Wednesday, August 18, 2010

The Wrong End of a One Ended Stick

According to the South African Independent, a member of the Swazi royal family has dismissed the severity of the HIV epidemic in Swaziland, where prevalence is the highest in the world. He thinks the HIV industry is exaggerating the number of people infected in order to make money. The royal is sadly mistaken. The HIV industry will do anything to make money but they are not exaggerating. The healthcare industries make enormous amounts of money out of disease and the threat of disease but they don't need to make up the figures.

The deluded personage may also be right in saying that circumcision won't achieve much more than soap and water. But he appears unaware that clean water and adequate sanitation are not available to many Swazis. And he is also right, but for the wrong reasons, if he thinks that abstinence, being faithful and even using condoms will not eliminate HIV transmission. They may reduce sexually transmitted HIV but they will not reduce HIV transmitted through unsafe medical or cosmetic practices.

The thing that the Swazi royal, along with the entire HIV industry, fails to appreciate is that HIV prevalence in Swaziland is 86 times that of, say, India. That's just as well because the population of India is about 1000 times that of Swaziland. So if the ever-hungry HIV industry really wanted to exaggerate the number of people infected with HIV, India would be the place to do it, not Swaziland. But how could the sexual behavior of so many Swazis be so different from that of the rest of humanity, including that of India? Only a handful of countries, all African, come anywhere close to Swaziland's HIV prevalence figure.

Royals, members of the HIV industry and journalists should be able to work out that Indians have sex, quite a lot of it, with much of it being unprotected. And the number of HIV positive people in India is twice the population of Swaziland. But if rampant sexual behavior is enough to explain high HIV prevalence among the Swazis, substantially less rampant sexual behavior among Indians should give rise to a lot more infections, shouldn't it, given the multiple? But even among Indian sex workers, who the same royals, industry members and journalists will agree, must engage in a fair amount of sex, HIV prevalence is less than 5% and declining. That's lower than national prevalence in about 20 other countries, including Kenya, Tanzania and Uganda.

Nearly one fifth of all HIV positive people, about 8 million people, live in five African countries with a combined population of less than 70 million. India and China together, with about one third of the world's population, have about three million HIV positive people. If there were something so extraordinary about the sexual behavior of people in those five African countries, I think it would stand out, somewhat. And it would explain why ABC doesn't work: people are simply too busy to listen to the advice. If they stopped to listen and put on a condom, they wouldn't get enough sex in for that day.

But there is no evidence that sexually active people in countries such as Swaziland, Botswana, Lesotho, Zimbabwe and South Africa have four or five times as much sex as Indian sex workers. Nor is there any evidence that people in those countries take four or five times more sexual risks. Levels of sexual behavior in these and other African countries is similar to those found in countries with far lower HIV prevalence. The behavioral paradigm, which suggests that high HIV prevalence in African countries is mainly due to heterosexual sex, can not possibly be correct.

Despite the obvious falsity of the behavioral paradigm, it still shapes most HIV prevention programs and most national HIV strategies. The one thing the HIV industry refuses to do is establish exactly where HIV infections are coming from. The figures in 'modes of transmission' surveys are mostly guesswork, skewed by the very paradigm that is in question. The Swazi prince is wrong, Aids is not a scam. But the HIV industry's explanation of HIV transmission is a scam. Perhaps his high and mightiness will look into the matter, given the eagerness of the world's press to make his views so widely known.


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