Thursday, March 24, 2011

'We Haven't a Clue, But We're Doing a Great Job', Say Academics

With a population of only about 800 million, sub-Saharan Africa (SSA) has 22.5 million HIV positive people. The rest of the world, with a population of about 6 billion, has 10.8 million HIV positive people. While 2.81% of SSA is infected, only 0.18% of the rest of the world is. In that sense, SSA's epidemic is 15.5 times worse and that of the rest of the world and Lesotho's (an exceptionally high prevalence country) is 75 times worse.

So how do we interpret these enormous differences? If we accept UNAIDS' and the HIV industry's claim that about 80% of HIV is transmitted heterosexually in African countries, does this mean that people there have more sex than non-Africans? And how much more? Ten times more? Fifty times more? Or is it more dangerous? Ten times more dangerous? Fifty times more dangerous?

In a kind of a sort of a way, they do mean this, or something like this. But they don't mean anything very specific. So if most sexually active people had sex four times a month, perhaps Africans have the time, energy and inclination to have sex at least once a day, every day, and often more than once. Actually, they would need to have a lot more sex with this, or it would need to be unbelieveably dangerous, to account for some of the very high prevalence figures found in SSA.

But the industry clings to its behavioral paradigm, the belief that HIV is mostly transmitted sexually in African countries. Some representatives of the industry recently published a paper wondering what kinds of sexual behavior change resulted in substantial declines in Malawi in recent years. The concluded that it may have been a reduction in the number of sexual partners among (heterosexual) men. They weren't sure about this, though, nor are they sure what could give rise to such a reduction.

I'd like to know what caused sexual behavior in Malawi and other SSA countries to increase to non-humanly possible levels in the first place. And why is it that it's always men who engage in the highest levels of 'unsafe' sexual behavior, but always women who outnumber men, often vastly, in numbers infected? And if it wasn't quantities of sexual behavior, but rather increased risks, why did these increase and then decline?

The authors note the lack of success so far for most interventions. They even cast doubt on the potential effectiveness of mass male circumcision, pre-exposure prophylaxis (PrEP) and immediate initiation of antiretroviral therapy for all HIV positive people, without these being accompanied by substantial changes in behavior. This is almost anti-establishment.

Perhaps they would like to reconsider their adherence to the behavioral paradigm? Because in the case of Malawi, it is possible that more than 50% of HIV infection comes, not from heterosexual sex, but from unsafe healthcare. With the appalling health facilities found in many SSA countries, it is plain arrogance to insist that 80% of HIV transmission is heterosexual and that most of the other 20% is a result of mother to child transmission.

In fact, if nearly 20% of infections are said to be from mother to child, it is very likely that many of these are, in reality, also a result of unsafe healthcare. And far from all these infants being infected by their mother, some mothers may be infected by their infants during breastfeeding.

The authors of the paper conclude, as they did in a recent paper on Zimbabwe, that there was the 'funeral factor', the fear of contracting, suffering from and dying from HIV/AIDS that may have given rise to changes in male sexual behavior. It's always good to have something to attract journalists, but this doesn't explain why so many more women are infected than men. If HIV is not all being transmitted through heterosexual sex, then some interventions that address non-sexual transmission are urgently needed.

The HIV industry has been kicking around the oversexed African theory of HIV transmission for almost thirty years. In addition to being insulting to Africans, especially African women, it does not stand up to scrutiny. This paper is just one more in a long line of travesties. These researchers claim that behavior change has averted tens of thousands of deaths. On the contrary, the number of infections and deaths that have resulted from the failure of HIV research is incalculable.


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