Thursday, September 1, 2011
I commented on an intriguing article last February and I'm not going to write another commentary now. But for some reason, UNAIDS have only just managed to include it in their very carefully selected weekly collection of very carefully annotated articles, HIV this Week (one doesn't want to say anything that flies in the face of idiocy, does one?).
The article is entitled "It's not just who you are but where you live: an exploration of community influences on individual HIV status in rural Malawi" and it concludes that it's not just proximity to a major road that is highly associated with increased odds of HIV prevalence but also proximity to a public health clinic.
What would have been a eureka moment for people with basic reading and analytic skills, though, has put UNAIDS on the defensive. The UNAIDS author, evidently more highly trained in publicity and face saving than epidemiology, calls the findings 'thought provoking'. They note that rural residence 'seems' protective, which is what virtually every other similar study has shown.
But UNAIDS can't figure it out, because they are honor bound to bring sex into it. Why should living in a rural area protect you from a sexually transmitted disease? Oh, it's because extramrital sex may occur in urban areas. Phew, there was me thinking that people may face non sexual risks in additon to sexual risks when it comes to HIV, which is difficult to transmit sexually but easy to transmit through the sort of poor quality healthcare facilities found in all high prevalence countries.
UNAIDS finds higher HIV risk with proximity to health centers "puzzling". Because they are absolutely positive that HIV can not be transmitted any other way in African countries but through sex. This certainty is not acquired through any kind of investigation, of course. It is just the entire UNAIDS 'theory' of HIV transmission in African countries. (HIV is mainly transmitted through male to male anal sex and intravenous drug use in non-African countries.)
But the astute commentator contents her or his self by reflecting that "health posts are often located in small commercial centres that are themselves associated with increased sexual risk taking" and that "people with HIV infection may move to be closer to health centres for improved access to care". The commentator may be right. But isn't it about time to check? It doesn't take a long, carefully planned study like the one in question to find out what conditions are like in Malawian hospitals, or in other African countries.
In fact, someone at UNAIDS already knows what hospitals are like because they have published a leaflet for UN employees, warning them that "Extra precautions should be taken, however, when on travel away from UN approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere." Perhaps UNAIDS just haven't read the leaflet yet.
The commentator is interested that "income inequality, as opposed to absolute poverty, is associated with increased HIV in women" and asks "Why would this be so?" Predictably, their suggested answer is related to sex, via mention of trust, social ties, risk and what not, but mainly to sex and African women and we all know where that leads, don't we, etc.
Have UNAIDS saved their skin again? Perhaps so, but only at the cost of continuing to propagate the stereotype of the sex and money obsessed African, who really doesn't give a damn about much else. The truth is, HIV is not only transmitted through sex. UNAIDS just don't wish to investigate non-sexual HIV transmission. Therefore, the institution needs to be abolished and replaced with an institution that can produce a comprehensive and non-racist HIV strategy.