Wednesday, May 5, 2010

UNAIDS To Reconsider Evidence on Non-Sexual HIV Transmission: Only Joking!

My post was getting a bit long yesterday but it is also important to remember other blood related risks that may transmit HIV, hepatitis B and C and other blood borne diseases. For example, sharing a razor or perhaps certain cosmetic instruments, tattooing equipment and body piercing equipment that haven't been sterilized, can all be risky. Yet, UNAIDS don't mention any of these possibilities in their 2009 Aids Epidemic Update.

It seems extraordinary that, given the efficiency of transmission of blood contaminated instruments and the relative inefficiency of sexual transmission, UNAIDS should be happy to dismiss medical transmission as very small and to fail completely to mention cosmetic or other modes of transmission. Have they even checked, and can we see the data collected? We just don't know how much these phenomena could have contributed to HIV epidemics in countries with very high prevalence.

In Kenya and Tanzania, haircutting and other cosmetic processes don't just take place in hairdressers and salons. Women go to each other's homes for such things and you even see people doing their grooming in public. In Dar es Salaam, several times, I saw men shaving the head of another man with a hand held, two sided razor. They would then swap over and both would end up with a lot of cuts on their heads. It's impossible to estimate how much this could contribute unless it is properly investigated.

Yet UNAIDS can happily report the various modes of transmission and say that sexual transmission can even account for 94% of all transmission in Swaziland. That means that the extremely risky (male to male and male to female) anal sex that must take place accounts for only a few percent, at the most. Hospitals and clinics in Swaziland must be so well run that they also account for a few percent. Barbershops, tattoo parlours and hairdressers hardly ever contaminate anyone, perhaps never. And this is in a country with over 25% HIV prevalence! Come on, UNAIDS, this is just not credible.

But UNAIDS and many others just keep to the behavioural paradigm which says that in African countries, HIV is mostly transmitted by sexual intercourse whereas in non-African countries it is mainly transmitted by intravenous drug use, men having sex with men, commercial sex work and a few other things. This behavioural paradigm is one of the main sources of stigma and, despite deploring stigma, UNAIDS will not admit that the paradigm is based on a lot of guesswork and a lot of effort to ignore anything that may contradict them.

What UNAIDS need to do is admit that they are wrong, that research does not show that HIV is mostly transmitted by heterosexual sex in African countries. On the contrary, there is plenty of evidence that most people in African countries do not indulge in the levels of unsafe sex, or any kind of sex, that would be required for the behavioural paradigm to be credible. In addition, there is plenty of evidence that medical and cosmetic procedures often take place in unsterile conditions. It is simply not possible for non-sexual modes to account for as small a percentage of HIV transmission as they would have us believe.


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