Saturday, August 13, 2011

UNAIDS Want Equal Numbers of Male and Female HIV Infections?

Despite the fact that it clearly doesn't work, UNAIDS and the HIV industry are persisting with their incitement to racial hatred approach to HIV prevention. Following the UN/IRIN 'Swazis eating cow dung' article, which was echoed throughout the social and media networks without analysis or criticism, they are back to their 'African women are prostitutes' theme.

This time, the prostitution theme (or 'transactional sex', which could be interpreted to describe all sex) is set in the Swazi garment industry, where HIV prevalence stands at 50%. The industry mostly employs women and they receive very low wages for long hours, despite the value of their output to the US, whose 'African Growth and Opportunities Act' (AGOA) facilitates such sweatshop industries.

The trouble is, the two stories don't really go together very well. The one about HIV positive people eating cow dung because they are too poor to afford any other food suggests that HIV infects poorer people. But HIV prevalence tends to be lower among poorer people and higher among wealthier people.

And the story about sweatshops suggests that even those working in the formal economy are so poor, they need to supplement their income by having high risk sex for money. Those in the garment industry are poor and exploited, that's what instruments like AGOA are designed for, but they are by no means the poorest in the country.

The probability of transmitting HIV, even under the most risky circumstances, is far lower than one. So if 50% of women are infected, up to 100% of them have been exposed. Yet, not everyone in a population has sex, let alone 'unsafe' sex. Most of the women working in the garment industry are young. Low probability of an event occurring (HIV infection) means that the women must take a lot of risks, and this takes time.

Sex work has its risks, but sexually transmitted infections (STI) are not even the biggest worry for a lot of women. In many countries, HIV transmission is uncommon among sex workers unless they are also intravenous drug users. In other words, sex is not as big a risk for HIV as we have been led to believe. So why should sex appear to be such a risk in Swaziland, especially in the sweatshops?

The simple answer is, there is no evidence that women in high HIV prevalence populations have more sex, or more risky sex, than women in other populations where HIV is rare. It's easy for a journalist to pick up a few anecdotes about a woman who gets money for having sex in her spare time to supplement her sweatshop wages, just as it's easy to find someone to supply anecdotes about people eating cow dung (which they probably picked up from IRIN or one of the many media outlets that ran the story).

But this is just gossip and unless it sheds light on how women are being infected with a difficult to transmit disease in such shocking numbers, it is not going to reduce HIV transmission. There is something going on in Swaziland that is facilitating the spread of HIV and it is not just sex, which goes on everywhere.

What could it be? Well firstly, health services need to be investigated. Because they are clearly weak when it comes to simple functions, like guaranteeing a constant supply of drugs for HIV positive people whose lives depend on them. This is another thing the UN's IRIN covers frequently, weak health services. Health services don't even have enough staff, equipment, training or supplies to guarantee the minimum standards; how can they guarantee that they are not also inadvertently spreading HIV?

We know African health facilities are such dangerous places that the UN won't allow its employees to use the ones that ordinary Africans have to use. But do these sweatshops also have health services, such as routine immunizations, health checks and, even worse, STI testing and treatment? Assuming that the main risks people face are sexual could be bringing about the very scenario such procedures are supposed to prevent.

The chances that careless, underfunded, mandatory STI testing and treatment programs are spreading diseases, including HIV, are huge. It is highly suspicious that groups thought to be at risk of HIV are infected in unbelievable numbers when those who are said to be infecting them, men, are infected in far lower numbers, and much later in life.

It's quite possible that many women are being infected nosocomially, especially through unsterile injections relating to STI vaccination and/or treatment, and going on to infect their partners. This is in serious need of investigation, because an epidemic that infects half of all women in a demographic sector, even though it's a difficult disease to spread sexually, is not driven by sex.

If HIV being transmitted through unsafe healthcare is the explanation for the otherwise mysteriously high prevalence among young African women, the last thing Swaziland or any other African country needs is a mass male circumcision campaign. Yet that's what UNAIDS are demanding for high prevalence countries. Are they trying to do to African males what they have succeeded in doing to females?



mag atieno said...

African Governments ought to base their HIV response strategies. on research.There is no research that has proved 100% that HIV prevalence is high among prostitutes.

Current literature in Kenya shows that HIV prevalence in becoming increasingly high amongst those who are married.Hence reason why organizations are developing strategies geared towards those in marital relationships

Simon said...

Thank you for your comment, it's quite true, some of the high HIV prevalence figures among sex workers are quite mysterious when HIV in the population in general is so low. It makes you wonder who infected them.

It's also true that HIV prevalence is also high among those who practice 'safe' sex, so it is time to look at non-sexual transmission modes and find out how people in high prevalence groups are being infected.