Friday, February 11, 2011

UNAIDS Stigmatizes Sex Workers and Africans

John Potterat, Devon Brewer and others published a paper over 7 years ago showing that deaths from AIDS in a group of US sex workers were exclusively among those who admitted to injecting drugs or were inferred to have a history of doing so. Sex workers in the cohort faced many risks that could have lead to their death, but sexually transmitted HIV didn't seem to be one of them.

A study carried out in the late 90s in Italy, by Michele Spina, Salvatrice Mancuso and others, estimated HIV prevalence and condom use in a group of sex workers. HIV rates were higher than in the general population (though lower than in many high prevalence African countries). But the majority of the HIV positive women were injection drug users.

Condom use with paying customers was probably higher than would be found in African countries. But the fact that some of the HIV positive women were not injection drug users does not mean they were infected sexually, either. In reality, sex, even unprotected sex, has not been demonstrated to be the main risk factor in HIV transmission.

A third study, carried out 5 years ago in Uzbekistan by Catherine Todd, Mumtaz Khakimov and others looked at HIV prevalence among sex workers and the sort of risks they face. The majority of infections were among those who injected drugs. A fairly substantial number who didn't inject drugs were also infected. And treatment for a sexually transmitted infection (STI) was also found to be a risk factor. But non-sexual risks don't seem to have been taken into account.

I'm not suggesting that sex work is not hazardous, or that one of the risks sex workers face is not infection with (and transmission of) HIV. I just think that the risk of sexual transmission in sex workers in developing countries is exaggerated. I think the very fact that people are sex workers leads to the assumption that if they are HIV positive, they must have been infected sexually.

I think a similar assumption is made about HIV positive people who are not sex workers, that if they are HIV positive and they admit to being sexually active, they must have been infected sexually. This is the normal assumption in African countries. They may have been infected sexually, but couldn't a proper assessment be made of the non-sexual risks they have faced, as well as the sexual risks?

The assumption that Africans are almost always infected with HIV sexually leads to the ridiculous conclusion that even those who have never had sex, have only had sex with one, HIV negative partner or those who only ever engage in very low risk sex, if they test HIV positive, must also have been infected sexually.

The possibility that some people, perhaps a large number, have been infected non-sexually, is generally dismissed by the HIV orthodoxy. This is despite the appalling conditions in health services in African countries. It could be that people who have to attend health facilities actually face the highest risks of HIV infection.

Take sex workers, for example. They often attend clinics every few months for checkups, injectible contraceptives (the most popular form of contraceptive for sex workers and non-sex workers alike), for treatment for STIs and other invasive procedures. If any procedures in the facilities they visit are unsterile, the chances of nosocomial transmission of HIV (transmission through medical procedures) and other diseases are very high.

Take pregnant women as another example. They make visits to ante-natal clinics and undergo various invasive procedures, including injections. They may make several visits to clinics, before and after delivery. Every visit is a risk if medical practices are unsafe. And HIV rates are particularly high among pregnant women, who often seroconvert very late in their pregnancy or even after they give birth.

UNAIDS and other institutions connected with the AIDS industry usually ignore nosocomial HIV transmission, or they downplay it and claim its contribution to African epidemics is negligible. But how could it be negligible in some of the filthiest, most underfunded and understaffed facilities in the world when it is a significant risk in other countries, where conditions are far better?

While UNAIDS downplay the risks faced by Africans, they warn their own employees to avoid African health facilities because of the possible risks of nosocomial infection and unsafe healthcare in general. How could it be a risk to a rich UN employee and not to a poor African? The WHO accepts that a significant percentage of injections in African countries are contaminated. So it's time to consider non-sexual HIV risks when developing HIV prevention programs; it's time to rewrite global HIV prevention policy.



Red Bulls said...
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Paddy O'Gorman said...

"ridiculous" is the word. In 25 years interviewing prostitutes on Benburn st or Baggot st in Dublin, I have never yet come across an HIV+ prostitute who wasn't also an injecting drug user. As venereal diseases go, HIV is at least difficult to transmit.

Simon said...

Thanks Paddy. Well, you should see the havoc that is wreaked when health professionals take risks, I have a few examples that I'll post up tomorrow. If anything can drive a high prevalence HIV epidemic, it's unsafe healthcare! Injection drug use and anal sex are bad but at least people engaged in these activities make some kind of decision, unlike the millions of people who face medical treatment from people who lack training, equipment, knowledge and whatever else is required for safe healthcare.