Monday, January 3, 2011

Global HIV/AIDS Policy for Africa: Mass Denial of Human Rights

Rumor and myth continue to dominate academic writings about HIV/AIDS, especially when it comes to explaining why HIV prevalence has declined in many countries which have experienced a very serious epidemic. In brief, HIV academics don't really have a clue why the virus spread, peaked and declined in the first place. Therefore, they don't know which prevention programs work and which don't. Some of them may have worked, or they may just have appeared to work because they began shortly before the high death rate stage of the epidemic.

Leaving aside the somewhat risible strategies of abstinence and partner reduction, which were never as vital as the literature claimed, nor as successful, that leaves the one strategy that could have had some impact on sexual transmission of HIV. Using condoms could have been successful if people used them, consistently. But in most places, they didn't. Many people have used condoms, some even use them several times a year. But this is not enough to have much impact on sexual transmission.

A fairly typical set of results comes from Kilifi, in Kenya's Coastal Province. The "mean number of condoms used was 2.2 per person per year among all sexually active individuals". Usage was lower in rural contexts. The majority of people in all East African countries live in rural areas. And not only is condom use lower in rural areas, so is HIV prevalence. There is more than a hint that the extent to which HIV is a mainly sexually transmitted virus has been seriously exaggerated.

Uganda is one of the few countries credited with playing an active part in reducing HIV transmission. The country may have achieved all sorts of feats, it's hard to tell, because rates of transmission there peaked and declined just as mysteriously as they did in other countries. It's just that in Uganda, the epidemic arrived, spread, peaked and declined earlier than it did in Kenya, Tanzania and most of the very high prevalence countries of Southern Africa.

Knowledge about condoms, HIV, unplanned pregnancy and other matters is not nearly as widespread as all the hype suggests. People in urban areas, people with better education and people in higher income brackets know a lot more than people in rural areas. HIV rates being higher in less isolated areas and lower in more isolated areas tends to make popular reduction strategies look a bit pointless.

But I wouldn't like to suggest that higher condom use or knowledge about sex, sexually transmitted infections, unwanted pregnancy, etc, are associated with higher HIV rates, just that they are not particularly relevant to HIV rates. Nor is it to suggest that using condoms to reduce HIV transmission, the transmission of other sexually transmitted infections and unplanned pregnancies is not a good thing.

It's just that HIV is not, as UNAIDS and other 'experts' keep claiming, almost always heterosexually transmitted in African countries (but not in non-African countries). WHO admits on their web site that up to 14% of infections may be spread by unsafe injections and they have unpublished data that suggests such infection rates are even higher. As for the proportion of HIV transmitted by other non-sexual routes, none of these authorities have bothered to check yet.

Given the rates of transmission among intravenous drug users, men who have sex with men and mother to child transmission, the proportion of HIV transmitted through heterosexual sex is in urgent need of investigation. Otherwise there is a danger that these highly inefficient, expensive and deceptive 'prevention' interventions will continue to deflect attention away from the health services that may be causing more infections that they have ever been able to prevent.

A recent paper shows that 50% of the 500,000 people currently infected with HIV in Uganda are under 25. The study also shows that young people know very little about sex, condoms, HIV or pregnancy, despite the hundreds of millions of dollars that have been spent. HIV rates in the area are high. Sadly, young people appear to have picked up many of the rumors spread about condoms by religious leaders, journalists and others who seem to prefer to maintain high rates of STIs and unwanted pregnancies (and the consequent high rates of unsafe abortions).

Firstly, young people need sex education and it needs to be an integrated part of their overall education (not an afterthought tagged on to an already under-resourced system). If religious and political leaders are hell bent on filling people's heads with rubbish (in addition to the bunch of lies they get from the HIV industry), at least with a good education they have some chance of working things out for themselves.

But their education needs to include information about non-sexual HIV transmission routes, such as unsafe healthcare, unsafe cosmetic practices and perhaps some traditional practices that involve exposure to contaminated blood. And in order for this information to be of any use, people need accessible and safe healthcare.

Countries with continuing high rates of HIV transmission can not afford to depend on luck. It is lucky that HIV transmission rates declined. But current rates of transmission are still too high. The HIV industry harping on about sexual behavior and the religious and political interests contradicting every piece of advice given is not going to lead to a reduction in current rates of transmission. As Uganda and other countries are finding, HIV rates can also start to rise again.

In places where very little HIV is transmitted non-sexually, fine, as long as steps are taken to eradicate these forms of transmission altogether. However, it looks as if non-sexual transmission is far from trivial in most African countries. This is in urgent need of investigation and this work can take place at the same time as the work on sexually transmitted HIV. But ignoring non-sexual transmission is probably doing more to spread HIV than continuing the many failed sexual prevention interventions.

The consequences of the lies and inaction from UNAIDS, many HIV/AIDS academics and various institutions are almost too terrible to contemplate. But we can not allow this mass denial of human rights to continue.


1 comment:

J Lundee said...


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