Tuesday, July 28, 2015

WHO to Warn About Unsafe Healthcare Transmitted Hepatitis, but not HIV?

UNAIDS, WHO, CDC and other institutions continue their insistence that HIV is almost always transmitted through heterosexual sex in African countries (though nowhere else), and that unsafe healthcare, cosmetic and traditional practices play a vanishingly small and declining role in transmission.
It was suggested to me recently by someone who questions the above views that these well funded institutions will eventually have to change their tune. However, he felt that they would not admit that they are wrong, or that they have known since the 1980s about the risks posed by unsafe healthcare and other non-sexual HIV transmission routes.
Unfortunately, the WHO is not very explicit about the problem: there are many health professionals who are unaware about the risks of reusing skin piercing equipment, especially injecting equipment. These health professionals do not warn their patients because they are unaware that they should not reuse syringes, needles, even multi-dose vials that may have become contaminated.
People may be surprised that there are health professionals who are unaware of these risks, or that they take these risks even if they are aware of them. But every year there are cases of infectious, even deadly diseases, being transmitted to patients through careless use of skin piercing equipment. Tens of thousands of people are put at risk, and that's just in wealthy countries.
As for poor countries, especially sub-Saharan African countries, where the highest rates of HIV are to be found, no one knows how many people have been put at risk, how many have been infected with hepatitis, HIV or other blood borne viruses, or how many are still at risk. People are not being made aware of the risks they face, so they can not take steps to avoid them.
The US National Institute of Allergy and Infectious Diseases (NIAID) still carries the rather limp "HIV cannot survive for very long outside of the body", instead of warning people that they should not allow the blood of another person enter their bloodstream. It is irrelevant how long these viruses survive; people need to know that contaminated blood may be entering their bloodstream so that they can take steps to avoid this.
Unsafe healthcare, cosmetic and traditional practices carry huge risks, especially in countries where blood borne viruses such as hepatitis, HIV and others are common. People can avoid infection with these blood borne viruses by avoiding potentially unsafe healthcare, unsafe cosmetic practices, such as tattooing or body piercing, and traditional practices, such as circumcision or scarification.

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Wednesday, July 1, 2015

Depo Provera and Circumcision: Violence Against Women Masquerading as Research

Although there are plenty of instances of institutionally sanctioned violence against women, this blog post is about two very prominent instances: mass male circumcision programs [*Greg Boyle, cited below; one of the most up to date publications on the subject, which cites many of the seminal works] and the aggressive promotion of the dangerous injectible contraceptive, Depo Provera (DMPA).
Why are mass male circumcision (MMC) programs instances of violence against women? Well, three trials of MMC were carried out to show that it reduced female to male transmission of HIV. They were show trials, with the entire process monitored to ensure that it gave the results that the researchers wanted. These trials have been cited countless times by popular and academic publications.
Less frequently cited was a single trial of MMC that was intended to show that it reduced male to female transmission of HIV. None of these four trials were independent of each other and the female to male trials produced suspiciously similar results, despite taking place in different countries, with ostensibly different teams. But the single male to female trial showed the opposite to what the researchers wanted: circumcision increased HIV transmission, considerably.
During all four of the trials, male participants were not required to inform their partner if they were found to be HIV positive, or if they became infected during the trial. If there had been any ethical oversight, those refusing to inform their partner would have been excluded from the trial. This is what would have happened in western countries, including the one that funded the research, the US.
Given that many women and men believe that circumcision protects a man from HIV, these MMC programs are giving HIV positive men the means to have possibly unprotected sex with HIV negative women. Many women and men were infected with HIV during the four show trials and almost all of those infections could have been avoided. How participants became infected during the trials has never been investigated, which is not only unethical, but also renders the trials useless.
Despite Depo Provera use substantially increasing the risk of HIV positive women infecting their sexual partners, and the risk of HIV positive men infecting women using the deadly contraceptive, this is the favored contraceptive method for many of the biggest NGOs (many of the biggest NGOs are engaged in population control of some kind). Therefore, its use is far more common in poor countries (especially among sex workers) and among non-white populations in rich countries.
These two instances of violence against women (and men) are funded by the likes of CDC, UNAIDS and the Gates Foundation. Many research papers extolling the virtues of MMC and Depo Provera are paid for by such institutions, copiously cited by them in publications, and constantly wheeled out as examples of successful global health programs. Yet, they are both responsible for countless numbers of avoidable HIV infections.
There is currently a lot of institutional maundering about violence against women and certain instances of it, but some of these same institutions are taking part in the perpetration of it; they are funding it, making money and careers out of it, promoting themselves and their activities on the back of what is entirely unethical. Why do Institutional Review Boards, peer reviewers and academics, donors and others seem happy to ignore these travesties? Who is it that decides that this is all OK, when it clearly is not?
Why are these not considered to be unethical: aggressively promoting the use of a dangerous medication, and an invasive operation that will neither protect men nor women? Is it because those promoting them are making a lot of money out of them, because the victims are mostly poor, non-white people, because the research and programs take place in poor countries, because ethics is nice in principle but too expensive in practice...? Or all of the above and more?
* Boyle, G. J. (2013). Critique of African RCTs into male circumcision and HIV sexual transmission. In G. C. Denniston et al. (Eds.), Genital cutting: Protecting children from medical, cultural, and religious infringements. Dordrecht, The Netherlands: Springer Science+Business Media doi: 10.1007/978-94-007-6407-1_15

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Thursday, June 25, 2015

Africans Several Steps Ahead of 'Global' Health?

Many articles about ebola continue to mention a two year old boy who was probably infected with the virus some time in December of 2013. The articles refer to the boy as the 'index case', as if his being infected set off the recent epidemic in West Africa.
In fact, working back from confirmed cases, the trail goes cold before December 2013. There is no data about the virus and the investigation becomes pure speculation at this point. There is no evidence that the boy was infected by a bat, nor is there evidence that bats or other animals in the area carry ebola.
Articles mentioning this two year old boy, bats, 'corpse touching' at funerals and even sexually transmitted ebola (of which no cases have ever been confirmed), are commonplace. It is not just the media that revel in them, but also many scientific and medical articles.
But the people of West Africa seem oblivious to many of the warnings they have been receiving about ebola. And maybe they are right?
In Guinea, cases of malaria and deaths from malaria far exceed numbers of people infected with ebola and deaths fromebola. More importantly, the number of deaths from malaria has increased because people have been avoiding health facilities, fearing they might be infected with ebola.
Worse still, their condition may be mistaken for ebola and they could end up in an ebola treatment unit, with other suspected ebola cases, some of which turn out to have the virus.
To fear health facilities in Africa is perfectly logical. Healthcare conditions in most African countries are appalling. Not just ebola, but HIV, TB, hepatitis and other diseases have been spread by unsafe healthcare practices, such as reused injecting and other skin-piercing instruments.
CDC, UNAIDS, WHO and other health agencies may be convinced by their own propaganda, but people in Guinea, Sierra Leone and Liberia are not. And, it seems, they have entirely valid reasons for ignoring this 'official' advice. Unfortunately, that means many people will suffer from and die from easily treated conditions.
But 'global' health is in crisis because those most likely to suffer from 'global' health conditions are probably least likely to trust health facilities in their country. The interference of various international agencies (or local offices of international agencies) is only likely to increase this mistrust.
Nigeria has problems with 'quack' doctors. Nigerians escaped a serious ebola epidemic, but the second largest HIV positive population in the world resides in Nigeria. Nigeria has also swallowed the dubious claims of UNAIDS and others that HIV is almost always transmitted through heterosexual sex in Africa countries.
The ebola epidemic has shown that people find it hard to trust 'global' health agencies. Warnings about various sexual practices and HIV have also fallen on deaf ears. But perhaps ordinary people are right to ignore 'global' health agencies. Perhaps bush meat and 'corpse touching' are either not as common or not as risky as we have been told. And perhaps the appalling conditions to be found in health facilities are much more risky than we have been told.

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Monday, June 15, 2015

South Africa - Never Mind HIV, We've Got Penis Transplants

One ebola case, out of tens of thousands identified over nearly forty years, may have been sexually transmitted; the evidence is slim, but CDC and others really want this one case to be used to stress that people should be made aware of this highly remote possibility (if it is even remotely possible).
Strong evidence that a significant proportion of transmissions of ebola is a result of unsafe healthcare is quietly ignored; CDC and others don't wish to warn people that the healthcare systems expected to deal with such outbreaks are far too weak to keep people alive, and are likely to be part of the problem in the cases of ebola and HIV.
South Africa has transplanted one penis on to a man who lost his through a botched circumcision. The US government is ploughing a few billion dollars into circumcising tens of millions of African adults (and an unknown number of children), so they will not be in a hurry to warn people about the hundreds of botched circumcisions reported every year (nor the uncounted thousands that remain unreported).
The English Guardian has a lengthy article about this single penis transplant, and has had a few, equally salacious articles, about botched circumcisions that occur in traditional, non-sterile settings. That same smug, self-satisfied newspaper has had next to nothing to say about appalling conditions in healthcare facilities in places where HIV prevalence is very high, or about the possible role of unsafe healthcare in transmitting HIV, hepatitis C and B, ebola, TB and various other diseases.
The craze for circumcising African men is based on the view that HIV is almost always 'spread' by men, through 'unsafe' sex, which almost every 'African' engages in, almost all the time (a view based entirely on prejudice). The press is completely unmoved by the fact that circumcision of men may increase HIV transmission from males to females, considerably.
The media goes crazy about the 'possibly sexually transmitted' ebola case, even exaggerating it into a dead certainty that it was sexually transmitted; and they are happy to promote the view that Africans engage in types and levels of sexual behavior that should be curbed by various (failed) measures, paid for by donor money. But this is just a continuation of what various colonizers began.
The racism behind the view that HIV is almost always transmitted through heterosexual contact in (some) African countries, but no non-African countries, has always remained unremarked by the press. The prejudice behind singling out uncircumcised African men and HIV positive women for intense vilification is rarely mentioned.
The fact that about 7% of HIV positive women in South Africa, the country with the largest HIV positive population in the world, report being sterilized forcibly, receives occasional mention. But readers seem to prefer articles about penis transplants and one possibly sexually transmitted case of ebola, it appears.
The health services are unable to cope with any illnesses and throwing money at HIV will not result in reasonable numbers of well trained and equipped staff, adequate supplies and, most of all, levels of cleanliness and hygiene that eliminate the possibility that many patients will end up being infected with something in hospital that is far worse than what they were admitted with.
There is nothing new about this denialism, but it needs to be recharacterized; health services are not just inadequate, they are dangerous. Aidsmap.com are certainly not alone in bemoaning the fact that many women in South Africa are infected with HIV relatively late in their pregnancy, sometimes after giving birth, even many months after.
Nor are Aidsmap alone in failing to consider the possibility that some of those women, perhaps most of those women, were infected with HIV through unsafe healthcare, reused syringes, needles, various types of equipment and various processes that require a far better level of hygiene than will be found in extremely high prevalence provinces, such as KwaZulu Natal and Mpumalanga.
The pharmaceutical industry does very well out of HIV and several other diseases that have hit the headlines in the mainstream press, and are deemed worthy of enormous funding. Many NGOs have been built by HIV money and will only thrive and prosper as long as a few diseases are considered worthy of massive funding.
The press loves a story about a penis transplant in a country too poor to prevent thousands of unnecessary deaths every year, of women giving birth, babies, children and adults with easily treated and prevented diseases. Appalling conditions in health services in most African countries does not merit the attention of the press, they are far too commonplace. If a story from 'Africa' has even the remotest connection with sex, publish it; if not, forget it.

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Thursday, June 11, 2015

Cambodia Healthcare Transmitted HIV Inquiry Watered Down

Some of the recent articles about the massive outbreak of HIV caused by reuse of syringes, needles and other skin piercing instruments in health facilities in Roka Commune, Battambang Province, Cambodia, make it sound as if being unregistered is the main problem; unregistered practitioners, unregistered clinics, etc.

But as this article about unsafe injections in US health facilities makes clear, it is the behavior of well qualified people in legitimate facilities that can threaten the health and lives of patients, especially in poor areas. Being registered may result in practices and practitioners being scrutinized from time to time, if there are mechanisms and personnel for such scrutiny.

But in Cambodia there are numerous unlicenced practitioners and facilities because there is a chronic and long term shortage of trained and qualified personnel. There are also shortages of equipment and supplies. The cost of healthcare is simply too high for most people, so they resort to unlicenced practitioners and practices.

But that does not mean things are completely safe in legitimate facilities, where some or most of the employees may be relatively well trained and qualified. Nor does it mean that there are adequate measures taken to inspect premises or practitioners, nor consequences for unsafe behaviors.

The current 'investigation', which seems to be progressing at a snail's pace, is being carried out in conjunction with UNAIDS and the World Health Organization. But these organizations specialize in disinformation about health facility transmitted HIV. The current approach in Cambodia is to point the finger at one unlicenced practitioner, and his practice, rather than health services in their entirety.

Now it seems the investigation into how almost 300 people became infected with HIV is being further watered down by concentrating on the issue of licences, which suggests that it is not scrutinizing the potentially unsafe behaviors of those working in healthcare. It even appears that some of the clinics being closed down are run by Chinese nationals or ethnic Chinese Cambodian nationals, using unsafe healthcare to deflect attention from anti-Chinese prejudice (something UNAIDS is unlikely to question).

The Cambodian government, UNAIDS, the WHO and others are missing the most important point about the 300 people so far identified as being infected with HIV through unsafe healthcare: it is not unlicenced practitioners or facilities that spread diseases, it is unsafe behaviors, such as reuse of syringes, needles and other equipment; people have a right to SAFE healthcare, not just any old healthcare.

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Saturday, April 25, 2015

Ebola and ‘African’ Sexuality: Life in the Old Fantasy Yet?

Not one single case of sexually transmitted ebola has ever been demonstrated, in nearly 40 years. The presence of the virus in some form in semen has been demonstrated. But the possibility that the virus can be transmitted via that semen has not. And the author is even, to some extent, aware of this.
So why do the media rant on about sexually transmitted ebola? Could it be a continuation of some of the racist views of Africans that date back many decades, perhaps centuries? Several decades (at least) before HIV was identified, it was assumed that prevalence of certain sexually transmitted infections in African countries, such as syphilis and gonnorhea, was a result of 'promiscuity'.
More enlightened researchers published papers, also decades ago, arguing that there was absolutely no evidence that levels of 'promiscuity' were higher in African countries than elsewhere. Some of them also argued that the conditions of health services, along with the living and working conditions to which people in colonial Africa were subjected, were far more significant factors than sexual behavior.
Some of them were reacting to the efforts of the various different eugenics movements to provide 'scientific' evidence for their extraordinary views. However, once HIV was identified and found to be more common in some African countries than anywhere else, the myth of 'African' promiscuity returned. And it remains, explicitly or implicity, in HIV policy, journalism, and in much of the academic writing.
The characterization of African people as promiscuous goes hand in hand with the characterization of African men as sexually incontinent, animalistic, uncaring about those around them, particularly their own family members, and completely unamenable to change.
African women are seen as being entirely incapable of resisting the will of the men around them. They are mere victims, misused and discarded, to be 'rescued' by decent westerners, if they are lucky. They are then subjected to the pity of their rescuers, the journalists who write about them, and others who think this sort of thing 'just shouldn't happen'.
The author claims to have met with members of a women's 'secret society'. We are informed that such societies are "ancient cultural institutions found all over Sierra Leone". We can't gainsay that if we've never been to Sierra Leone, after all, they are secret, although we might ask how secret they are if the author could meet with them.
But, far more important than the claim that ebola is transmitted sexually (and it might be, occasionally), is the tone of the article, about how much women suffer, with the strong implication that this is the fault of Sierra Leonean men. But poverty, bad health, low levels of education, poor living conditions and terrible labor conditions are a fact of life for most people in Sierra Leone, male and female.
Education may be, as the headline says, crucial. But whose education is crucial? Whose knowledge? Whose data? Whose research? This academic seems to have recorded the result of decades of racist informed education, and now presents it to us as the unassailable views of Sierra Leonean women, at least, the ones who belong to these common 'secret' societies.
However, there are promiscuous people everywhere, but most people are not promiscuous. There are violent and abusive people everywhere, and the perpetrators may well be more likely to be male than female. But most people are not violent or abusive. Most men are not. And most women are not mere victims of everything that goes on around them.
This is not to say that there are not huge imbalances and great injustices, with many women suffering, often at the hands of men. But whatever strategy may bring relief to the suffering of women and men, it will not be one based on a puerile and reductive belief in the incredible baseness of African men, coupled with the complete inability of African women to defend themselves in any way.
Ebola, HIV, hepatitis, TB and many other diseases can be transmitted in various ways. One of the modes of transmission for all of them is unsafe healthcare, believe it or not. In the case of HIV, such transmission has been strenuously but entirely unconvincingly denied. Sex is one of several modes of transmission for HIV, but it is unlikely to be a significant mode of transmission of ebola.
But transmission of ebola through unsafe healthcare practices appears to be slipping through the net, as academics indulge in their fantasies about an assumed 'African' sexuality, along with a great love for seeking (female) 'victims' that they can rescue, study, and hopefully write scholarly(ish) papers about. These academics are not just deceiving themselves, they are deceiving those they claim to be concerned about.

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Friday, April 24, 2015

Medical Costs: Protectionism Harms Children

This is reposted from the Watoto Kicheko blog.

One of the big expenses that parents (and orphanages!) face in developing countries like Tanzania is the cost of medicines and treatment. Even healthy children need vaccinations and have lots of other health needs that can only be met using pharmaceutical products. Medical costs run high.

You might think that developing countries would pay less for lifesaving medicines and vaccinations, but you would be wrong. Medical costs are often disproportionately high in poorer countries. Pharmaceutical companies negotiate prices in secret, and countries often have to sign a confidentiality agreement in the process.

Medical costs disproportionately high in developing countries

Apparently "Tunisia pays more than France; South Africa pays almost three times more than Brazil." But it's hard to compare what countries like Tanzania pay for medical costs because of the secrecy surrounding this industry, all cloaked by vague claims about 'commercial sensitivity'.

Medical costs - one of our sick girlsThere's a vaccine for pneumonia, but it is too expensive for most people in developing countries, and even for NGOs operating in the majority world. Pfizer and GSK, who spend massive amounts on publicity, have failed to negotiate openly and fairly.

Medical costs addressed by MSF campaign

Medicins Sans Frontieres (Doctors Without Borders) are currently running a campaign called #AskPharma to draw attention to these inequitable practices. An estimated one million young children die of pneumonia every year and Medicins Sans Frontieres want to start by getting the price down to $5 per child for the three shots they need.

This is still a large amount of money and could easily buy the food for ten meals in Tanzania. Conditions such as TB and HIV infect and kill far fewer children acute respiratory infections in this country, yet the medical costs for these are often covered, or partially covered, by international intitives (albeit still at an excessive price).

Top deadly diseases of children and infants

The top killer of children in developing countries is acute respiratory infections. Other big killers are malaria and diarrheal conditions, both of which are preventable. It should be cheap to prevent them, but diarrhea kills another 1.5 million children, globally.

The World Health Organization (WHO) reminds us that "About 44% of deaths in children younger than 5 years in 2012 occurred within 28 days of birth – the neonatal period. The most important cause of death was prematurity, which was responsible for 35% of all deaths during this period."

Many Watoto Kicheko children were born prematurely, and are far more susceptible to pneumonia and other Medical costs - drippreventable disease as a result. This issue is very close to our hearts.

Pneumonia is a horrible sickness, I have had it myself. But I was lucky to be in the UK, where medical costs and treatment are covered by national insurance. Few people die of pneumonia in the UK, or other wealthy countries.

Watoto Kicheko children face high risk from pneumonia

But it is especially common among children who are weakened by malnutrition, other childhood illnesses, lack of breastfeeding, etc. Therefore, it is something that we at Watoto Kicheko are always watching out for.

Please help raise awareness by supporting the Medicins Sans Frontieres campaign. Doing so will also help the children at Watoto Kicheko, by helping to reduce medical costs.

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