Saturday, September 18, 2010

HIV Incidence Has Been Declining Since Before UNAIDS Was Established

A couple of recent studies lend considerable support to the theory that HIV was originally spread widely throughout Africa via unsafe injections (cited in this article). In the first half of the 20th century, syringes and needles were frequently reused without being sterilized, with the result that various blood-borne viruses were transmitted to very large numbers of people.

The article also claims that medical procedures are now safer, which may well be true. There has certainly been awareness among health professionals since HIV was first identified that the virus can be transmitted through unsafe injections. As a result, some countries introduced strict health care guidelines, some even enforce them.

But countries with underfunded and declining health services, like Kenya, may still be transmitting HIV and other viruses in this way. It's difficult to be sure or to say exactly how much this may be contributing to the country's epidemic because UNAIDS and the rest of the HIV industry have little interest in investigating. But the state of Kenya's health services, according to a Service Provision Assessment, suggests that many people are probably not accessing health care services at all; and the ones that are could be receiving low quality and unsafe health care.

One of the big mysteries about HIV is how it quite suddenly went from being rare and difficult to transmit sexually to becoming a pandemic, reaching extremely high levels in some African countries. And this is without becoming any easier to transmit sexually.

This led to some pretty racist theories about African sexual behavior which now form the orthodox view of HIV in Africa: that 90% of transmission is through heterosexual sex. The orthodox view sometimes cites high rates of urbanization as giving rise to increased levels of 'unsafe' sexual behavior.

However, urbanization trends started before HIV emerged and it's still happening. There are plenty of places where urbanization is high, even in Africa, but HIV prevalence, the number of people living with HIV, is relatively low. Yet HIV incidence, according to UNAIDS, has been dropping for some years. Having said that, even in countries where urban rates of transmission have gone down, rural rates can be going up.

Of course, holding such views as they do about African sexuality, UNAIDS and the industry claim that incidence has been declining because unsafe sexual behavior has gone down. And they claim that their policies and prevention interventions have been behind the decline in unsafe sexual behavior.

In reality, there is no evidence that African sexual behavior is extraordinary enough to give rise even to a relatively low rate of HIV transmission, let alone the high rates of transmission that have been seen in some African countries. Nor is there evidence that sexual behavior has changed significantly. And there seems to be little correlation between knowledge and behavior relating to safe sex and HIV transmission rates. In fact, it has long been clear that most HIV prevention interventions don't have any impact on HIV transmission.

Recent press releases by UNAIDS, the marketing and publicity wing of the HIV industry, widely copied and pasted by the world's press, now claim that incidence, the yearly transmission rate of HIV, has declined. And this is very likely to be true. Except that incidence rates have been declining since long before any of the current rash of prevention interventions had begun.

Incidence rates in Kenya peaked in the early to mid 1990s and have never returned to levels seen then. Among sex workers in Nairobi, HIV incidence peaked in the mid 1980s. Incidence peaked earlier in Uganda than Kenya because Uganda's epidemic started earlier. Again, incidence levels have never returned to those seen at the peak of transmission. Why? We just don't know.

The Kenyan government hadn't even got around to accepting that there was a HIV epidemic in the 1990s. The various prevention programs, such as they were, didn't get started until some time in the 2000s. By this time, prevalence had been falling for years. It would do, given that incidence had peaked and declined about ten years previously. And prevalence rates kept falling because death rates were peaking at about this time.

Embarrassingly, the time that Kenya started plugging the various prevention programs paid for by the global HIV industry was also the time that the rate of decline in incidence probably reduced. Prevalence now is at the same level as it was at in the early 2000s. It could be claimed that prevalence remains high because many people are on antiretroviral (ARV) treatment and so are living for longer. But death rates of people on ARVs are probably quite high, too. It's hard to tell because so many are lost to follow up. Health record keeping is not one of the health service's strong points.

But then, despite using words like 'evidence', 'evidence-based' and 'evidence informed' a lot in their publications, UNAIDS doesn't seem to distinguish between genuine evidence and something published by people who get paid very well to say the right thing. It would be unfair to suggest that all UNAIDS policy is based on prejudice and research of dubious provenance, and I wouldn't want to give that impression. They also rely heavily on not talking about anything that may undermine the orthodoxy. In this respect, most academics and all the global media support and defend them vigorously.

(For discussions of Pre-Exposure Prophylaxis, seem my PrEP Blog.)


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