Saturday, August 14, 2010

It’s Undermined Itself; Will the HIV Industry Now Abolish Itself?

There are many myths and confusions about HIV/Aids and Wikipedia lists and debunks many of them. But one of the most dangerous myths arises, not so much because of what is said, as because of what is not said. The view of the HIV industry is that most HIV in African countries is spread by heterosexual sex. According to the industry, unsafe healthcare probably only accounts for about 2.5% of HIV transmission.

There are two major consequences arising from the HIV industry's view, which is widely accepted as being based on the most up to date and reliable information: firstly, people in African countries are left unaware of what could be a significant source of HIV infections and, therefore, of how to protect themselves; and secondly, it is generally assumed that people who are HIV positive have engaged in unsafe sex and many become the victims of stigma and discrimination as a result of this association.

Unfortunately, this is one of the myths that Wikipedia does not deal with. They do deal with a closely related myth, that 'HIV survives for only a short time outside the body' but they simply replace that myth with a weaker version. Similarly, the article mentions the danger of sharing hypodermic needles among intravenous drug users, but they don't point out that sharing syringes also carries a serious risk.

There's a recent article by Dr Devon Brewer in the Swaziland Times on myths about HIV and other viruses only surviving for short periods outside the body. Small amounts of contaminated bodily fluids can stay infectious for a week or more, whether wet or dry. As this has been known for over 20 years, it's a bit of a mystery that so many influential people and institutions still appear to think otherwise. Interestingly, healthcare workers in developing countries are taught the myths while those in developed countries are taught to see all potentially contaminated blood and bodily fluids as dangerous.

More detailed information about non-sexual HIV transmission can be found in a book, published free of charge online, by Dr David Gisselquist, entitled 'Points to Consider'. The extent to which non-sexual HIV transmission has been underestimated, even denied by the HIV industry is shocking, but also very difficult to understand. Once the industry wakes up it will be a big job to disabuse people of the inaccurate and incomplete information they have been fed for so long. But sooner or later, it will have to be done.

Despite recognising the risk of transmitting HIV and other viruses through sharing injecting and other potentially contaminated equipment, the Wikipedia article fails to acknowledge that the same risks occur when potentially contaminated equipment is shared in healthcare contexts or even during cosmetic procedures. This failure seems illogical, but they are in good company, given that UNAIDS and the rest of the HIV industry go to a lot of effort to downplay such risks.

The reason why this set of risks is so much more important than the various other myths discussed in Wikipedia and elsewhere is that people could easily protect themselves if the existence of the risks was not denied by the industry. The HIV industry does attempt to defuse some myths. But their adherence to the 'behavioral paradigm', the view that most HIV is transmitted through heterosexual sex and that transmission can be reduced by influencing sexual behavior, means that people are not warned about non-sexual risks. And the HIV industry has not even investigated many instances of non-sexually transmitted HIV, so they don't have any idea of the extent of such transmission.

Healthcare for most people living in Sub-Saharan African countries is appalling. Many people with treatable and preventable conditions are unable to afford even the most basic medical care. They have no option but to put up with these conditions until they recover or until they die. Foreign donors are very keen to promote certain kinds of healthcare, such as childhood immunizations. Well run immunization programs can save the lives of many children. But badly run programs can result in healthcare related infections and other risks. Even in developed countries, those working in healthcare facilities need to observe very strict guidelines about sterility. When they fail to do so, the consequences can be dire.

Gulu district in Uganda is proposing that they force parents to be immunized and to have their children immunized against a number of diseases. Yet, one of the officials advocating such measures admits that they don’t have enough drugs and that often, drugs are stolen. But not only are drugs stolen or in short supply in government run clinics, other equipment is also affected. Often, there is not enough sterile equipment that should only be used once and this can result in the same equipment being reused. In populations with high prevalence of HIV and other diseases that can be spread by contaminated equipment, such conditions could easily lead to far more than the 2.5% figure estimated by UNAIDS.

Prevalence of HIV and other viruses shouldn’t be very high among young children and infants, so the risk of being infected through unsafe healthcare may be lower than in other scenarios. But pregnant mothers are routinely given injections, as are women visiting family planning and sexually transmitted infection clinics. Those involved in commercial sex work would be particularly at risk from unsafe healthcare as they regularly visit clinics for both vaccinations, treatment and injected contraception. It’s no wonder that HIV prevalence among sex workers in Zimbabwe is currently said to stand at around 80%. Heterosexual transmission risks are very low compared to the risks people face in healthcare facilities that work with high HIV prevalence populations, especially where equipment is in short supply and the risks are not widely recognised.

The most pernicious aspect of the myth that most HIV transmission in African countries results from unsafe sex and that very little results from unsafe healthcare is that it is propagated by the very industry that has built itself up around promises to reduce transmission and eventually eradicate the disease. Far from reducing transmission, the industry is more likely to be responsible for a significant percentage of transmission and for continuing to fail to prevent transmission by implementing adequate levels of safe healthcare. To make matters worse, the industry has stigmatized the victims of the sort of institutionalized racism and sexism that arises from blind adherence to the behavioural paradigm.

A sympathetic analysis of the HIV industry’s refusal to deal with non-sexual HIV transmission might point to the consequences of people losing faith in their health services. But people in African countries have already lost faith. This is one (only one) of the reasons that the HIV industry’s efforts to treat and prevent HIV have been so futile. If people are not engaging in risky sex, they will not listen to those who insist that they are. Even those who are engaging in risky sex will not wish to be stigmatized. And they too face the same, perhaps even greater, non-sexual HIV risks. The HIV industry has been founded on a myth, but one that undermines their utility. Will they go or will they have to be pushed?


No comments: