Thursday, December 30, 2010

No Leap of Faith Required to Question HIV Orthodoxy, Just Honesty

Many millions of words have been dedicated to what was said to have happened in Uganda in the 1980s and 1990s that resulted in a serious HIV epidemic peaking and declining dramatically.

Well, for a start, all the high figures cited for HIV prevalence in Uganda in the early days of the epidemic are for specific groups, such as pregnant women. Prevalence for the whole sexually active population at that time is rarely given and is probably not clear, even now.

Once more detailed prevalence figures were established for later periods in the epidemic, it became clear that there had long been more women infected than men. This should have resulted in questions about who infected all these women.

But HIV professionals don't ask such questions because they don't fit the 'behavioral paradigm', the view that HIV is almost always transmitted sexually in African countries (but not in non-African countries, go figure). They are content to talk about how low the prevalence figures are now, though they are nothing to boast about.

So the 'dramatic' drops in HIV prevalence, from double figures to single figures in a few years, never occurred. What drops in prevalence did occur would mostly have been down to very high death rates.

All the talk about behavior change was mostly just that, talk. Some behavior change may have occurred, probably as a result of people witnessing massive levels of sickness and death, but this would have been after incidence rates had already peaked and declined.

Why incidence rose so rapidly in the 1980s and perhaps before, and why they peaked and declined, is not clear. At least, it's not clear if you accept the behavioral paradigm. There is no evidence that 'unsafe' sexual behavior inexplicably increased in the late 1970s and early 1980s and then declined again before the end of the 1980s.

Unless there was some identifiable change in levels of sexual behavior that led to barely credible feats of promiscuity in Uganda some years before the HIV epidemic peaked, it remains a mystery why the epidemic ever infected so many people.

And it's not just in Uganda that there remains this mystery. The massive rise in promiscuity that occurred there must have taken place a few years earlier in Western Equatorial countries, where HIV had been a less serious epidemic for even longer. Sometimes it becomes more of a mystery to explain why some places in Africa never experienced this strange phenomenon.

Anyhow, this totally unrecorded rise in promiscuity must have taken place in Tanzania a bit later than it did in Uganda. In Kenya it must have taken place a few years later still, because incidence there increased and peaked a few years later.

Then Southern African countries experienced this same unrecorded and mysterious increase in promiscuity that barely affected Western and Northern African countries at all.

Outside of African countries, no wave of promiscuity was needed to explain serious HIV epidemics because this virus which is said to be spread predominantly through sexual behavior in African countries is accepted as a virus that spreads most efficiently through unsafe injections among intravenous drug users and among men who have sex with men.

That's the way the behavioral paradigm goes, anyhow. It claims that Africans have inordinate amounts of unsafe sex and that different African countries at different times experienced enormous increases in unsafe sexual behavior that 'explain' the resulting difference between low HIV prevalence countries such as Senegal, medium prevalence countries such as Uganda and high prevalence countries such as Swaziland.

The original question about what 'happened' in Uganda, prevention interventions and the like, was if the same thing could occur in other countries. Well, the same thing didn't occur in other countries, according to the official story. Outside of Uganda, most governments denied the existence of HIV or ignored the epidemic. Very few leaders were in any way open about HIV in their own country.

Despite this, most medium and high prevalence countries have followed a similar epidemic pattern to that found in Uganda: HIV arrived and spread rapidly, peaked and declined. Since the initial decline, infection rates have continued at a relatively low rate, as have death rates.

But all this appears to have occurred independently of anything the respective governments did or didn't do. Whether governments reacted to the epidemic or ignored it, roughly the same pattern resulted.

So, the two things the behavioral paradigm encourages us to believe are different but not wholly compatible: firstly, the paradigm paints Africans as grossly promiscuous and unconcerned about their own health or the health of their children.

And secondly, when called upon to explain the original increase, peak and deline in HIV infections, the orthodoxy makes up a story of a promiscuous people (because all Africans are the same under this paradigm) becoming even more promiscuous, because of urbanization or some other factor that may have little or no explanatory power.

We are then left with the problem that the Senegalese and people from various other low prevalence countries have never really been particularly promiscuous. And even some tribes in a country like Kenya have less sex than others. The Luo, with high HIV prevalence, according to the paradigm, must have a lot more 'unsafe' sex than the Somalis, who have low HIV prevalence (despite having the highest fertility rates in the country).

If we accept a sexual explanation and follow the argument through, we still have to tie ourselves in knots. What gave rise to an epidemic of promiscuity that eventually resulted in a serious HIV epidemic in only some parts of some countries?

It's way past the time for HIV 'experts' to accept the fact that HIV is spread both sexually and non-sexually and that when it can't be adequately explained by normal sexual behavior, found in every country in the world, that something other than sexual behavior must be involved.

No leap of faith is required to question the HIV orthodoxy; all that is required is a bit of honesty and integrity. I don't think that's too much to ask but, we're still waiting.



Tamaku said...

What's also desperately needed is a 'wikileaks' on HIV ARV drugs - I fear much remains unknown as to side effects.

Happy New Year, Simon. xxx

Simon said...

Hi Tamaku, hope you're well. You're right, not much is said about side effects. There's a man called Dr Joseph Sonnabend who has raised the issue in relation to pre-exposure prophylaxis after rather dubious trials were hailed as the future for gay men who wish to have unprotected sex.

Side effects may not be so much of a problem in wealthy countries with high levels of health and education but they could be very serious in poor countries, where even water and sanitation are in short supply. Whatever about side effects in ARV drugs, their use on healthy (HIV negative) people is highly questionable.

Happy new year to you too, and to George. I follow your blog on Google Reader, I especially like the story of the young woman in the jacuzzi. Haven't seem many of them in Nairobi, jacuzzis that is, not young women.