Saturday, April 23, 2011

Comfortable With High Rates of Mother to Child HIV Transmission?

According to the UN, "Extra precautions should be taken...when on travel away from UN approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere." This excellent advice is given to UN employees. But it is not given to people who don't have the benefit of access to 'UN approved' medical facilities.

Is everyone comfortable with this? UNAIDS say that only around 2.5% of HIV transmission results from unsafe medical practices in high prevalence countries. But they think it necessary to warn UN personnel working in high prevalence countries to avoid the health facilities that people in developing countries have to put up with, if they actually have access to health facilities at all.

Sometimes you read about how awful it is that large numbers of infants are still born HIV positive or go on to be infected by their mother (mother to child transmission or MTCT). And it is horrific, but it is preventable. The problem with worrying mainly about the infants is that they are infected by someone else who is already infected, possibly their mother. And their mother's infection was probably also preventable.

So why does UNAIDS not worry about the person who infects the infant? And why is the person who infects the infant possibly their mother? I can't answer the first question but I know UNAIDS don't worry about it because they deny that unsafe health care plays a significant part in HIV transmission, and therefore refuse to investigate possible instances of it and they refuse to give proper estimates for its extent.

And the reason I say the person who infects the infant is only possibly their mother is that many infants have been identified whose mother is HIV negative (for instance in Mozambique and Swaziland). UNAIDS has tied itself in knots trying to argue that many babies are breastfed by a HIV positive person who is not the child's mother, etc. And while that might be a possiblity sometimes, it is unlikely to explain away all such instances.

Many women are known to become infected with HIV when they are already pregnant. Many are infected in the second or third trimester, even in the few months after they give birth. Now, I can't prove that women abstain from sex during and just after pregnancy. But nor do I think UNAIDS can demonstrate that most women don't abstain or, at least, reduce their coital frequency.

Nor can I prove that women don't have large numbers of unprotected sexual experiences with people who are not their partner during and just after pregnancy. But nor can UNAIDS demonstrate that they do. Indeed, the belief that African women, from a handful of African countries, sometimes from limited regions in those countries, engage in reckless sexually behavior ragardless of their own personal risk or circumstances, sounds to me like pure prejudice.

Sarah Boseley of the UK Guardian reports on a study questioning the suitability of antiretroviral treatment for young sufferers, a study which finds that very high rates of resistance result when people born with HIV are still young. And continued incidence of resistance is just a matter of time.

There is good and bad news for Sarah Boseley and for others who think that HIV rates in people born with HIV or who convert in their first few months or years is totally unacceptable: it is very likely that most mother to child transmission is preventable. And most of it is not just preventable in the way such transmissions are preventable in Western medical contexts, through careful support, treatment and medication.

It is very likely that a large percentage, perhaps the majority of transmissions, are a result of unsafe health care practices, injections, transfusions, intravenous drips and various other invasive procedures. After all, who believes that health facilities in high HIV prevalence countries are able to guarantee safety from transmission of HIV and other blood borne conditions? UNAIDS certainly doesn't.

The bad news is that little is likely to be done to reduce this kind of transmission because UNAIDS and other institutions who decide how HIV is transmitted (no, establishing how it is transmitted is not an empirical matter, don't be silly) have failed to investigate non-sexual transmission of this kind. In fact, they have refused to investigate, despite plenty of evidence that there is a case to be answered.

Is everyone comfortable with this? What makes the behavior of UNAIDS and those who follow their directives so despicable is that UNAIDS and other parties are well aware that a lot, perhaps a majority of HIV transmission, is a result of unsafe medical practices. It is not just a matter of sexual behavior. Africans do not have weired sex lives and they do care about their children, sexual partners, families and compatriots. Africans do not want their children to be born with HIV. But UNAIDS don't seem to mind.


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