Sunday, May 8, 2011

Unless You Accept The Stereotype About African Sexuality, HIV Theory Doesn't Make Sense

Ghana has taken steps to reduce hospital acquired infections by publishing guidelines to avoid a phenomenon that affects hundreds of millions of people every year, globally. Airborne diseases are mentioned in the article, blood borne infections are not. But it is refreshing to hear it admitted that hospital acquired or nosocomial infections even occur in African countries.

While everyone accepts that such infections occur, UNAIDS and other institutions deny that HIV is very likely to be spread this way. It would be odd if that were the case, particularly in high prevalence countries, where health facility conditions are appalling. But any public mention of hospital acquired infections is better than the constant denial that HIV could be transmitted this way when it clearly can.

At 1.9%, Ghana has much lower prevalence than East African countries, where it is three or four times that level, or Southern African countries, where it can be 10 to 15 times higher. But even low prevalence countries can experience rapid increases in HIV transmission if it gets into health facilities and is not identified quickly and eradicated.

HIV theory has never adequately explained how generalized epidemics can occur. These are epidemics where the virus is transmitted widely among the population and not just in specifically high risk groups, such as intravenous drug users and men who have sex with men.

People who are not in these groups are at low risk of being infected because heterosexual sex is a very inefficient mode of HIV transmission. But there are several countries in Africa which have a generalized epidemic; in fact, the majority of people infected face only a very low risk of being infected, yet they are infected in huge numbers.

The standard reflex (it can't really be called an argument) from UNAIDS and the rest of the HIV industry is that Africans have superhuman levels of sex with many lifetime partners, many of whom overlap with each other. In addition, Africans care little about their own health and welfare, or the health and welfare of their partners and family members.

Billions of dollars spent on wagging fingers at Africans about how much sex they should have, with whom, what kinds of sex, etc, has had little influence on sexual behavior, although there are wild claims of success. But even where levels of sexual behavior have been assessed, this has never explained the generalized nature of the highest prevalence epidemics, all of which are found in African countries.

However, this hasn't dented the confidence of UNAIDS and others in the industry in the merits of continuing to insist that Africans have eye-watering levels of sex. After all, there are some very expensive pharmaceutical products available now and the many rich countries seem willing to spend billions, perhaps even trillions, on doling out these drugs, regardless of how much or little influence this has on HIV transmission.

Giving drugs to people who are HIV positive doesn't offer pharmaceutical companies the sort of profits they want. Only a few million more people every year are put on treatment using current guidelines. And even though those guidelines have been changed to help the pharmaceutical industry out, the few tens of millions of people who are HIV positive or who will be infected in the next 20 or 30 years is just not enough to satisfy the industry.

Luckily, the HIV industry's prejudice about Africans is almost universally believed. People don't bat an eyelid when they are told that each HIV positive person infects 7 people over the roughly ten years between becoming infected and dying (or going on antiretroviral drugs).

If the probability of a HIV positive man infecting a HIV negative woman is estimated at about 1/500 and that for a HIV positive woman infecting a HIV negative man is 1/1000, all HIV positive people would need to have sex at least every single day, perhaps twice a day, with a lot of people, for up to 10 years.

We know that most people don't have sex that much, nor do most people have that many partners (though some do, not just in Africa) but we have been conditioned to accept figures like how many people each HIV positive person must infect to explain high prevalence figures. And the prejudices about Africans are rarely questioned.

And that's just great for the pharmaceutical industry. Because it has been suggested that if everyone in high prevalence countries is tested at least once a year and put on antiretrovirals immediately, this will cut transmission to the extent that the virus will be almost eradicated in a few decades. This strategy is called 'test and treat' or 'treatment as (or 'is') prevention'.

Even better, some other genius has come up with a strategy called pre-exposure prophylaxis (PrEP), whereby HIV negative people said to be at high risk of infection (from low risk sexual behavior) are put on antiretrovirals, which is said to reduce the chances of their being infected. And perhaps this works, to an extent. The worry is about putting people on these drugs when their risk of infection is very low.

But the market for drugs could now run into hundreds of millions, perhaps many hundreds of millions of people.

So before trying to maximize profits for these pharmaceuticals, it would be worthwhile identifying the exact contribution of all known types of both sexual and non-sexual transmission before putting hundreds of millions of people on drugs. It is not true that each HIV person infects seven more, not sexually, anyhow. If you believe that, you should think about why you do, and whether it could really be true.


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