Thursday, June 10, 2010

Abolishing UNAIDS is a Prerequisite to Fighting HIV Pandemic

I'm not just suggesting that UNAIDS have failed to reduce HIV transmission to the extent that the epidemic will be wiped out in the foreseeable future, although they have certainly failed to do this. I'm suggesting that they seem content to allow HIV to spread, especially in developing countries, as long as it is not transmitted sexually.

This is disingenuous because people who are not infected with HIV sexually, for example, if they are infected though medical treatment or cosmetic treatment, can still go on to infect others sexually. It is not possible to significantly reduce sexual HIV transmission without also reducing non-sexual transmission. It is also rather pointless to target sexual transmission and exclude non-sexual transmission completely.

The question is, why does UNAIDS see its mission as relating almost entirely to sex? In the early days of Aids, before the exciting prospect of a UN agency entirely devoted to one disease was even recognised, non-sexual transmission of HIV was still considered important. Warnings about HIV risk included risk of medical transmission and risk from other procedures that involved possible blood borne transmission.

As a result, Western hospitals changed the way they did things, especially relating to any procedures involving possible blood exposure. Blood transfusions represented one of the greatest threats and even developing countries now have policies relating to transfusions that are estimated to have cut this form of HIV transmission considerably, perhaps completely.

But developing countries have not had the resources or the training to improve their health facilities enough to convince the UN, and probably many others, that they are safe. And indeed, they are not safe. Westerners travelling to developing countries, especially in Africa, are often warned about medical and other treatment that could carry the risk of exposure to HIV and other blood borne diseases. But Africans are not warned.

An unusual exception to the practice of warning Westerners (and not bothering about people in developing countries) seems to be occurring at the moment. I don't think people visiting South Africa for the World Cup are being warned about non-sexual risks, although they are hearing plenty about the sexual risks. Some of them will probably feel they have had enough sex by the time they get to South Africa. Others may only feel their appetites whetted.

But South Africans are still, to a large extent, in the dark about non-sexual HIV transmission. A report from a few years ago estimated that the number of new infections per year among those aged between 2 and 14 was about 69,000. About 192,000 people between 15 and 24 were infected. But where are all these infections coming from? What makes a South African more or less likely to be infected?

69,000 children infected in one year! What are the possibilities? That their mothers are all HIV positive (the report authors say it is unlikely that these are linked to mother to child transmission)? But many (not all, unfortunately) HIV positive mothers receive treatment to prevent transmission to their infants. And even among those who don't, HIV transmission is not 100%. There are other possibilities, but certainty is needed. When a country has tens of thousands of HIV positive children, this needs to be investigated, so we can be sure what is going on. If you were the parent of one of those children, would you accept UNAIDS contention that most HIV is transmitted sexually?

Being black in South Africa means you are 9 times more likely to be infected than if you are from any other race. Being from Mpumalanga province means that you are 12 times more likely to be infected than if you are from Northern Cape. And if you are from an urban slum, you are over 5 times more likely to be infected than if you are from an urban non-slum area. If you are from a rural area, you are far less likely to be infected, regardless of whether you are from a slum or a non-slum.

Females between the ages of 20 and 29 are over 6 times more likely to be infected than males of the same age group. Just in case these figures suggest that the predominantly well off male and younger visitors to the World Cup could be at an advantage, they will be mainly in urban areas and if they happen to visit medical or cosmetic outlets, the contaminated blood they are exposed to could have come from a male or female of any age or race and from any location.

Also, rates of new infections among people who reported never having sex or who reported not having sex in the past 12 months stood at 1.5% and 2.4%, respectively. This could represent tens of thousands of people whose HIV infection probably came from a source other than sex. Where did their infection come from? From being African, according to the UNAIDS received view; they have simply underreported their sexual behaviour, in other words, they lied.

So, if you are visiting South Africa and you end up in bed with someone you meet there, you would be crazy not to wear a condom, just as it would be crazy in any other country in the world. You would be better off avoiding sex altogether, if that is your favoured way of reducing the risks you face for HIV, unplanned pregnancy and other sexually transmitted infections.

But you are not protecting yourself adequately if you think that having sex is the only way of becoming infected with HIV. You may well be safe enough if you take the right precautions, no matter who you sleep with. But you will be in far greater danger if you have to go to a hospital, a dental surgery, a tattoo parlour or a hairdresser.

If soccer fans visiting South Africa are lucky enough to be able to choose the health facilities and other service providers they visit, that's great. But South Africans will not be so lucky. As long as UNAIDS insists on playing the sexual card, people will remain in the dark about non-sexual risks. Providers of health and cosmetic services will continue to use unsafe procedures and people will continue to be infected with HIV.

Now that fifa and other commercial interests have their snouts firmly in the trough and journalists have been distracted by one of their favourite subjects, sex, UNAIDS is unlikely to take the only sensible route of warning people about both the sexual and non-sexual risks of HIV. As to why they have so far refused to accept that non-sexual transmission of HIV plays a significant part in the HIV pandemic in Africa, that is anyone's guess. But people are being infected, they are suffering and dying, unnecessarily. Why does UNAIDS receive public money to behave in this way?


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