Saturday, April 9, 2011

Can We Guarantee that Public Health is Truly in People's Interest?

There's been an outbreak of measles in Somalia and apparently it may be connected with rumours that the vaccine could cause HIV in children and interfere with their reproductive abilities.

What is your reaction to such a statement? Would you dismiss it as nonsense and say that public health programs aim to prevent and treat diseases, not spread them? Would you say that no one would try to influence the fertility of a whole population, for any reason, and even put their lives at danger while claiming that it is in the interest of public health?

That would be a naive reaction. Some of the wealthiest institutions in the world care a great deal about the fertility of whole populations, especially when those populations are poor. Let me name some: the US Government, the Bill and Melinda Gates Foundation, FHI, PSI, the World Bank, and there are many others.

We don't know what lengths these parties would go to for the sake of their agenda. The Tuskegee Syphilis 'experiment' may seem like something that happened a long time ago, but Ugandans taking part in more recent HIV research were followed to see how long it took for some of them to become infected and how long it took for some of them to infect others. Many of them are now dead, others are still suffering from the disease and transmitting it to others.

What does the WHO or UNAIDS care about who gets HIV, how many people they may go on to infect or how many people die, and whether painfully or not? UNAIDS still insists that HIV is almost always transmitted through heterosexual sex but an estimated 30% of HIV positive infants in Mozambique (who can be matched with tested mothers) have mothers who are HIV negative.

UNAIDS's response in such situations is to suggest that the infants were raped. It's pretty obvious what their attitude towards Africans is, when they know that infant rape is no more likely in African countries and that incidence of rape, even infant rape, could never be high enough to explain such massive rates of infant HIV.

Quarraisha Abdool Karim, one of the people behind the CAPRISA vaginal microbicide gel fiasco, is planning another way of influencing reproductive choices, in the interest of public health, of course. This time, the idea is to hand out sums of money 'to reduce HIV infection in High School Learners'.

This is interesting for public health experts working with TB. This disease if often caused by occupational hazards, such as mining. It might be too extreme to pay people not to breathe when they are working. But you could compensate them for not working on some of the more dangerous tasks. That would at least drive up the value of labour.

Karim's plan, by the way, is not without it's exclusion criteria. Those who are 'cognitively challenged' will be excluded. I wonder if those who could be considered morally challenged would also be excluded, but there's no mention in the brief details on WHO's site.

Several countries have reported involuntary sterilization carried out on people who were said to be HIV positive. But a program in the US, 'Project Prevention', plans to offer people money to be sterilized if they are drug 'addicts' or 'alcoholics'. If 'addict' or 'alcoholic' just refers to users of these drugs, this would be bad enough, though I wonder who is judging. But what if those judging are evangelical Christians?

And the project is hoping to move to South Africa where it will aim at HIV positive women. Why it won't aim at men, I don't know. There are far more male than female drug and alcohol users. But women are always an easier target. Project Prevention's final solution can eventually move on to men.

One of the people behind this 'initiative', Barbara Harris, says "How can anyone object to anything that can prevent innocent children suffering needlessly?" She could try asking UNAIDS personnel in Mozambique the same question. Apparently Project Prevention are already operating in Kenya, where people are offered $40 (about a month's wages, a fraction of what those in the US receive) to take long term contraception.

Doctors needn't worry, they are given $7 to perform the insertion. Let's hope they wear a new pair of gloves with each patient and avoid reusing single-use instruments. They haven't had a great record of taking such precautions in the past. Even simple procedures like this carry serious risks in countries with a miniscule capacity for health provision, one of those risks being HIV.

This charade reminds me a bit of the mass circumcision campaigns currently raging in Kenya. In a country where only a few dollars are spent per head on health, some institutions are willing to pay many times that to slightly reduce (if at all) the probability of infection with one disease out of hundreds.

Measles is a terrible disease and it is especially worrying that the outbreak in Somalia (and other countries) could have been avoided if it were not for some rumour, probably completely unfounded. But public health authorities do not have much credibility when it comes to being able to assure people that there is no hidden agenda. There usually is a hidden agenda and it looks as if global public health is busy sawing off the branch they are sitting on.

The article concludes: "it is sad that in this day and age our children must die because of ignorance and lies". But the rumours in Somalia are based on lack of information. Far worse are the lies and half truths based on thorough knowledge coupled with an unspoken (and unspeakable) agenda. Lies do not exclusively arise from ignorance; the most harmful lies are those from people who know the truth.


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botiquin de armario said...
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