Tuesday, August 24, 2010

UNAIDS Suppresses Revolution in HIV Prevention

In 2002, a number of articles were published in the International Journal of STD and AIDS (IJSA) that questioned the contribution of sexual transmission to HIV epidemics in African countries. They raised the possibility that non-sexual transmission, especially unsafe medical injections, contributed a far higher percentage of HIV transmission than previously recognised.

Given the amount of evidence presented in these articles, one might expect HIV epidemiologists and infection control experts all around the world to sit up and take note, broaden their research interests or even rethink some of the current ideology.

But very little indeed happened. An improbable number of people put their names to a short article denying that non-sexual HIV transmission plays a significant part in African countries' HIV epidemics. The authors reasserted that sexual transmission 'continues to be by far the major mode of spread of HIV-1 in the region'. Worse still, they reassert the need to increase efforts to reduce sexual transmission of HIV.

Almost a decade has passed since these IJSA articles were published and quite a number of additional articles have appeared, also casting doubt on the 'behavioral paradigm', the view that HIV is almost always transmitted sexually in African countries. These have been almost entirely ignored.

If the view of UNAIDS and the HIV industry is that HIV is mostly transmitted sexually, per se, that it is primarily a sexually transmitted infection (STI) which may sometimes be transmitted non-sexually, that would be easier to deal with. They would be quite wrong and the evidence against their claim would be undeniable (which is not to say they wouldn't deny it).

But things are not that simple. UNAIDS and the HIV industry claim that HIV is mostly sexually transmitted in African countries. They accept that non-sexual transmission occurs in non-African countries, especially among intravenous drug users. Contaminated blood is one of the most efficient routes for HIV transmission, so it is obvious that HIV positive people sharing injecting equipment run a very high risk of transmitting the virus or being infected with it.

Yet again, though, while going with the argument that transmission occurs when drug users share injecting equipment, the HIV industry does not accept that HIV transmission through reuse of contaminated medical equipment occurs to any great extent in Africa.

The WHO (World Health Organization) admits that up to 10% of blood transfusions in developing countries may be contaminated, and therefore be responsible for transmitting HIV and other pathogens. The WHO also accepts that as many as 17% of injections may be unsafe and they even estimate that about 70% of injections in developing countries are unnecessary.

This is why I accuse UNAIDS and the HIV industry of institutional racism: they believe that non-sexual HIV transmission occurs but they won't accept that it's a problem for Africans. This is an important distinction because they accept that medical practices are so unsafe in African countries that they won't allow their employees and associates to risk using them. But these same medical facilities, they claim, pose little or no risk to Africans; at least, not to the extent that they or anyone else should do anything about it.

No matter how you look at it, that is institutional racism. Evidence that should give rise to a revolution in HIV prevention programmes in African countries has been ignored. Instead of targeting risks, such as those that could be found in plenty in medical facilities, UNAIDS and the HIV industry have chosen to ignore anything that doesn't relate to sexual transmission of HIV, in Africa.

The majority of HIV positive people globally are from Africa and most of them live in Africa. Medical standards are so low in many African countries that a lot of people receive little or no health care, good or bad. Ironically, this may protect a lot of people from HIV and other viruses, such as hepatitis C virus. Certainly in Kenya, HIV is lowest where health care coverage is lowest and the virus tends to spread very slowly to places where people have little or no access to medical facilities.

The majority of HIV positive people in African countries are women. This is why I accuse UNAIDS and the HIV industry of institutional sexism. The view that HIV is almost always spread sexually (in African countries) is translated into the view that women spread HIV. The stigma that HIV inevitably brings with it derives from the behavioral paradigm. If most HIV is transmitted by unsafe sex, it follows that most HIV positive Africans have a lot of unsafe sex (there has to be a lot of unsafe sex because HIV is not easy to transmit sexually). If most HIV positive people are women (and the ratio of infected females to males is usually very high), HIV is mostly transmitted by women.

Of course, most women have sex with men and they are unlikely to transmit HIV to other women directly. And the many men these women do not transmit HIV to can not go on to transmit it to others. But questions about why so many more women are infected, why so few men in some areas are infected (if they are so sexually irresponsible, etc), why some infants and children are infected when their mother is not, any questions that make the behavioral paradigm seem less tenable, are either dismissed by the HIV industry or just not raised.

Instead of a revolution in HIV prevention, we now have reaction, a refusal to consider the role of non-sexual HIV transmission in African countries. We are left with a preponderance of 'prevention' programs that don't work, not because they are inherently ineffective (though they are) but because they bear little relation to how HIV is being transmitted. I accept that I don't know what proportion of HIV is transmitted non-sexually. But nor do UNAIDS or the rest of the HIV industry. I am asking that they deal with the evidence that has been presented to them, rather than sweeping it under the carpet.

In 2002, a new form of HIV denialism was institutionalized by UNAIDS. It was based on prejudices relating to race and gender. According to the institution and its followers, HIV is an STI; but only in African countries. HIV can also be transmitted by unsafe medical treatment; but only to non-Africans. The earlier denial of the connection between HIV and AIDS was bad enough, but the UNAIDS brand of denialism is internally contradictory. You can't even articulate it without being struck by the crudeness of its logic. However, if the rantings of the recent Vienna AIDS conference are anything to go by, this denialism is the state of the art.


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