapy (ART) is required to achieve that. But drugs are not made available to 95% 0f those who need them in the world – mostly very poor and in the developing world. Pharmaceutical companies and governments blatantly pursue patent rights over lives! In 2000, ART for a year for one person in Africa cost $US15,000. Remember people are living on about $US2 per day or $US730 per year.

Doctors Without Borders set out to manufacture generics because in their evidence based policy analysis, it was the only thing they could do. They were warned by the best that it could not be done, but with help form the world's best scientists and technicians they did it and brought down the price of ART in some of Africa to $US100 per year – still a big chunk out of $US730, but not 21 times more than $US 730. In 1999, 20,000 people in Africa were on ART and now there are 5,000,000 on i t.

Malawi, with a population of about 12,000,000, has 100 doctors or one doctor for 120,000 people – quite typical for much of Africa. Ontario, on the other hand has 12,945,000 people and according to the website of the College of Physicians and Surgeons of Ontario, it has 23,266 doctors or one for every 557 people. Young people have to be sent to Europe and the West to be trained in medicine and 80% stay in the country where they studied. As Orbinski wryly noted, "You cannot take Ibo or Mpho to Paris to live and expect them to return to the poor farm in a scorched part of Africa." Now Doctors Without Borders is setting up teaching partnerships with western institutions like the University of Toronto and the BC Centre of Excellence in HIV with local Africans schools to do medical training there and hopefully keep more of the new doctors where they originally intended to be!

When I left Botswana, the organization where I worked had to cut almost a third of its staff due to the world financial crisis creating a big reduction in financial aid. A friend of mine had worked on building a school in Mali in 2008 and it now sits half completed for the past year for the same reasons. Equality is still a long way away – but some are working on it!

Thursday, May 21, 2009

HIV and Education

In the past decade or more, the level and quality of HIV education in the public school system in Canada has declined considerably. A study that tracked high school students’ knowledge of HIV and compared it to knowledge levels ten years earlier, came out 2 years ago. It found a very significant decline in those HIV knowledge levels. Recently students in 7th, 9th and 11th grades believed either that there is a cure for HIV or that HIVis a chronic manageable disease not to be too concerned about. Little was know about transmission, risk factors and what it actually is.

On the other hand, as noted in an earlier post, authorities in Kenya, wanting to break the cycle of ignorance about HIV and its taboo status in that country, decided that getting the relevant information to the young people was a top priority. They embarked on an ambitious programs over 7 - 9 years of training certified HIV instructors in every one of the more than 18,000 primary and secondary schools in the country. They achieved that and did so trying to allow for as much local delivery and decision making around the process as possible. A commendable and difficult goal that was achieved with the help of Dr Eleanor Maticka-Tyndale, holder of the Canada Research Chair in Social Justice and Sexual Health, at the University of Windsor and other NGO assistance. Dr. Maticka-Tyndale reported on this effort.

A recent evaluation of the project reported in a current HIV journal. It noted some problems in achieving the intended outcomes, and of course they largely have to do with peoples’ preconceived notions and fears.

The first big issue is the reluctance and inhibition of many of the teachers to discuss sexuality with the students even when the students indicate that they want to do so. This is based on the perception and fear of being seen to condone teen sex, pre-marital sex etc. The second issue is not that different and throws religion and morality into the mix. This is based on perceived pressure from parents expressing disapproval about talking about having sex outside the bounds of marriage and the “sinfulness” of all sexual expression that entails. The morality states that sex should not be a part of unmarried students lives and any sexual expression outside of marriage is sin!

And so open, informed and honest talk about HIV, HIV education and prevention gets compromised, if it happens at all

The situation in Canada and Kenya and many places in between, occurs in spite of the fact that on May 7, 2009. UNICEF warned that too many young people are unaware of the risks of HIV.

What do the Social Sciences tell us?

A few interesting bits.

Looking at factors that reach beyond the individual reveals very telling information about how humanity and, we in the west, are dealing with the pandemic. Some interesting factors come out when we look at income as a Determinants of Health relating to HIV. Determinants of health are the leading factors that contribute in aggregate to health status in an individual or populations. Determinants include: income, education level, living environment, personal behavior, health care access, genetics and social/cultural issues.

Dr. Katherine Hankins Chief Scientific Advisor at the United Nations AIDS directorate in Geneva, points out that the correlation between HIV and poverty [ which we are already aware of] is the greatest where the divide between the have’s and the have not’s is relatively greater. That is saying that the greater the difference in income between the rich and the poor, the greater the incidence of HIV and the poorer the quality of life with HIV. At the poverty end of the spectrum, there are competing demands for very limited funds such as food, shelter and schooling for children. As a result adherence to any possible medical regimen, good diet relaxation and rest all suffer, and with that the individual.

Harm Reduction refers to a set of interventions designed to diminish the individual and societal harms associated with any potentially harmful activity such as with 'recreational' drug use, including the risk of HIV. In Canada and elsewhere those interventions that we know will help to reduce the transmission of HIV, i.e. work positively to prevent HIV infection, are heavily and unduly influenced by preconceived notions of morality. That is to say, that the methods of harm reductions are in activities that are judged by some to be immoral and harm reduction is seen as some sort of approval of those behaviours and must be avoided, obviously at the cost of people getting infected with HIV and often, because they are at the poverty end of the economic spectrum, AIDS and an earlier death.

An example of this is the resistance to needle exchange programs in Canadian prisons when all international and national studies show a positive impact with regard to HIV and no negatives such as an increase in drug use, use of needles as weapons, etc. Another is the refusal to support safe tattooing even after a government website said that all evaluations of their own study on safe tattooing were positive in outcome. No reason was given for refusing to continue the safe tattooing project. A final example is the continuing determination of the federal government to shut down Insite – the controversial medically supervised safe injection site for drug injectors in Vancouver. This model has been used to great and positive effect all over Europe and our Government would rather see people die than offer a safer way to manage their addictions.

I will not editorialize this time…. You know my stand on life versus drug use!.

Thursday, May 14, 2009

HIV Information:Treatment as Prevention

The second plenary speaker was our own Dr. Julio Montaner, Director of the reputable British Columbia [BC] Centre of Excellence in HIV / AIDS at St. Paul's Hospital in Vancouver [shown below]; the current President of the International AIDS Society; Professor, Chair in AIDS Research and Head of the Division of AIDS, Department of Medicine, University of British Columbia and originator of many leading edge ideas, one of which is treatment of HIV/ AIDS as a way to prevent the further spread of HIV / AIDS. This idea is currently gaining some currency in other countries, notably Switzerland and was given, at least, lip support by the BC Premier as a campaign announcement [with no funding mentioned] in the first days of the re-election campaign that ended today with his third victory. [I have become somewhat cynical about the promises of politicians over the course of my adult life and, at no time more, than during my work in the HIV / AIDS arena.]
In the 28 years since the official start to the HIV /AIDS pandemic, further infections by the virus have been fought on a number of different fronts, but they have been unsuccessful in halting the spread of the disease. We have used education to make people aware of what is involved and to get them to change their behaviour. This has been mixed up by the conflicting messages. The safety message has been, ”Always use condoms”. But this has been consistently countered by those who do not want to talk about sex and sexual practices, usually compounded by their inaction and their refusal to let the young learn safer sex because that “is tantamount to giving permission for sexual expression.” !! The other conflicting messages have been those of a religious nature in concert with the above and saying “sex outside marriage is sin, contraception is sin, and anyway condoms don’t work - to the point of the RC statement that condoms have tiny holes in them that allow the virus though”, as I have noted previously ad nauseum. However, people, and particularly young people, still seem to be having sex with higher infection rates than those who were taught to play safe.

We have tried harm reduction, such as clean needle distribution for Intravenous Drug Users [IDU], sanctioned tattooing in prisons with sterile equipment and safe injection sites like the one [Insite] currently under the political gun here in Vancouver. We make only feeble attempts at the harm reduction that comes from providing the homeless with housing and food. Here is another effort that is fraught with mixed messages and lack of support because they are judged to sanction the “undesirable” behaviour of drug use as opposed to the goal of saving lives. The etiology of drug use is little understood or there might be a bit more empathic action by taking collective/societal responsibility for some of the conditions that lead to addiction instead of blaming only the addicts for their “weakness”.

The final prevention efforts have been exploration and development of technologies like the production of vaccines or microbicides. That effort came crashing to a halt in the past year when the one big hope for a vaccine ended in total failure and the scientific community agreed that it had to go back to the drawing board. We know that means at least ten more years before the next possible vaccine can be generated.

So how does treatment work as prevention?

First, we know that the two measures that indicate a PHA’s [Person with HIV/AIDS] relative health are 1] the T or CD4 cell count – the number of certain healthy immune fighter cells in the blood, and 2] the viral load - the amount of HIV virus that is in the blood. These factors generally work in an inverse ratio, i.e. when the viral load goes down the CD4 count goes up. These blood work counts are the measure of how well HAART [Highly Active Anti Retro Viral Therapy] is working in an individual with HIV.

The lower the amount of virus in the blood, the lower the infectivity of that person. HAART can reduce the amount of virus in the blood to undetectable levels, although we know that it does not eradicate it completely, and discontinuing HAART means the virus levels will shoot up again.

We also know that the lower the CD4 levels drop, the longer it takes to recover them and general immune strength. From below certain levels, it never completely recovers to former levels again. Science is also finding out that allowing levels to drop and then recover has very long term effects such as greater susceptibility to non-AIDS defining illnesses such as cardiac, liver and kidney problems and it, it seems, a plethora of other conditions. The conclusion is that it is best to try to keep the CD4 levels as high as possible. To that end, the International AIDS Society - US Guideline Committee recently recommended that HAART be started at a 350 CD4 count, up from the previously recommended 200 CD4 count. AND, it is now leaving it up to the individual doctors to determine if HAART should be started earlier if there appear to be pre-existing conditions. Many are recommending that, since without HAART, CD4 cell counts drop at a rate of about 100 per year. As the normal range of CD4 cells is from 500 to about 1300 and the long terms benefits of HAART are becoming more pronounced, why wait with HAART? Treatment now prevents serious long term illness in the future and their attendant high treatment costs. This is the way HAART works

The prevention part of the argument is based on the relative infectivity of the person. With HAART, the viral load drops on the first day that it is administered, stopping viral replication quickly. Undetectable viral load means very low infectivity to a non HIV + person, although not 100% as the virus does still reside in the body at some minimal and undetectable levels. We know that HAART works as prevention. It has been used for years to prevent transmission of the virus from an HIV+ mother to her baby during birth by putting her on HAART no later than the second trimester of pregnancy. These mothers do not breast feed their babies. Mother to child transmission in British Columbia is zero. Sero-discordant couples [one partner is HIV+ and one is HIV-] stay sero-discordant, when the infected partner is on HAART. And recently, we have a study in BC that shows a reduction in the spread of HIV when systems were set up for HIV+ addicts to get their HAART along with their methadone.

In the western world, it is estimated that about one quarter of HIV+ people have not been tested for HIV and do not know that they are positive. Given the information shared in the last post, doing more comprehensive testing in the higher risk populations and then treating the HIV+ people with HAART will reduce the transmission as well as offer better health possibilities to the people. In BC, by giving HAART to 2500 more PHA’s at a cost of up to $20 million annually, will result in 150 to 200 fewer infections per year. Each infection costs the medical system $250,000 to $750,000 over a lifetime – thus that prevention investment becomes a saving of lives, a great improvement in the quality of life of those treated and an economic saving of $37,500,000 to $150,000,000 for those 150 to 200 individuals not infected as a result of treatment.

What is the rationale and argument against treatment as prevention? Perhaps it is the short term gratification levels in the political system and that there is no political will to intervene on behalf of the marginalized!

Tuesday, May 12, 2009

HIV information gains and Politics

Three weeks ago I was fortunate to attend the annual conference of the Canadian Association of HIV / AIDS Research held in Vancouver B.C. It was an interesting blend of significant plenaries by international and Canadian speakers and presentations on the latest Canadian research on various aspects of HIV/AIDS in Basic and Clinical Sciences, Epidemiology and the Social Sciences. There was significant learning on my part that, when added to the material of the previous post, has also stimulated my thinking about best next steps and action for me in this field.

The first plenary, that I attended, was given by Dr. Elizabeth Pisani, former journalist and epidemiologist, author of the well known book on the global action on HIV / AIDS titled: The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, 2008. [Sample quote: “The health statistics in your newspapers are boiled up out of cauldrons of uncertainty, of best guesses, of spilled samples, of errors corrected on the fly.”] As a former journalist, Pisani brings a skeptical approach to the business of epidemiology and is quite educational in the process.

She opened my eyes to facts that I know, but had not taken the time to put together logically because the conclusion is too unpalatable. In the western world, HIV is transmitted almost solely among the denizens of highly marginalized groups, the majority of whom just happen also to be poor. They are men who have sex with men [MSM], including gay men. [This is a category created to include those many men who do have sex with men but do not identify as gay such as married men, those playing on the down low and those who do not take part in or identify with the “gay subculture”.] The marginalized groups are MSM, intravenous drugs users, aboriginal people, sex trade workers, prisoners and recent HIV+ immigrants.

These groups are seen as being on the wrong side of acceptable and there is no political payoff for our elected officials to approve funding their needs; in this situation, research for a vaccine and appropriate treatment for HIV disease. So there is very little funding. What there is, is shrinking with inflation over theyears. In Canada, there has been no increase in funding in the past 10 years. New funding that was fought for under the Liberal government, was then ignored when the current government came to power just as the funding was about to be implemented. I imagine the story is the same in many other western countries that have elected more right wing governments over the past 15 years.

The attitude towards immigrants seems to be transferred to their home countries, many of which just happen to be identified as "third world" and thus influences our international lack of generosity.

Pisani asks, how can epidemiologic data more effectively influence public health policy? The implications of epidemiological data are often politically or socially unpopular as noted in the previous paragraph, and the data are often not used in a timely or complete fashion. She urges better work; that epidemiological surveillance needs to measure variables relevant to programs and to combine data from surveillance and programs for integrated analysis and interpretation. We don’t need a ZERO risk approach, we need to reduce risk. “Stop torturing the data” to say what we think funders want to hear and even what they say they want to hear. Use the data honestly and say what the data indicates is actually happening.

Sunday, May 3, 2009

Botswana and my thinking

I have been back from Botswana for over a month now.  I am trying to analyze how the experience has influenced and possibly changed my thinking about my approach to life and HIV disease.  I think that there has been a shift in what I think is important and how to approach the work that I do, and even change it in the long run.

Let me be clear that I did not experience Africa, I experienced Botswana and a few days in Zambia.  Not everything I have learned and realized can be extrapolated to other countries, maybe nothing can as I have not experienced them.  As I read and am pointed out similarities between various parts of Africa, I might consider that some of my thinking might apply.

 There are a number of significant understandings that arise out of my Botswana experience. 

1.    Botswana is considered a middle income country in Africa and has achieved an official Gross Domestic Product of $13,000 per person because of the Diamond industry which all goes into the government coffers.   (this income is there for the people in infrastructure, water,  govenment jobs and basic health care including HAART, but not as direct personal income) This compares with its neighbours as follows:  South Africa $10,000; Namibia $5,400; Zimbabwe $200; Zambia $1,500.  The USA Gas a GDP of $49,000.  For Africa it is well off – but in the world it is poor.  I met people who live on less than $100 per month is a country where food cost just a bit less than in Vancouver.  Cell phones are ubiquitous because they are the only means of communication.  Most people walk everywhere or use the minivan bus system where one can travel across town for $.40.  Many people have their own goats and chickens.  A number of people I met where raising nieces and nephews, AIDS orphans I would say, although the topic was carefully skirted,  as well as doing the traditional support of elderly parents.  The people are poor.

2.    HIV is rampant at about 24% and estimated to be up to 35% in some population groups.  This compares with 18% in South Africa, 15% in Zimbabwe and .6% in the USA and officially .4% in Canada.

3.    HIV is highly stigmatized – no one talks about it.  I worked with several people in their twenties who had lost their parents. They would not say how they died - the stigma is too much.  This is in a country where up to 1 in 4 or 5 are HIV+.

4.    As a result of 27 + years of HIV and the death associated with AIDS, my generation is missing.  There are noticeably few people around in their 40s, 50s and 60s – at least that is my unscientific observation.  The staff I worked with were largely in their 20s and early 30s, reasonably well educated, but with little experience and maturity.  The lack of management experience was very noticeable and confirmed by several professional people I talked to.  The need for management skill and depth is huge. 

5.    The country is working hard to move from a agrarian culture and society to a modern technology 21st century culture in one generation and the learning curve is steep.  Old values do not change over night and influence all parts of life.

6.    It is a country that is about 80% Christian and that impacts a lot.  It is an accepting faith where things are not questioned and-or thought out.  Most things are accepted as truth and not put into context or culture.  This has an impact, I believe, on how people deal with HIV and sexuality.

7.    Traditionally this is a country with multiple relationships (at least one relationship at the town home, one at the farm home and one at the cattle station) as are many African cultures.  This impacts the spread of HIV and needs to be addressed.

8.    The culture still has a Bride price to be paid.  Two young women where I worked were engaged and when I asked them when they were to be married they matter-of-factly told me when their fiancé was able to get the cows or the cash equivalent.  Interestingly, one of them kept after me to find her a husband in Canada before I found out she was engaged – and this was in earnest.  This impacts how men view their marriage as an ownership contract and impacts how women are treated.  Remember, I worked at a non profit started by women for women called Women Against Rape and most clients are there because of rape within the marriage.  This also impacts HIV.

9.   The Botswana government had a new HIV prevention campaign rolled out while I was there.  The tag line was One Life, One Partner.  It felt to me as realistic and useful as the Abstinence Only campaign that George Bush and the Republicans put out in the face of many studies that show the rates of infection in the wake of such a campaign are higher than with any other campaign.

10.  I was at an HIV conference last week and sat through a presentation on how another country in Africa, Kenya, was stepping out and getting Certified HIV Teachers into all its 18,000 schools over the past 8 years.   Interestingly, I ran across an evaluation of that valiant effort in a professional HIV/AIDS journal  this weekend.  It focussed on some of the major problems Kenya is encountering in this effort.  The major one, as always, was the lack of adequate resources.  That is expected.  Another big one is the fear about and the unwillingness to talk about sex and sexuality, even when the students are asking to talk about it.  And lined up with that is the fear of backlash from parents who do not want sex and sexulaity discussed because they fear that talking about these issues will encourage young people to indulge in sex – and we all know that does not happen when you ignore it and also that everyone just runs out from the class and hops to IT!  

This is compounded even more by the "proper and common" religious perspective that these are sinful things – indulgent and licentious.  Combined with the fundamentalist positions (especially RC) that all sex is for procreation it becomes a very strong restraining force – not understandable in a poor continent that cannot feed the people it already has.   I always wonder why it is OK to condemn people to death (literally to kill them) by denying them theknowledge of,  access to and approval for condoms and that those as yet not conceived, never mind having been born, take precedence over the living.  Of course, the Pope yet again made another egregious, outrageous, unscientific statement about condoms not working while I was there.  Does no one advise this man, who seems to have his head stuck in another universe?  His guilt, in terms of lives lost as I see it, is unspeakable  ( I know, I know : Judge not that you be not judged – Matthew)

11. The result is that condom use is not talked about as HIV prevention, or STI prevention and not even advertised – a major policy issue.

12. Another thing that I got some hint of and confirmed with several black Africans, is that there is still the distinct odour of colonialism and patriarchy on the part of some whites.   I got it a fair sense of this in the airports and places that were schedule controlled in comments such as: "This is the African way", "Welcome to African time.".  Several quite direct things that I observed, were actions by an older white woman and another by a young white man – essentially talking down to black citizens in derogatory tones for NO reason.

I could probably go on.

So what has that done to my thinking?

 While the one-on-one HIV work is essential and needs to be done everywhere – the treatment and care, the counselling, the individual advocacy, the solace giving and the grieving are all vitally important and we have to continue all of them.

But the experience in Botswana, plus some information I have learned and realized since then – the subject of the next post - are altering the way that I think and where I think I want to exert my energies.

All the above care and nurturing work needs training and resources.  To pay for the care and the requisite training, needs funding that will only come as the result of public and political awareness, public care and concern and the will to intervene based on the belief that all human beings deserve to the right to live a dignified and pain free life, the right to achieve the opportunities that life lays out.   That is not to say we all get to an equal place but we all have the right to equal opportunity. And we are so far from that in spite of all major religions telling people to live in love, equanimity and caring for those who need it.

There are very limited resources made available in the so called first world.  There is less available in the so called 3rd  world to deal with this pandemic  that we could/should have controlled by now; but there was and is no will.  Remember Ronald Reagan?  – well, his spirit is alive and well and living globally in 2009.

I find myself angrier and angrier.  At the pettiness, at the outright hate of the religious right of all religions and philosophies, at all the judgement and condemnation based on illness, addiction, sexual orientation, race and economic status, culture and education. The bigotry.  What can impact on any of these in a small way?  How?

There are no resources, so I am thinking more and more about advocacy, collective that is, education and policy making.  I have many skills – where can I best use them?  May be not where I am right now.   I hope it becomes clearer for me – and that I will find where I can do my best – and maybe, that is where I am right now.  

Confused ? – so am I :) ! That is the whole point of this post - to articulate my quandry.