Saturday, September 24, 2011
In the Kenyan Modes of Transmission Survey, which purports to estimate the relative contribution of each HIV transmission mode, the guesstimate for the contribution of men having sex with men is lumped in with a figure that is said to include prison populations.
This is a ridiculous way of estimating the contribution of these different modes of transmission in particular, though the entire document is unlikely to have any verifiable figures. But, as not all men who have sex with men are in prison, not all prisoners have sex with men and not all HIV transmission, especially in prisons, is transmitted sexually, it's difficult to understand why some well paid consultants even bothered to produce the document.
So when you come across an article entitled "Same Sex Hindering HIV Fight in Prisons", you might wonder where they get their figures from. We are promised a reduction in HIV transmission rates because the prisons are introducing 'counselling'. But will the counsellors inform prisoners and prison staff about non-sexual as well as sexual risks? HIV 'prevention' activities tend not to do so.
In a prison, you don't always have that much option about what kind of health care services you receive. It seems unlikely that you will meet with much sympathy if you complain that services don't include sterile procedures. Equally, you are unlikely to be able to choose who shaves your head, how sterile the instruments are or how careful the hairdresser is.
In fact, given the lack of attention to non-sexual HIV transmission through unsterile health care and cosmetic services, it is unlikely that many prisoners would even notice or be aware of the risks they are facing every time they go to the clinic or the barber's. It's as unlikely as non-prisoners knowing such things.
Also, tattooing is said to be very popular in some prisons, as are other forms of body art that involve breaking the skin. Instruments for tattooing and other skin piercing activities are not easy to come by, nor are materials for making paint. This means that they are likely to be reused, perhaps even sold to others.
Drug taking and various forms of traditional medicine, rituals and oath taking may also contribute to the many risks. The extent of male to male sex is not clear. But it is unlikely to represent anywhere near the highest risk of transmitting HIV and other blood-borne viruses in prisons.
Interestingly, Kenya's prison population is given as just over 50,000, which is not inordinately high for a country of more than 40 million people. And HIV rates are said to be less than 7% in prisons, which is about average for the country as a whole. Bear in mind, though, HIV prevalence in Kenya and other high prevalence countries is usually far higher among females, whereas most prisoners are male.
The rates, then, are higher than among Kenyan males, but the figure doesn't seem in any way extraordinary. In fact, it is low enough to make you wonder if male to male sex really does happen a lot in prisons. After all, it seems unlikely that the prisoners have access to safe sex counselling or to condoms.
But the Modes of Transmission Survey is a highly deceptive document. The figures try to make the case for blaming most HIV transmission on individual sexual behavior. Yet there is a body of evidence that a substantial percentage of HIV transmission is not through sexual behavior. Far more likely modes of transmission are unsafe medical and cosmetic services.
Therefore, HIV prevention efforts need to be directed more towards the real causes of its spread, not those imagined by the HIV industry. It's time to stop playing with mathematical models that use manufactured data and produce some real data on HIV transmission in Kenya.