Tuesday, April 14, 2015

How Ordinary Tanzanian Men Can Help Reduce the Number of Orphans

 [Reposted from the Watoto Kicheko site and blog]

One of the most effective ways of keeping newborns, infants and under fives alive is by making sure that their mother does not die. That means supporting women who are planning to have children, who are pregnant, or who already have young children.

I would suggest that one of the best potential sources of support for mothers-to-be and mothers, is fathers. A lot of NGOs make a big deal of working exclusively with children, infants or mothers. But ignoring fathers, or even worse, branding them as in some way wayward, is not helpful.

Including fathers more in pregnancy and birth has not yet developed very much here in Tanzania. Some women will tell you they don't want their husband there, and some men will tell you that they don't want to be there, during the delivery.

But one of the biggest sources of opposition to fathers being present when their wives are giving birth in Tanzania, and even when they go for antenatal care, may be health facilities themselves. Health personnel in East Africa currently have a disproportionate influence on the treatment patients receive, with the wishes of the patients often being sidelined.

I have been present for the birth of my two sons here in Tanzania, the first time in Dar es Salaam and the second in Moshi. I have yet to meet a nurse who thinks it is a good idea for fathers to be present when their wife is giving birth. It is possible to persuade doctors, but many people can't afford a consultation with a doctor, and rely on the professionalism of nurses and other staff.

Perhaps Tanzanian fathers don't realize that their mere presence could strongly influence the sort of treatment their wife receives? Nurses would feel under more pressure to treat pregnant women with respect, which they do not always do when there is no one to stand up for them. Or fathers could be there just to ensure that their wives get the minimum level of attention they need, when they need it.

Tanzanians are well aware that health facilities are in bad condition, and that will not change in a hurry. They are also aware that health personnel are often far too stretched to prioritize simple courtesy. Indeed, many patients and those accompanying patients will admit that they fear being shouted at by nurses and health personnel in front of other patients, and are often too intimidated to say anything at all.

If fathers attend at least one antenatal care visit and express their wish to be present when their wife is giving birth, they can start to exert a lot more influence over the care their wives receive. Better care is safer care, and safety is paramount; safety is one of the main reasons for giving birth in a health facility, with a health professional present, it is one of the main reasons why maternal, newborn, infant and under five deaths have declined in the past few decades.

But they haven't declined nearly enough yet. Recent figures show that 26 newborns die out of every 1000 live births; 51 infants die out of every 1000 live births; and 81 under fives die out of every 1000 live births. Infants and under fives, who should be facing fewer serious health risks as they get older, are more likely to die, as if they cease to matter so much once they are no longer newborns.

Maternal mortality stands at 454/100,000 live births, and that rises to much higher levels in certain hospitals. This includes the Muhimbili Maternity Hospital, the biggest and most prominent in the country, where mortality is about three times higher than average.

It's hardly surprising that only about half of all births in Tanzania take place in health facilities!

Just being with your wife when she is giving birth can improve the care she receives. Just being in the delivery room with her can remind those attending to her that there is a reason for the father to be there; he is concerned about his wife's safety as she gives birth.

If women survive birth and leave the hospital as healthy as they were when they arrived, they will be able to give their newborn and their other children the attention they need. Newborns, infants and under fives will be healthier, and more likely to survive, go to school, grow up and have healthy children themselves.

Antagonistic attitudes towards men are detrimental to the lives of all those we profess to care about. The attitudes of NGOs and of health professionals, as well as the attitudes of men and women, need to change.


Saturday, April 11, 2015

More about State Sponsored and Gender Based Violence in the US and Africa

So the victims have now launched a lawsuit against the Johns Hopkins University over its involvement, something the university has 'vigorously denied'. The university has expressed 'profound sympathy', which I'm sure the victims and their families will appreciate.
These vigorous denials were echoed by the Rockefeller Foundation, who also claim to have had nothing to do with the experiments. Big Pharma giant Bristol-Myers Squibb declined to comment.
This infamous episode in the history of American public health experimentation overlapped with the much longer and more extensive Tuskegee Syphilis Experiment (1932-1972). Although this occurred within the US, the victims were African-Americans, so the vigorous denials and profound sympathies were not deemed necessary until some time after the experiments had been halted.
Carrying out questionable public health programs in non-US countries by US institutions is a lot more common now. Injectible Depo Provera hormonal contraceptive (DMPA) is rarely used among non-white or wealthy populations, inside or outside the US. This is despite the fact that the drug has been shown to double the rate of transmission of HIV from HIV positive men to HIV negative women, and from HIV positive women to HIV negative men.
The vigorous denials continue: just search for #DMPA on Twitter and the same faces come up over and over. The tweeters often attack anyone questioning the use of DMPA, especially among poorer non-white women in the US and among people in African and Asian countries, where it is often the most common form of birth control used.
Those defending DMPA don't generally deny that it doubles HIV risk, as they are often among the research teams who estimated this risk in the first place. They tend to argue that a doubling of risk is not high enough to warrant issuing proper warnings, and that the risk of being infected with HIV is not as serious as the risk that those using DMPA may have an unplanned pregnancy, as if there are no other contraceptives available!
Spite towards Africans expressed through dangerous 'public health' programs was entirely normalized once it was decided, for purely political reasons, that HIV should be marketed as a sexually transmitted infection that heterosexuals were very likely to contract and transmit.
Although the virus mainly infects men who have sex with men (MSM) and intravenous drug users (IDU) in wealthy and middle income countries, it mainly infects people who are neither MSM nor IDUs in Africa. In fact, the largest demographic infected in most African countries is women from their mid teens up to their late forties.
How could this be so?
Well, if you've ever had the misfortune of being treated in an African hospital, given birth there, or even just visited someone you know, you will find it very easy to believe that unsafe healthcare constitutes a huge, but under-researched risk. Less of a risk, but also under-researched, are unsafe cosmetic and traditional practices.
Consider this when reading about some of the experiments carried out in Guatemala: "Prostitutes were infected with venereal disease and then provided for sex to subjects for intentional transmission of the disease", syphilis was injected into the spinal fluid of some victims.
Children were also subjected to these 'experiments', as were orphans, prisoners and mental health patients. Some of those involved were worried about what people not involved might think if they found out, but they don't seem to have worried about their victims; one woman is reported to have had gonnorheal pus from a male subject injected into both her eyes.
But it's not only African (or African American) women that are so maligned by wealthy western institutions that massive 'public health' experiments can be carried out using public money, often resulting in private gain, with total impunity. The English Guardian article notes two 'experiments' carried out on men, aiming to infect them with sexually transmitted infections and then watching the effect this had on them, their families and others around them.
For example, "An emulsion containing syphilis or gonorrhoea was spread under the foreskin of the penis in male subjects" and "The penis of male subjects was scraped and scarified and then coated with the emulsion containing syphilis or gonorrhea".
This obsession with sex, sexuality and sexual organs continues to occupy publicly (and privately) funded western HIV scientists in African countries. Research into non-sexual transmission of HIV is almost unheard of, except in the form of 'vigorous denial' that it ever occurs.
These circumcision programs are targeted, like Tuskegee, Guatemala and the use of Depo Provera, at non-white, poorer people, often African and female (while the MMC programs must target men, the operation has been shown to double transmission from males to females).
Data collected is often published selectively, to promote funded interests, and anything that suggests the programs are harmful is either uncollected, ignored or remains unpublished. Those criticizing such practices are attacked, branded, ridiculed and persecuted by professional (and often very well qualified) trolls.
In years to come, articles in the English Guardian may describe these appalling practices, that occurred in the past, as if they could never happen in the present. But similar phenomena continue to occur, with funding from western governments, 'philanthropists', academic institutions and others, while the public (and the media) look the other way.


Saturday, April 4, 2015

Instances of State Sponsored Violence Against Women in Kenya and the US

The English Guardian has an article on the decision of a Kenyan court to amend a law that criminalizes certain instances of HIV transmission, potentially including transmission from mother to child. But the author misses the true injustice of the law, which is one of many instances of woman bashing and victim blaming that the HIV industry and the media have made their staple fare.
The true injustice is that many women in African countries are infected with HIV through non-sexual routes, probably through unsafe healthcare, but also possibly through unsafe cosmetic and traditional practices that involve skin piercing. These infections are avoidable: women need to be told that they face such risks, that HIV is not just a sexually transmitted virus, that it is not even predominantly sexually transmitted.
As long as the media continues to spew out the misogynistic rubbish they receive from UNAIDS and the HIV industry's PR machinery about HIV almost always being transmitted through unsafe heterosexual sex in African countries (but not elsewhere), countries like Kenya will pass unjust laws like this one.
The media also loves rubbish about 'deliberate' transmission of HIV, 'revenge' transmission, anything extreme, which they depict as normal for Africa. The level of anti-African bigotry to be found in the media is on a par with the kinds of antisemitism that was commonplace in many countries before the second world war.
Of course, extreme levels of misogyny are reserved for African women. In the US, a woman has received a 20 year prison sentence for having an abortion. So state sponsored violence against women doesn't even raise an eyebrow in the US either? But the difference is that the English Guardian recognizes the injustice in this case, but not in cases of HIV in women in African countries.
Prevention of mother to child transmission of HIV (PMTCT) is a wonderful technology, and has probably saved many lives and averted numerous infections. But what about averting infections in the women first? This would be the best strategy for averting infections in infants.
It is of vital importance for women to know what HIV risks they face, so that they can take measures to protect themselves. The Guardian's humbug conclusion that "The law also puts women at risk of violence or rejection by their husbands because it allows doctors to disclose the status of patients to their next of kin" needs to be rewritten.
It is the HIV industry and institutions like UNAIDS that insist that women's biggest risk for infection with the virus, even their only risk, is unsafe sex. Many African women have just one sexual partner, and that person is HIV negative. Many HIV positive women were infected late in their pregnancy, even just after giving birth.
It is unpardonable to insist that all HIV positive mothers must have had sexual intercourse with someone other than their partner. This is what puts the women at risk of stigmatization, violence and rejection, as well as at risk of being infected with HIV, and infecting their fetus or infant.
This kind of victim blaming is a clear instance of violence against women, yet it is promulgated by the very parties who claim to be protecting the rights of women: UNAIDS, WHO, various academic instutions and the enormous, top-heavy HIV industry that they and others constitute. And the media tag along, like poodles doing tricks for the odd pat on the head.
The quote "If we want to reduce the spread of HIV and Aids and put an end to the stigma, violence and discrimination surrounding the disease, our public policies must be based on medical evidence and grounded in human rights" would be spot on if it added that the view that HIV is almost always transmitted through heterosexual sex in African countries is most certainly not based on medical evidence, or any other kind of evidence.


Friday, March 20, 2015

Human Papilloma Virus Vaccine and the Unsafe Sex Canard

A recent study asks 'Does HPV [Human Papilloma Virus] Vaccination Promote Unsafe Sex in Adolescent Females?' and the answer is a resounding 'no'.
Those who followed similar questions about condom promotion 'promoting' unsafe sex, comprehensive sex education 'promoting' unsafe sex, and the like, will be unsurprised, because all of these interventions have had positive impacts, and all have been shown not to result in increases in unsafe sex.
On the other hand, the $1.3 billion that PEPFAR, the (US) President's Emergency Plan for AIDS Relief, spent on abstinence and faithfulness programs "showed no evidence the messages had any impact on behavior or HIV risks".
I wonder how many billions of non-PEPFAR money went into similarly ineffective programs, and how much is still being spent on programs either destined to fail, or destined to do more harm than good, such as the massive male circumcision programs currently underway.
One piece of research found that "[T]here was no evidence of a reduction of [HIV] incidence in women as a consequence of the reduction in HIV prevalence in men due to circumcision". And that's after nearly seven years of circumcising people and assuring them that incidence among women will also drop.
They now say it could take ten years to see any impact on women, something I don't remember hearing when the programs were being aggressively promoted. So we should see results in three years time in Rakai, then? Of course, it will be difficult to tell which were the effective programs in a place where so many HIV activities are taking place at the same time.
The only evidence about the effect of mass male circumcision on male to female transmission of HIV is that it increases it by 50%, yet women are a lot more likely to be infected than men already, and this is being aggressively marketed to women as well as men.
HPV is vaccine preventable, yet in the US an estimated 25% of females between age 14-19 are infected. HPV causes cancer and genital warts. But "vaccination rates are low, partly because of a perception that vaccination may promote unsafe sexual activity among recipients."
This irrational fear of 'unsafe sex' appears to increase the risk of HPV and its consequences, also the risk of HIV, unplanned pregnancy and various other avoidable conditions. Advances in public health appear to evoke the most extraordinary reactions in some people.


Friday, February 27, 2015

Hepatitis C Virus: Revenge of the Killer Icebergs

Several of the people commenting who have been infected with HCV sound as if they don't quite understand how this came about, although they know that they have never engaged in any of the well publicized activities that are said to constitute the most serious and the most common risks.
We shouldn't be facing this problem with HCV; it's much too like the problem we still face with HIV, the view that it mainly infects people who engage in illicit activities of some kind, their partners and even, sometimes, their children. Trying to scare people about heterosexual HIV being the tip of an iceberg, when public health authorities knew perfectly that that wasn't true, backfired.
It will backfire with HCV too. Many people are still afraid to be tested for HIV, to be frank about their status, to discuss it with people with whom they may become sexually involved, etc. So why are we risking the same sort of stigmatization with HCV?
The article says: "Only in recent years have doctors realised that the hepatitis C virus (HCV) can be sexually transmitted. As it is carried in the blood but not present in significant amounts in semen and other bodily fluids, the risk of transmission during sex was presumed to be negligible. That was until patients who had never injected drugs started testing positive."
But patients who had never injected drugs, nor had any other identifiable risks, may have had an endoscopy, colonic irrigation, treatment with contaminated vials (generally multi-dose vials), been exposed to insulin pens, fingerprick lances, been circumcised in a non-sterile setting, received certain beauty treatments (eg, blackhead removal), complementary therapies, or skin-piercing and other invasive traditional practices, shared certain types of haircutting equipment, including machinery, donated blood (donors can face a risk from reused equipment), served time in prison, had anything inserted into a mucus membrane (including hands wearing reused surgical gloves), etc.
The article mentions sharing toothbrushes and razors as if that's the end of it. The research that the article refers to makes it clear that the relative contributions of various risk factors, whether sexual or non-sexual, have not yet been established.
Mentioning that "Rougher sex, anal sex and the sharing of sex toys, especially among people who are also infected with HIV, make sexual transmission possible" may spice up the article a bit, but it could also deflect attention from other risks. These other risks may well be a lot less likely to transmit HCV (or HIV) than certain sexual practices or intravenous drug use, but the list includes things that many people do many times a year.
We need accurate and comprehensive information about hepatitis C, not scare tactics resembling the ones that failed so devastatingly with HIV. In addition to common skin-piercing and invasive healthcare, cosmetic and traditional practices, it is possible that ordinary, everyday sex, transmits HIV; it may not be as risky as the spicy kinds journalists like to report on, but it is likely to be a damn sight more common.


Tuesday, February 24, 2015

Syringe Reuse - HIV Industry to Revise Finger Pointing Strategy in Africa?

The WHO has started their global campaign to increase awareness of the dangers of unsafe healthcare, especially through reused syringes, needles and other skin piercing equipment, and have issued a brochure on injection safety.
It's lucky that the inventor of the K1 auto-disable syringe, Marc Koska, heard about the problem of reused injecting equipment in 1984. Only a few years later attention was drawn away from unsafe healthcare to unsafe sexual behavior as the main route of transmission for HIV.
Although HIV in wealthy countries now mainly infects men who have sex with men and people who inject illicit drugs, and this was already clear in the late 1980s, public health institutions decided to emphasize the risks people face from heterosexual sex.
Perhaps these institutions had their reasons, and the campaign was 'successful'; many people all around the world still believe that heterosexual sex is the biggest risk for HIV. The risk to heterosexuals was, and is, very low, but few people around in the 1980s could forget the relentless scare campaigns.
But in poorer countries, most people becoming infected with HIV were clearly not men who had sex with men or injecting drug users. They were just ordinary people, many of whom who had never had sex, never had 'unsafe' sex, or only had sex with a person who was also HIV negative.
There were also a lot of infants infected by their mothers, and there still are, although the prevention of mother to child programs have been among the most successful in the history of HIV.
The issue of non-sexual transmission of HIV in developing countries remained ignored, even strenuously opposed by what became an enormous HIV industry. And so, those infected with the virus, and whose infants were infected with the virus, were accused of being promiscuous, careless, dishonest and even cruel to their family and those around them.
Perhaps this will herald in a new era, making it possible to raise the issue of non-sexual transmission of HIV through unsafe healthcare without accusations of denialism (although it seems to be the opposite of denial), being anti-scientific (although there is no shortage of evidence) or of diverting attention from the importance of sexual behavior, which was never as important as the massive scare campaigns would have us believe.
One newspaper article cites Koska as saying “I always wanted to be a superhero and save the world”. I don't know if he really said that, but I'd like to believe he did. Because the benevolence of his motives contrast strongly with the apparent motives of certain parties in the burgeoning HIV industry, for whom HIV transmission is but a route to wealth, power and career advancement.


Monday, February 23, 2015

Cambodia, Unsafe Healthcare, Injections: Time for a Changing of the Guard?

There's a very succinct set of photographs by Marc Koska of the SafePoint Trust about the HIV outbreak in Cambodia's Roka Commune. Over 270 people are said to have tested positive so far, several of whom have already died. Unsafe healthcare is thought to have been behind this outbreak, reuse of syringes and other skin piercing equipment by medical practitioners who do not have the knowledge, skills or equipment to avoid such occurrences.
Koska invented an auto-disable syringe many years ago, a syringe that breaks if you try to reuse it, but he has been lobbying health and HIV institutions to promote the use of this simple and cheap technology ever since.
It is highly unusual for the BBC to express the slightest hint of disagreement with the mainstream view of UNAIDS and other institutions, that HIV is almost always transmitted through unsafe sex, and hardly ever through unsafe healthcare. Perhaps because this outbreak was in Cambodia, where HIV prevalence is low, this story flew under the radar.
Sadly, as the article points out, use of auto-disable syringes is too late for those already infected, but it is not too late for other Cambodians, nor for HIV negative people living in countries where HIV and other blood-borne viruses are common and, more importantly, where safe healthcare is uncommon.
UNAIDS and others in the HIV industry have been ranting on about 'unsafe sex' and completely avoiding the issue of unsafe healthcare, even denying its possible role in the most serious HIV epidemics in the world, which are all in Africa. Perhaps this will bring various kinds of unsafe healthcare into focus, however belatedly.
Cambodia is not the only Asian country where unlicensed practitioners operate; and even licensed practitioners may reuse needles, syringes and other skin-piercing equipment. The practitioner who has so far been the only scapegoat is unlikely to be the only person to practice healthcare unsafely. The investigation should be global, not confined to a population of a few thousand.
As for African countries, it should be clearer than ever that unsafe healthcare must no longer be denied by UNAIDS and other health agencies as an important mode of transmission of HIV and other viruses in African countries. People shouldn't have to be Buddhist monks, very young or very old to be believed when they say they have not engaged in 'unsafe' sex, or any sex at all.
The UNAIDS view that HIV is almost always transmitted through 'unsafe' sex and hardly ever through unsafe healthcare is vehemently expressed in a BBC article from 2003, and these views don't appear to have changed since (although the UNAIDS official in question, along with some of her senior colleagues have since availed themselves of the revolving door).
The maliciously racist view of Africans that the senior UNAIDS official is, apparently, allowed to make public, doesn't seem to have changed either.
It's also worth bearing in mind that UNAIDS are well aware of the risks of healthcare transmitted HIV and other infections in developing countries. They publish a brochure warning UN employees not to use health facilities in such countries; this contrasts very strongly with what the BBC published the year before. Perhaps now they UNAIDS will promote this in Cambodia, and hopefully in Africa too?