Wednesday, September 29, 2010
Despite resolute denial from UNAIDS and other parties that a significant proportion of HIV transmission could be from medical procedures, injections in particular, there is at least one Kenyan politician who disagrees. And he is the Medical Services Minister, Anyang' Nyong'o.
Mr Nyong’o is quite frank about problems in health care provision, especially for poorer people. He points out that between 33 and 50% of Kenyans are taking the wrong drugs and up to 75% of antibiotics in Africa are prescribed inappropriately.
The minister has drawn attention to shortages of nurses, with only about one quarter the number required to meet WHO guidelines. There are also shortages among other health care personnel and overall standards are deteriorating.
Of particular importance, the minister said that there is “widespread use of the injection and prevalence of unsafe practices which put communities at risk of blood-borne diseases like Hepatitis B and C and HIV.” This is a courageous remark to make in the current climate of denial about blood-borne infections, in particular HIV. If UNAIDS could excommunicate, they would surely excommunicate the minister.
This is not the only courageous statement I have heard recently about blood-borne HIV. A Ugandan journalist, James Lutaaya, said in relation to criminalization of HIV transmission “The deliberate infection Uganda wants to prosecute…would not involve sexual relations as it is relatively unlikely that sex will lead to HIV infection...hence sex would be a very ineffective method of passing on HIV if someone was really intent on doing so.”
Lutaaya is right, but this is not the orthodox view. According to the orthodoxy, HIV is almost always transmitted sexually in African countries, despite there being little evidence supporting this view.
Interestingly, Lutaaya refers to the case of Nadja Benaissa, who was given a two year sentence for knowingly spreading HIV. Lutaaya feels that both Benaissa and the man she is said to have infected (the court didn’t have to prove that Benaissa infected him) share equal responsibility. That may be so, but the case also highlights another serious problem with prosecuting in such circumstances. The man Benaissa is said to have infected could have already been infected and he could have been fully aware of this. He could have been guilty of the same crime for which Benaissa was given a suspended sentence, yet he wasn't tried for such an offence.
Because the orthodoxy assumes sexual transmission and Benaissa, who knew she was HIV positive, had unprotected sex with the partner, it is also assumed that she infected him sexually. She may not have infected him at all, or she may not have infected him sexually. He could have been, as mentioned, already infected. Or they could have shared injecting drug equipment or some other form of exposure may have taken place. Certainly, the probability of her infecting him sexually by having unprotected sex with him a few times is very small indeed.
A woman is far more likely to know her HIV status, especially if she is or has been pregnant. It is also harder for her to hide her status, especially in countries where testing is routine for pregnant women. A man is less likely to know his status and more likely to be able to keep his status confidential. This doesn’t exonerate Benaissa, but it shows that the law is counterproductive if it aims to reduce HIV transmission. And its negative impacts will affect women far more than men.
The insistence that HIV is almost always sexually transmitted in African countries, or anywhere else, is quite illogical. Non-sexual transmission of HIV and other blood-borne viruses is not uncommon, even in countries where health spending per head of population is very high.
Per capita health expenditure in the US is over $7,000. But a possible two and a half thousand people were recently exposed to risks of blood-borne HIV, hepatitis B (HBV) and hepatitis C (HCV) virus in a government run hospital in the US as a result of unsterile equipment. Five thousand have been notified that they might have been exposed to similar risks because a radiologist with a drug problem and suffering from HCV used injecting equipment that was then used on patients.
In Australia, where per capita health expenditure is over $3,000, an anaesthetist with a drug problem has infected some patients, although it’s not quite clear how the infection was transmitted.
In African countries, per capita expenditure on health is about $10, on average. In Kenya, it’s about $6. The least UNAIDS, WHO and other institutions could do is investigate the extent to which HIV is transmitted non-sexually. Their claims about HIV almost always being transmitted sexually are no longer reassuring for the many people who have been infected and know they could not have been infected sexually. Perhaps Minister Nyong'o will take up the matter and challenge the ruling elite of the HIV/AIDS world?