Friday, July 1, 2011

Global HIV/AIDS Policy is Not All Lies; that's what Makes it so Dangerous

Using this blog, which takes my MA dissertation as its starting point, I have fought against certain prevailing ideas relating to HIV. For example, the idea that HIV should be exceptionalized. Exceptionalizing HIV distorts health funding and diverts resources that should be balanced out according to the relative needs of different health problems.

Another idea I have fought against is that of the sexually incontinent African, whose animalistic sexual and social behavior needs to be kept in constant check by the restrained and wise but also exceedingly generous Westerner. And the list goes on.

Often, I use papers and articles that don't aim to make any of the points I wish to make, yet they may throw some light on important issues, sometimes ones that contradict the author's intended point. These papers, interestingly, are usually by clinicians, scientists, epidemiologists and the like.

But sometimes I am able to cite authors who agree that Africans are people too, that HIV is not all about sex, that it is not possible for extremely high rates of transmission to be explained by any existing data about human sexual behavior and that other forms of transmission, which are common in low prevalence countries, are probably also common in high prevalence countries. These papers are usually not by the abovementioned sorts of academic.

So this article by Michael Grimm and Deena Class, both economists, is very welcome because it gets straight to the point: the amount of money still being spent on HIV exceeds that available for other health issues, many of which are responsible for far more morbidity and mortality than AIDS. They also point out that figures relating to HIV have been systematically exaggerated, including those about how much developing country economies suffer as a result of high rates of HIV transmission.

But most importantly, the authors argue that the relative contribution of sexual transmission in high prevalence countries claimed by UNAIDS leads to vast sums of money being spent on sexual behavior change programs, which have had little or no impact on HIV transmission.

The authors suggest that blood exposures in health facilities, along with less formal settings where people can also receive medical treatment, may account for a far higher percentage of HIV transmission than the risible 2% or less estimated by UNAIDS.

They don't mention other settings where blood exposures are also a possibility, such as tattoo parlors, beauty salons, hairdressers, roadside manicure and pedicure services, etc. But it's the non-sexual bit that counts!

This should all be good news for UNAIDS, or whoever takes over after everyone finally admits that they have screwed up, bigtime. Influencing sexual behavior is difficult, as the HIV industry's failure to come up with a viable strategy demonstrates all too well. But influencing health care procedures should be a lot easier.

In fact, most countries which have seen significant declines in HIV transmission since the epidemic peaked, and that includes most high and medium prevalence countries, have already probably started reducing non-sexual transmission. Blood donations may not be as carefully screened as the UNAIDS blurb would have us believe, but a lot of work has been done in this area.

Injection practices have changed a lot in many countries. There are autodisable syringes, which break after use so they can't be washed and reused. There are pre-filled syringes, one syringe per dose. Many people have been trained in recognising the potential for blood borne infection and some have even been supplied with the means to reduce infection.

Indeed, some would argue that the sudden and unexplained increase in sexual behavior that would be required to explain why HIV ever reached such high levels in a few countries, never occurred. Rather, the virus only took off once it got into health facilities, unrecognized and therefore uncontrolled.

The equally sudden and unexplained decrease in sexual behavior required to explain why prevalence subsequently peaked and dropped, before the useless sexual behavior programs even started, also never occurred. Much of the effort required to reduce HIV transmission took place in health facilities in the 1980s and 1990s. And the efforts even continued after UNAIDS was established, only to derail the whole process by obsessing about sex.

But these matters are all in serious need of investigation. Many hospitals in African countries don't have the supplies and equipment they need to ensure that people are not infected though unsafe healthcare. Many lack the training and supervision required. There is still a lot of work to do, as attested by UNAIDS' own warning to UN employees to avoid African hospitals.

As Grimm and Class point out: "it is telling that an HIV outbreak investigation (genetic sequencing of HIV genetic material to match specific viruses from different infected persons) has never been conducted in any high-prevalence African setting."  This is despite compelling evidence in Mozambique, Swaziland and other countries that nosocomial infection (infection through medical procedures) continues to be vastly underestimated.

UNAIDS used to claim that everyone is at risk of HIV infection, even long after it was obvious that this is not the case. But in African countries, where an unknown and probably significant percentage of transmission is non-sexual, everyone who uses health and cosmetic services is at risk of HIV infection. Will UNAIDS break their long tradition of ignoring evidence that their policies are useless?


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