Defenestration—it is one of the finest words in the English language and, not coincidentally, one with some of the greatest comedic potential. For anyone unfamiliar with this fabulous word, the dictionary definition of defenestration is the act of throwing someone or something out of a window. It’s most famous historical utilization came in an event known as The (Second) Defenestration of Prague, because there have in fact been multiple historically noteworthy occasions in which somebody was chucked out of a window. This particular defenestration occurred on the cusp of the Thirty Years War, a war that is intriguing not so much for the circumstances it was fought under, but because, unlike The Hundred Years War and The Seven Years War, it actually lasted for the duration it’s name implies. Anyhow, in the interest of sparing you all of the minutiae of 17^th century geopolitical relations in Western Europe, let’s just say The Thirty Years War was principally a fight between Catholics and Protestants in the Holy Roman Empire, a place that is has been pointed out, was neither holy, nor roman, nor an empire.¹

During the aforementioned defenestration, a group of Protestant officials cornered four Catholic muckety-mucks shortly after a particularly anti-Protestant member of the royal family was named as heir to the throne. The Protestants demanded that the Catholics come clean and tell them if they had recently persuaded the current ruler, King Matthias, to stop construction of Protestant churches on royal land. Somehow, the Protestants deemed that two of the Catholics were kosher, but that the other two were lying sons of bitches who needed to get theirs. So, naturally, they chucked the two papist buggers out the third story window to what would normally have been their death. However, the two men didn’t die, and here’s where the Catholic and Protestant versions of the story deviate. The Catholic side of the story has it that angels from heaven had swooped in and miraculously saved the lives of these two noble, god fearing men. The Protestants say that angels had nothing to do with it and that the two lucky bastards were saved by a propitiously placed pile of horse shit.

Two men in the act of being defenestrated

Now, I’m not one to disparage those who believe in the miraculous given the event in question truly has no reasonable explanation or is so improbable that its occurrence beggars belief. For instance, I once worked with a guy who had been exposed to toxic levels of radiation when he was in the military due to his proximity to nuclear tests conducted in the Pacific. Apparently, cancers began to manifest themselves all throughout his body and when he went to see an oncologist, he told him that he likely didn’t have more than a year to live. That was in 1985 and, as far as I know, his radioactive ass is still alive today. He should be dead. All of the other men he tried keeping in touch with after he was discharged have died. But he’s not, and, while I’m sure there is probably some scientific explanation lurking behind his defiance of death, I’m also totally cool with the idea that his mere existence is miraculous. Landing in some horse turds after getting flung out of a 3^rd story window ain’t a miracle. It may be proof that the forces governing the universe have a sense of humor, but it’s not a miracle.

This discussion of what should and should not constitute the miraculous is especially pertinent right now after a 2 ½ year old Mississippi child was declared to be “functionally cured” of HIV earlier this month.² The child, whose mother arrived at the hospital in labor without being seen earlier in her pregnancy and unaware that she was HIV positive, was immediately placed on a three drug cocktail of antiretroviral drugs as soon as it was born. The Pediatrics Department at the University of Mississippi Medical Center soon got the infant’s viral load—the amount of active HIV present in her body—down to undetectable levels and continued administering the treatment to her for around 18 months before the mother abruptly stopped bringing the child in for treatment. After 5 more months, the mother brought the child back in for to resume treatment and, instead of finding that the disease has begun to progress and spread through its body during her absence, the doctors found that the toddler’s viral load was still undetectable. Further testing was able to detect trace amounts of viral genetic material in the child’s blood, but none of it was able to replicate or cause any further damage. Unlike adults who are tested after failing to adhere to their treatment with antiretroviral drugs, none of the virus was found in the “reservoirs” of the child’s body, areas where the virus lies dormant and is unable to be destroyed by current HIV medications.

Before long, the disappearance of HIV from this child’s body was being hailed as a miracle by media outlets and HIV specialists alike. No less of an authority than Dr. Carlos Del Rio, co-director of the Emory Center for AIDS Research, referred to this case as being a miracle³, which is a perfectly understandable reaction for someone who has spent his life fighting an epidemic that kills over 230,000 children under the age of 15 each year.⁴ But, the truth of the matter is that there is very little of the miraculous involved in this young child’s situation. There’s not much miracle in the inexplicable escape of entirely avoidable catastrophe. If a soldier is riding in a convoy through Khandahar that gets hit by an IED and he’s the only one to survive, that doesn’t constitute a miracle. If a heroin junky happens to have a court date on the same day his dealer gets a bad batch of junk and all of his friends OD while he’s standing before the judge, that’s not a miracle.

If Christ had taken those two fish and five loaves of bread and simply given them to 7 of the families sitting amongst the multitudes before him, then that would not have been a miracle. For the 7 families that received the food it would have been a blessing and for the thousands of others it would have meant famine. The reason why it is a miracle is that it fed all 5,000 of the men⁵ who stood before him when there was no earthly reason to believe such a thing was possible. It would truly be a miracle if the freak genetic happenstance that led to this young child being functionally cured could be applied to the hundreds of thousands of babies for are born with HIV each year. The miracle lies in the possibility of making sure that no HIV positive pregnant woman in the United States or across the world comes to term with a child before first being put on anti-retroviral therapy.

This would be the real miracle.

What this child in Mississippi has done is win a lottery that no one would ever want to be entered into in the first place. He or she is now the sole toddler in recorded history to be functionally cured of HIV, but that is a pyrrhic victory which I would wish upon no one and which should never need to happen in the first place. I do not know whether this child is boy or a girl, but I would bet my house that he/she is black and lives in a household whose annual income is around or below the poverty line. That the child’s mother waited until she was in labor to see a doctor and that she disappeared from treatment for months at a time lets me know that she doesn’t have healthcare and that she is often not adherent to her HIV medication. Even if the child is cured, her mother is not. As her CD4 count plummets and her viral load grows, her immune system becomes a ticking time bomb. This miracle child may soon be forced to grow up without a mother and, given the likelihood that Mississippi’s last abortion clinic will be shut down in the near future, she may herself become a mother before reaching adulthood. The sexual education at her high school will be abstinence based and will likely teach her about as much about safe sex as the show Home Improvement taught audiences about carpentry. And, due to cuts from sequestration, over 7,400 other people living with HIV/AIDS will lose access to life saving medications while a further 424,000 HIV tests will be conducted nationwide to prevent the types of diagnostic mishaps that lead to the miracle child’s HIV positive birth.⁶

Where’s the miracle in all of that?

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Categories: HIV News

Tags: antiretroviral drugs, HIV, HIV prevention, miracles, Mississippi, mother-to-child HIV transmission, public health, Sexual Ediucation, the Defenestration of Prague