Pandemics and travels

It has been an inordinately long time since I last posted to my website. A lot has happened. In early July I travelled from Durban to Cape Town for a few days, seeing friends and staying with Derek and Lynn (my brother and wife). On Sunday 10th July I flew from Cape Town back to Norwich via Amsterdam. By Thursday I had a scratchy throat, headache, cough, and a metallic taste in my mouth. A day later I tested positive for Covid-19. The virus I had written so much about got me! I was not seriously ill, but it was not pleasant. I am convinced I was infected in an airport or on a plane.

I was due to travel to Montreal for the International AIDS Economics Network (IAEN) meeting ahead of the International AIDS Conference on Monday 25th July. Although I do not believe I was infectious, travelling seemed unwise. I was very relieved to consistently test negative in the days before I flew. At one point I thought my attendance was in doubt which would have been difficult for my colleagues as we were co-organising a meeting.

Covid-19 is a horrible disease. I had two vaccinations and a booster, but it did not stop me getting the virus. At no point did I feel my life was threatened, and indeed the new, essential, bit of medical kit, a pulse oximeter, indicated that my blood oxygen levels remained high. I was lucky I think, but the cough is taking ages to disappear. It is still annoying, especially at night. Thank heavens for the vaccinations. Interestingly, at the conference, when I revealed I had just had Covid, more than half the people I was speaking to said, “oh so have I”. It seems there has been a pandemic wave which, because it did not kill or hospitalise most people, has not been recorded or noted. Interestingly the other members of the household in the UK remained well! The conference may well have been a super-spreader event.

My reflection, having had the disease, is that it is probably impossible to avoid infection. Certainly, international travel, airplanes and airports mean one is very likely to be exposed, despite wearing masks (which was not mandatory for passengers on the flight to Europe). However, if people have been vaccinated, they should not get seriously ill. It can be treated with a range of drugs. A friend I saw at the conference, who took the medicine, warned that this seems to lead to a rebound positive test a few days later. I really hope vaccinations plus infection will ensure a degree of immunity for a decent time, but I don’t know if this will be the case.

It is over two decades since the first meeting of the IAEN was convened in Durban and I was involved from the very beginning. The Network generally held two-day meetings ahead of the International AIDS Society’s biannual AIDS Conference. In 2020 a virtual meeting was held in conjunction with the San Francisco conference. In Montreal we had a ‘hybrid’ meeting, as they are now called, with a mix of in person and virtual presentations.

Our meeting faced a number of challenges. In the past we raised sponsorship for scholarships and partnered with local academic establishments to save money on room hire. We were not able to do either this year. In addition, many potential participants from the developing world were unable to obtain visas in time for the meeting, indeed the senior Canadian government minister who was expected to attend did not. We suspect he knew he would be heckled and did not want the confrontation or the bad press that would follow. This lack of support was covered in the Canadian press, not that it will make any difference. Despite all this we were delighted to have 60 people in the room and present a full programme of research.

Montreal is a delightful city and I enjoy it, although we did not have very much time for sightseeing. Initially I stayed in the hotel my colleague booked us into. I won’t name it here though. It is a family hotel, run by Taiwanese immigrants, right on the edge of the red-light area. There is a hard to find door on the street that leads up to the reception area and then there were two floors of rooms. These were adequate but in need of renovation and redecoration. The reception was not staffed all the time, not that it made much difference since most people who appeared behind the desk did not speak very much English. I had to resort to the standard English practice when faced with this: speaking loudly, slowly and clearly and using mime. As I left one midday there was a couple checking in, without luggage. This led me to speculate that the rooms may be let for periods of less than a night. I found an unopened package of condoms on the floor next to my bed which tended to confirm this supposition.

I had been unable to get accommodation in this cheap hotel for the entire period, so ended up moving to an anonymous, but very standard, Travel lodge style hotel. This was nearer the conference centre, so it suited me. This hotel even had a gym, an amenity I would have used religiously until quite recently, indeed I found it marginally worrying that I did not feel guilty about it. Mind you the ‘Palais de Congress’ is a vast building, as a result I had no difficulty in managing my 10,000 steps per day. Unfortunately, I also kept up my wine intake.

This blog was partly written on the train from Montreal to Toronto, a journey of just under six hours. The train was late! I ended up in a carriage with two Chinese families in the seats in front of me. One mother was travelling with two children, about five and two. She brought their own food, and it was interesting watching the littlest one using chopsticks, she had about as much skill as I do. Obviously, this is a skill which has to be learnt rapidly. She spent a happy half an hour playing with her facemask and then moved on to sticky sweets! The journey is not particularly interesting, scenic, or fast! But trains are comfortable and environmentally friendly and the connection to Kitchener is good.

It was fantastic to connect with so many old friends and colleagues. One I only bumped into on the last day. Mitchell Warren heads up AVAC. I first met him when he was starting his career in Durban. I was able to tell him that I thought of him and his family frequently in Durban, my walk to the Glenwood Bakery takes me past the house they lived in. He was amused and pleased to learn this. The South African contingent was sizable and very present. I was told there were over 30 Swazis there, but I only met one. In the past we would have organised a meeting of Swazi researchers, but I failed to do this, largely I think because of travel and not being very well.

We did however manage to publish a special issue of the African Journal of AIDS Research on ‘AIDS in the Time of COVID’. This was thanks to superhuman efforts by the editorial team in Grahamstown, and the fact that authors and reviewers were responsive to the deadlines. Inevitably a few articles simply did not make it, so we will mop them up with a special section in the next issue, assuming, of course, that they get through the peer review process. I was delighted that we were able to produce such a timely issue with the support of UNAIDS. Even more pleasing is the fact that it is open access, anyone can look at it and download the articles, including anyone who reads this blog!

War in Europe

My last blog post was on 23rd February 2022. The next day we woke to the news that Russian troops had invaded Ukraine. A month later the fighting rages across the nation. I find it shocking to write those words. The Western press reports the Russian war has not gone to plan. They were, we are told, expecting a quick invasion accompanied by the collapse of Ukrainian resistance, and Russian troops being welcomed as liberators. This is certainly not the case. However, it is important to recognise that the truth is the first casualty of war.

This month’s blog is a reflection on my experiences in Ukraine. Kyiv is one of the cities I most enjoyed visiting. The Ukrainians we met and worked with were wonderful people. My time there made me want to learn Ukrainian and go back as a tourist. What is happening is quite dreadful and unprovoked. Putin appears deranged and vicious, but it is difficult to predict what will happen.

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Lovely Lisbon and Demonstrating in Norwich

I went to my first conference in nearly two years last month. It was fantastic for many reasons: a chance to get out of the UK; visit a new country and city; meet with colleagues; catch up with developments in the field; and above all be reminded of what we had lost. My word I enjoyed myself. The primary purpose of the trip was to attend the International Association of Providers in AIDS Care’s (IAPAC) Fast-Track Cities 2021 Conference.

To their credit the conference organizers included Covid-19 in the programme. My presentation, which I shared with Corey Prachniak-Rincon, an IAPAC staffer, was on ‘Exploring Legal, Public Policy, and Finance Dimensions of Health Responses.’ The take-home messages were not encouraging, until Covid is on the decline, HIV will not be a priority, even though it (HIV) is not going away. The number of HIV infections continues to rise.

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Announcement: The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response

The University of the West Indies, HEU, Centre for Health Economics, International AIDS Economic Network (IAEN), and the Pan Caribbean Partnership against HIV and AIDS (PANCAP), invite you to participate in a virtual discussion on “The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response”, Wednesday, 21 July 2021 from 9:00 AM – 11:00 AM Eastern Time.

You can register for the virtual discussion by clicking here.

Poster for "The Next and Last Pandemics: The Consequences of COVID-19 and its Impact on the HIV/AIDS Response" virtual discussion

Are we winning? Yes and no!

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

I finished my quarantine in my Waterloo apartment a week ago. I had three days confined in an airport hotel and then 11 more in Waterloo. The government was efficient at checking up on me. Every day I got an automated email with a weblink, and had to complete a form online. There were at least two phone calls and one visit from a private investigator, who had been repurposed as a quarantine inspector, complete with stab proof vest. He came to the door of the apartment, but said he was not allowed to enter it – which somewhat defeats the objective of checking.

The whole of the post-hotel quarantine depends on the honesty of individuals entering Canada. The press has reported, with outrage, of people flying to American airports and crossing the border by road, thus avoiding some of the more intrusive processes. I must be honest and say it was not too bad, though the current lockdown is wearing. Friends made sure I was well supplied with the essentials (food and wine), and so my incarceration went by reasonably quickly. But then I have a large apartment with a great view. I am privileged and I recognise it.

My overarching impression in Ontario is of a province on its knees, and an overwhelming weariness with the whole process. The smiles are becoming fixed, that is when you can see them because people wear masks outside. The problem is the lack of clarity and consistency. As I understand the situation, rules are enforced at the local level. Where I am, it is enforced by Region of Waterloo Public Health. They work closely with Public Health Ontario, the relevant section of the provincial government, which sets policy, and at the national level, with the Federal Ministry of Health. The lockdown is tight; people should only leave their homes for essential reasons, socialising is not allowed, and currently schools are closed. This last regulation has, as in Europe, had an extremely detrimental effect on children and their parents.

A large part of the problem is the Provincial Government, run by the Progressive Conservative Party of Ontario under the leadership of Doug Ford. The world over, conservative governments have reduced public health expenditures and services, and Ontario is no exception. Indeed, Ford was forced into a humiliating climb down when he attempted to announce that the provincial police would enforce his regulations,1 only to have various forces announce the next day that they would not be doing this.2 The numbers in the province are coming down slowly. There is a decent website3 giving data for the province. The citizenry needs clear guidance and, above all, to know the nightmare will end soon, but this is lacking.

The little mall across the road has a security officer at a desk at each entrance. Their task: to ask each customer if they have any Covid symptoms as they enter. It would take a pretty stupid individual to admit to having signs of Covid. I suppose it is important to be seen to be doing something, and this has certainly created employment. Interestingly most of the security officers seem to be recent immigrants from Southeast Asian countries. That probably indicates that these are minimum wage jobs.
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Hotting up in June

This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.

The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.

I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.

The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.

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Understanding AIDS

I’ve written a guest blog post on Oxford University Press’s blog titled Understanding AIDS:

In 1981, the first cases of patients with the disease that was to become known as AIDS, were identified in hospitals in New York and San Francisco. By late 1983, the cause of AIDS — the human immunodeficiency virus (HIV) had been identified. Significant numbers of cases had been reported from central Africa. In southern Africa, where I lived and worked, we had seen only sporadic occurrences — mainly among gay white men. However by 1987, HIV-infected men were identified in the workforce serving the mines industries and farms of South Africa. Armed with knowledge of labour migration and the potential for the spread of this disease, I wrote and presented my first (highly speculative) paper on AIDS at the first ‘Global Impact of AIDS’ conference held in the Barbican Centre in London.

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HIV and AIDS: A Very Short Introduction

The second edition of HIV and AIDS: A Very Short Introduction, by Alan Whiteside, has just been published by Oxford University Press.

HIV/AIDS: A Very Short Introduction provides an introduction to AIDS—the most serious human epidemic in centuries—tackling the science, politics, demographics, and devastating consequences of the disease. The first case was identified in 1981; by 2004 approximately forty million people were living with the disease, and about twenty million had died. The outlook today is a little brighter. Although HIV/AIDS continues to be a pressing public health issue, the epidemic has stabilized. The worst affected regions are Southern and Eastern Africa. Elsewhere, HIV is found in specific, often marginalized populations. Although there remains no cure for HIV, there have been unprecedented breakthroughs in understanding the disease and developing drugs

You can find out more on the Oxford University Press website.

Money in Montreal

My main event in September was the Global Fund for AIDS, TB and Malaria (GF) replenishment meeting in Montreal. This took place on a Friday and Saturday in the middle of the month. To get there, I took the train from Kitchener to Toronto and changed for Montreal. The journey took from 9 am to about 5 pm and was incredibly productive; I got through a mountain of reading. The rail service in Canada is a great way to travel. It is not fast but the trains are comfortable, there is an ‘at seat service’ for tea, coffee or meals, and it is a good place to read, work and generally chill.

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Laurier professor’s leadership builds African-led HIV and AIDS research capacity

News release:

WATERLOO – Laurier professor Alan Whiteside is providing his extensive expertise in HIV and AIDS research to lead a training and mobilization project advocating for African-led scholarship. Whiteside will be the lead researcher on a grant to Laurier from the Bill & Melinda Gates Foundation to build research and publication capacity among African researchers. The grant will support Whiteside’s training and mobilization project advocating for African-led scholarship in support of the African Journal of AIDS Research.

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