Saturday, August 21, 2010

Prejudice Wins Over the HIV Industry

It has been well established that HIV is transmitted through sexual contact, through contaminated blood and other bodily fluids and from mother to child. However, UNAIDS and the HIV industry have a rather anomalous view of the disease. They have decided (or decreed?) that HIV is primarily spread through heterosexual sex in African countries (and from mother to child). But in other countries, so the story goes, HIV is primarily spread through contaminated blood, by intravenous drug users and unsafe medical practices, through men having sex with men and among commercial sex workers and perhaps their clients.

If HIV is mainly spread through blood-borne transmission, one would expect it to follow a similar pattern to other blood-borne diseases, such as hepatitis C virus (HCV). Two researchers have found that to be the case in a number of Asian countries. Countries with low HIV prevalence also have low HCV prevalence and countries with high HIV prevalence have high HCV prevalence. This means that countries with low HIV prevalence might see rates increasing at some stage in the future.

If HIV is mainly spread through heterosexual sex, as it is said to be in African countries, one would expect it to follow a similar pattern to other sexually transmitted infections. But this is not the case. Sexually transmitted infections are very high in many countries where HIV prevalence is not very high. Also, sexual behaviour that is said to increase the risk of HIV transmission tends to be a lot more common in countries that have relatively low HIV prevalence.

Differences between male and female sexual behaviour are also telling, where such differences have been detected by empirical enquiry, as opposed to speculation and assumption. Whereas males are more likely to engage in unsafe sexual practices, females are more likely to be infected with HIV. Men also tend to have more partners than women. But there is nothing to suggest that what is mainly a blood-borne disease in some countries should be mainly sexually transmitted, and rarely blood-borne, in others.

So, UNAIDS and the HIV industry are wrong in (at least) two important respects: firstly, it is unlikely that HIV is transmitted primarily through unsafe heterosexual sex in African countries because there is no evidence that levels of unsafe heterosexual sex there are high enough; and secondly, it is unlikely that HIV is rarely transmitted through unsafe medical procedures and other possible blood-borne routes. Conditions in African medical facilities are poor, just as they are in many Asian medical facilities.

In fact, in African countries where many people have (or at one time had) access to medical facilities, HIV rates are the highest in the world: South Africa, Zimbabwe, Swaziland, Lesotho, Botswana and others. In countries where many people have little or no access to medical facilities, HIV rates are far lower. For example, Kenya, Uganda and Tanzania, especially the rural parts of these countries. And in almost all areas with high HIV prevalence, more women than men are infected, often far more women.

So UNAIDS and the HIV industry have spent years tying themselves in knots trying to explain why a disease that is both sexually transmitted and blood-borne is mainly sexually transmitted in some countries and mainly blood-borne in others. This is especially difficult when neither levels of sexual behaviour nor conditions in medical facilities bear out such a conclusion. But if you supplant evidence with prejudice in developing a health strategy, you are bound to end up with such anomalies.

This sort of institutional racism results in the rather obtuse view that Africans engage in inordinately high levels of sexual activity, despite evidence to the contrary. HIV prevalence has reached hyperendemic levels in many Southern African countries, so the HIV industry insists on sexual behaviour change. Why these racists have also concluded that virtually no HIV transmission occurs as a result of unsafe medical practices is a complete mystery. But as a result, the industry feels that no effort need be made to improve conditions in medical facilities.

HIV, which is difficult to spread sexually, quickly spread to every country in the world throughout the 80s and 90s. In most countries, prevalence has remained below 1%. But in some countries, over 25% of sexually active adults are infected. No adequate explanation has been given as to how this could happen if HIV is mainly sexually transmitted. On the other hand, there have been several outbreaks of medically transmitted HIV (that have been properly investigated. In addition to Romania, there were also outbreaks in Libya, Kazakhstan and Russia that were caused by unsafe healthcare). The combination of sexual and blood-borne infection could help explain how these hyperendemics occurred.

This is not a conclusion. All we can conclude is that non-sexually transmitted HIV plays some part in countries with high HIV prevalence. The part that non-sexual transmission plays may have been more significant in the past, certainly in countries that have had the capacity to improve medical and other facilities. But rates of HIV transmission in some hyperendemic countries are still too high to be explained by sexual transmission alone. This means that a lot of work needs to be done to ensure that medical facilities and other places where blood-borne risks exist are made safe.

But first, UNAIDS and the rest of the HIV industry need to agree to investigate the extent of non-sexual HIV transmission. They need to agree to prevention programs that target non-sexual transmission, in all its forms. Unless people are aware of the risks they face, they will not know that they need to avoid these risks, let alone know how to avoid them. Surely levels of institutional racism and sexism that allow millions of people to become infected with HIV and to die of Aids are serious enough to deserve the world’s attention?


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