Saturday, February 26, 2011

Why Are UNAIDS So Averse To Reducing HIV Transmission?

The usual headlines and the usual claims about the number of HIV infections prevented by male circumcision, this time in Swaziland. This time it's 88,000 new infections and, as always, there will never be any way of telling how many infections were prevented. Because the majority of men in Swaziland (over 80%) are HIV negative, it will be easy enough to cite a notional figure for how many men would have been infected if the surgeons hadn't jumped in and circumcised most of the men.

The circumcision enthusiasts could look at it another way and ask how many men were infected through heterosexual sex, because that's what circumcision is supposed to reduce. But if they scrutinized the figures too closely people might start to ask if circumcising hundreds of thousands of men (there are only just over one million Swazis), this could be an embarressment to the HIV orthodoxy, with their years of manufactured 'evidence'.

Male circumcision is said to reduce HIV transmission from females to males by up to 60%, but that's the highest figure, in trial conditions. It doesn't reduce transmission from females to males and it may well increase it. But we don't talk about that. And it is said to reduce transmission during penile-vaginal sex, not anal sex. It has no positive impact on transmission through anal sex, unsafe health care or unsafe cosmetic practices, whatsoever.

Now, the assumption is that those Swazis, being Africans, have a hell of a lot of sex, especially 'unsafe' sex, regardless of what they might say about their own sex lives. So UNAIDS and their collaborators calculate HIV transmission with the assumption that it's almost all heterosexually transmitted and that unsafe health care is almost non-existant. Unsafe cosmetic practices (tattooing, manicures, etc) are rarely mentioned.

The trouble with these assumptions is that they are all flatly contradicted by the very figures that the HIV industry usually use. The five yearly Demographic and Health Surveys, for Swaziland and other high HIV prevalence African countries, clearly show that most Africans are no more sexually active than non-Africans and, crucially, that levels of sexual activity, unsafe or otherwise, show little correspondence with HIV prevalence. Similar remarks apply to other high prevalence African countries.

Swaziland has some of the highest transmission rates in the world, but the most likely people to be infected are pregnant females. And why wouldn't they be vulnerable if they are clearly having unprotected sex? But it's not even the females who are having the most children that are most likely to be infected, it's usually the wealthiest and best educated who live in cities and suburbs. Poor, uneducated, rural-dwelling females are far less likely to be infected, regardless of their higher fertility rates.

And look at the male-female ratio for HIV prevalence: for every 5 females infected, there are only three males infected. We are told (incessantly) that women are more susceptible, which may well be true. But who is infecting them? Because UNAIDS and their allies claim that almost all females are infected sexually. Is there a merry band of males, who must be doing amazing amounts of work, going out of their way to spread HIV far and wide?

Even if most women, under the heterosexual transmission theory, are being infected by men, many men are not being infected by women. It's said to be roughly twice as difficult for a man to be infected by a woman than it is for a woman to be infected by a man (1 in 1000, compared to 1 in 500). But of the three men being infected for ever five women in Swaziland, some of those men are either infected through having sex with other men (MSM) or through intravenous drug use (IDU).

The HIV industry and the media love the idea that IDUs and even MSM also have sex with women. They love to talk about 'risk groups' and 'bridging groups' (people who are at high risk transmitting HIV to people who are at low risk). Some MSM and IDUs undoubtedly do have heterosexual sex, but many probably don't. Neither the media nor the industry can cite any reliable figures anyway. But there are clearly some men who are not infected through heterosexual sex and some who are not infected through any kind of sex.

If far more women than men are infected and many of the infected men are not infecting the women anyway, how appropriate is male circumcision when it comes to reducing HIV transmission? If you assume 80 or 90% heterosexual transmission then it's easy to produce glib figures, such as the 88,000 new infections mentioned. But unless you can show that most transmission is heterosexual, or even sexual, the circumcision intervention ceases to look so effective (if you were even persuaded in the first place!).

Carrying out unnecessary operations on millions of men is dangerous enough, but the promised reductions in HIV transmission will never materialize because they are based on a false premise about the high contribution that heterosexual transmission makes in high prevalence countries. Ignoring non-sexual transmission will not make it go away; the claimed millions of HIV infections that will be averted by mass male circumcision campaigns are false. But millions of new non-sexual infections will occur while the industry sits around patting each other on the back.


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