Wednesday, July 14, 2010

Two Point Zero Means We Haven't A Clue

A prominent UNAIDS spokesperson said "We haven't a clue what to do, really, we have never known. But we have noticed that putting '2.0' after anything will get you mentioned in all the press. And it's true, it works! We haven't had any ideas since we were established but we keep on repackaging tired old ideas that didn't work and the press tell the world what a great job we're all doing".

Sadly, a UNAIDS spokesperson didn't say that or anything else that could be verified. Such top-heavy, high spending bureaucrats with well padded buttocks are not known for making verifiable statements. But they do churn out a lot of photographs and colored diagrams. Their website, which was reasonably easy to find things on before, has succumbed to a late 1990s style splash page and underneath that, another splash page. Where they have put all their content has yet to become clear. Perhaps it's part of their 'treatment 2.0' effort. But some would say, quite cynically in my opinion, that this is no loss.

I was supposed to work for an organization that turned out to be siphoning off money from donors and using it for other purposes, nothing to do with development. But they had a real knack for finding people who would turn the right knobs when potential donors visited. If they were return donors, the same people could push all the right buttons to convince the donors that their money had been well spent and they would be wise to spend more. I think UNAIDS are similar. They have realised that one thing was missing from their attempts to break down in tears at every opportunity and beg for the massive amounts of money going to HIV treatment not to be cut.

They have realised that telling everyone that there are more people becoming newly infected with HIV than being put on treatment was not a good tactic, perhaps because it was too embarrassingly true. Even some of the more foolish people involved were able to think their way through the wet paper bag and see that this would mean the epidemic would just continue to expand. So now they are manufacturing figures to convince us that the childish 'prevention' programs they have wasted so much time on have worked, that you can just wave a magic wand and get people to do what you want and stop doing what you don't want.

On the surface, it looks like things have improved in Kenya a bit since 2000 and somewhat less so between 2003 and 2008. But the year 2000 was just after HIV prevalence peaked and started to drop. It dropped more quickly as death rates increased. Death rates probably peaked around 2003 or 2004 and HIV prevalence has changed little since then. It is claimed that hundreds of thousands of people are now on treatment so prevalence could be expected to have gone up as a result. But it doesn't seem to have done so yet. In fact, death rates are still quite high in Kenya. A few figures have improved between 2003 and 2008, people know the right answers to questions by now, but it is likely that HIV transmission is high enough to keep the epidemic going for some time to come.

If you buy the HIV industry's standard excuse (perhaps there's even an ISO number for it), that HIV is mostly caused by heterosexual sex, then you could easily find the figures seductive. More people now say they are having their first sexual experience later, they are having few partners, they use condoms more often, etc, etc. The behavioral paradigm holds that people (in African countries) have too much unsafe sex and all you have to do is persuade them to have less and HIV transmission will go down. The trend for 'safe' sex indicators has been going up since before HIV was ever heard of so, jumping on that bandwaggon, you could conclude that slight drops in HIV transmission have been a result of 'behavior change'.

If sexual behavior has changed significantly it is possible that some people are less likely to become infected with HIV. It all depends on things like whether they are male or female, urban dwelling or rural dwelling, of childbearing age, married or widowed and various other things. Females and urban dwellers are more likely to be infected. But far more people live in rural areas and out of the 1.5 million HIV positive Kenyans, about one million of them are rural dwellers. Also, the ratio of urban to rural infections is changing, with the percentage of rural infections rising. And while there are more women than men infected, that ratio is also changing. The percentage of men infected is catching up.

I have never seen any clear evidence that you can expect whole populations to say 'Oh, very well, then' when some foreign bureaucrats say 'Ok, you're having too much unsafe sex. Abstain, be faithful and use condoms.' People are more likely to say 'Butt out' or even 'What?'. But even if these 'prevention' efforts have had any effect, HIV is not just transmitted sexually. This is not news, it has been realized since HIV was first identified as the virus that causes Aids. It's just that, somehow, the HIV industry that subsequently developed didn't see non-sexual HIV transmission as worthy of their attention. Perhaps it's not 'treatment 2.0' enough.

So the articles about UNAIDS' non-new new approach are all over the place, bureaucrat-speak for 'We've really screwed up, but hey, that's our job, right?'. UNAIDS need to get clear about where HIV is coming from, who is transmitting it, in which areas and exactly how it is being transmitted. They have got by on 'modeled' figures for too long, figures that depend on too many unwarranted assumptions. Many people have been warning for years now that the behavioral paradigm is a piece of racist, sexist clap trap. They have written articles and books demonstrating how deceitful and misleading it is but UNAIDS and the entire HIV industry still takes this flat-earthist line.

The trouble is that when you set up a cabalistic peer-review system it eventually starts to poke up its own ass. All the 'experts' get together to scratch each other's backs, a sort of mutual delousing, and they agree that their articles are very worthy and must be published at once. Anyone from outside the cabal is ignored. There are millions of people being infected with HIV every year and after 25 years of research, all we can come up with is the same regurgitated nonsense in a new package? Why does UNAIDS still exist, after falling stillborn from the prolific UN? Is this is all they can come up with? People in developing countries, both HIV positive and HIV negative, deserve a lot better.


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