Wednesday, November 30, 2011
Francois Venter makes a number of interesting comments in his article in the Cape Times, which starts by criticizing Helen Zille for her recent public outburst about criminalizing 'unsafe' sexual behavior, which only served to show how little she knows about HIV, health, sex and the law (and how much she knows about pseudo-morality, petty politics and mainstream media). But Venter goes a lot further, taking on the mantra that has launched a thousand careers: HIV is spread through promiscuity.
Venter recognizes something that UNAIDS and the HIV industry have yet to understand, that Africans are people. Shocking as that may sound, even HIV positive Africans are people. They are not sex machines, engaging in levels of coital activity that would leave little time or energy for anything else. They have jobs and families and lives that don't allow for 24/7 sex.
The HIV industry have never actually calculated how high levels of sexual behavior would need to be to account for the notoriously high levels of HIV transmission found in countries like South Africa to even be feasible. They just went ahead and informed the world that Africans are weired when it comes to sex and that if they could just stop being so irresponsible, everything would be OK.
Venter is unlikely to be a recipient of HIV industry controlled funds, or he won't be for long, because he even goes so far as to point out that "HIV is actually not terribly transmissible when looking at risks per sex act measured in developed countries, when compared to other viruses like herpes." He contrasts this with the fact that "a young woman in KwaZulu-Natal has an almost 1-in-3 chance of being HIV positive by the age of 21 years."
There is clearly something different going on in South Africa, and it is not just sexual behavior. So Venter suggests the possibility of some biological factor that makes sexual transmission of HIV more efficient in certain places.
While I am in sympathy with him, I'm not sure I go for his contention that "the geography" could be more significant than the behavior, not in the way he seems to mean, anyhow. Africans in the US are far more likely to be infected, even if they are heterosexual and not intravenous drug users. The geography is very important in some ways, also in South Africa, when you look at those living in urban as opposed to rural areas; those in rural areas are far less likely to be infected.
Venter vaguely suggests more susceptible genes, a more virulent strain of HIV or some undiscovered environmental factor. These may all be relevant in some way, but there is a more likely possibility, given the considerations he mentions, and that is the relative contribution of unsafe healthcare and perhaps cosmetic services. In South Africa, even people living close to roads are more likely to be infected than those further away. In Malawi, those living close to health facilities are more likely to be infected than those further away.
Various co-factors Venter mentions may play some part, some co-factors almost definitely do. But Venter still reverts to the behavioral paradigm, concluding "It’s sex, sure, but high risk sex largely independent of how or with whom you have it." This is a pity as Venter even presents some of the evidence that shows that sex can't play as big a role as the HIV industry would have us believe. Sex plays a part, perhaps a big part, but it can not explain entire epidemics, such as the one in South Africa. The question is, what are the relative contributions of sexual and non-sexual transmission in high prevalence African countries?
I applaud Venter for going as far as he does, however, I don't think he goes far enough. But there is good news. Venter mentions costs. Well, campaigns to warn people about blood contacts, such as in healthcare and cosmetic facilities, along with efforts to properly investigate infections that are unexplained by sexual behavior would not cost much. They are even things he could do as part of his own work as a GP.
And most importantly, genuinely competitive pricing for generic antiretroviral drugs, without the connivance of Big Pharma and their friends (such as Bills Clinton and Gates), produced in high prevalence countries, would also reduce the ever increasing amounts of money thrown into the pockets of various multinationals. This may hurt, Dr Venter, but it won't hurt your patients.
[For more about non-sexual transmission of HIV through unsafe healthcare and cosmetic services, see the Don't Get Stuck With HIV site and blog.]