Wednesday, April 20, 2011

Do Some Researchers Get Commission for Each New HIV Infection?

An article by Drs Robert van Howe and Michelle Storms entitled 'How the circumcision solution in Africa will increase HIV infections' brings together many of the arguments I have been putting forward about HIV and circumcision, but far more elegantly. And there are some arguments I haven't discussed as well.

The authors question the assumption that all HIV infections in the three often cited randomised controlled trials of male circumcision (in South Africa, Kenya and Uganda) resulted from heterosexual transmission. They argue that less than half resulted from sexual transmission and that therefore the majority of infections would not have been prevented by circumcision.

They argue that concentrating on mass circumcision will deflect attention and resources from effective HIV prevention work and may result in an increase in HIV risk. They recommend the promotion of correct and consistent condom use, which, unlike circumcision, is highly effective. If circumcised men think they don't have to use condoms, HIV transmission could increase considerably.

This argument also makes pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by HIV negative people, said to reduce transmission by 44% when used by men who have sex with men, look like a very weak prevention strategy. PrEP also could lead to an increase in HIV transmission if it resulted in lower condom use.

The authors conclude that "a fifteen-fold increase in the circumcision rate would have the same impact as a 3.8% absolute increase in the use in condoms." So why not just concentrate on promoting the use of condoms and other complementary prevention strategies that actually work?

The authors also mention the barely mentionable iatrogenic HIV transmission which is clearly far more common in developing countries than UNAIDS and the HIV industry would like to admit. They comment: "Before Africans address sexually transmitted HIV, a concerted effort to eliminate the iatrogenic spread of the virus is needed."

They also note: "Condoms would be expected to be ineffective in regions where the majority of infections are from non-sexual transmission." Some authors, such as Drs David Gisselquist and Devon Brewer and Mr John Potterat have been writing on this subject for many years. But iatrogenic transmission is rarely mentioned in the official HIV literature and academic articles that discuss such concepts never seem to see the light of day.

Circumcision enthusiasts have concentrated their attention on populations where circumcision rates happen to be low and HIV prevalence high. But there are populations where circumcision rates are low and HIV prevalence is low. And there are populations where circumcision rates are high and HIV prevalence is high. It is hard to imagine why they have received so much attention, and presumably funding, when their overall stance is so unscientific.

But the vagaries of UNAIDS and the HIV industry have always been beyond comprehension to me. Meanwhile, massive rates of HIV transmission continue to occur in some of the most closely observed populations in the world. And yet those doing the observing don't seem to have figured out how HIV is being transmitted. Doesn't that ring alarm bells for anyone?

[For more about pre-exposure prophylaxis (PrEP), see my other blog.]


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