Sunday, March 27, 2011

Could HIV Policy Be Driving HIV Transmission?

Early on in the HIV pandemic it was thought that if people were to be told about the risks for HIV infection and how to avoid them, they would do so. Those involved in public health, professional and non-professional, took steps to inform people about both sexual and non-sexual modes of transmission and what they could do to reduce their personal risk. Improvements in health facilities were also made to eliminate accidental infection through various invasive practices as much as possible.

In a paper on knowledge of blood-borne HIV transmission risk, Dr Devon Brewer comments that "many Ugandans adopted injection practices that likely reduced their risk of HIV acquisition following the 'massive anti-AIDS education campaigns that began in 1985 [that] warned people about the dangers of sharing unsterilized needles and syringes'" (citing a paper by H Birungi). Brewer notes that "these behavior changes were accompanied by concurrent declines in HIV transmission".

Things changed later and non-sexually transmitted HIV risk is now said to have been taken care of. The entire HIV orthodoxy is built on an assumption that is covertly recognised to be incorrect: the behavioral paradigm. This is the view that HIV is almost always heterosexually transmitted in African countries and that non-sexual transmission, which is not uncommon in non-African countries, hardly ever happens in Africa.

Brewer found that in countries where it was known that certain behaviors carried a risk of HIV infection, sharing razor blades in this instance, HIV prevalence was lower. It is not clear to what extent sharing razor blades contributes to HIV epidemics and there are many other such risky behaviors, for example, the use of contaminated injecting and other medical equipment, contaminated cosmetic equipment, such as tattoo needles and ink, and various others.

But Brewer also found that "countries with high proportions of respondents endorsing condoms also tended to have higher HIV prevalence than countries with low proportions endorsing condoms." This is difficult to explain and, if you accept the behavioral paradigm, you might suggest that it means people do not avoid risks that they have been told how to avoid.

My take on the phenomenon is that those in areas with the highest risk of HIV infection, cities and more populated, accessible areas, are also those most likely to have heard the constant messages about condoms. And apparently they even use them more than those in rural, less populated and less accessible areas. But as HIV is less likely to be transmitted through sex and is very likely to be transmitted through unsafe healthcare and the like, those endorsing condoms also face risks not faced by people in rural areas.

Well, 'safe sex' messages may not have had much of an impact in high HIV prevalence countries. But this is not a reason for not advising people of the risks. In the same token, the fact that most people do not have much influence over those who provide them with health services is not a reason for failing to advise them of the risks involved, and the risks of sharing razor blades, for that matter.

People are entitled to know that HIV is far more likely to be transmitted through contaminated blood than through any kind of sex and that there are steps they can take to reduce risk to themselves and their friends and family.

The HIV orthodoxy think nothing of stigmatizing entire nations, a whole continent, blaming massive levels of HIV transmission on massive levels of unsafe sexual behavior. Yet they balk at the suggestion that those providing health services need to be reminded to avoid any risks of transmitting HIV and other blood-borne diseases. They accuse anyone questioning the behavioral paradigm of branding health care providers, while at the same time branding every HIV positive African as promiscuous, stipid and cruel, as mere spreaders of disease.

Brewer concludes, "Health officials have an ethical duty to warn the African public about blood-borne HIV risks. Where such efforts are currently absent, they should be started immediately; where such efforts are underway, they should be emphasized further and sustained. Public education campaigns should not only highlight blood-borne HIV risks comprehensively but also communicate practical strategies for avoiding the risks."

Public health professionals in African countries are in very short supply, underpaid, overworked, undertrained and underequipped. Conditions in public health facilities wouldn't even be approved for veterinary use in Western countries. Warning about health care transmission of HIV is not pointing the finger at health professionals.

If anything, it is pointing the finger at the over-qualified and extremely well paid policy 'experts' at UNAIDS and other institutions. This doesn't answer the queston of why so many people in the HIV industry have failed to do anything about non-sexually transmitted HIV; perhaps they can answer that themselves. But progress in eradicating HIV transmission will not be made until the truth about HIV transmission is acknowledged.


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