Thursday, November 10, 2011

Zille's Rhetoric about Criminalizing Unprotected Sex is Misinformed

South African premier Helen Zille [Sorry, Premier of Western Cape!] shows a worrying level of ignorance about HIV transmission in calling for "men who have multiple sexual partners and refuse to use condoms to be charged with attempted murder." She's right that using condoms reduces the likelihood of sexual transmission of HIV, substantially. But she's wrong if she thinks that HIV is almost always transmitted sexually in South Africa and other high prevalence countries.

Leaving aside the sheer stupidity of expecting to control HIV transmission by making unprotected sex with multiple partners a crime, increased condom use, even consistent condom use, is not always associated with reduced HIV transmission. If HIV were almost always transmitted sexually, as UNAIDS and the HIV industry claim, the effect of increased condom use would be very likely to have the desired effect. But often, HIV prevalence among condom users is the same as among non-users, or even higher.

A study of data from 22 countries shows that HIV prevalence is usually higher among women than among men and higher in urban than rural areas, particularly in high prevalence African countries. Prevalence is also generally higher among the wealthier and the better educated, unlike other transmissible diseases, which tend to infect poor and less well educated people in higher numbers.

But the report is clear on the issue of condom use: use of condoms is generally associated with higher HIV prevalence, among those who use condoms at all, and even among those who use them consistently. In some cases HIV prevalence may be lower, even much lower, but in others prevalence can be much higher. This is not evidence that condoms are not effective. It could suggest that most people don't use condoms often enough. But it is also an indication that HIV may not always be transmitted sexually.

Remarkably, Zille doesn't mention male circumcision, which is another very media friendly thing to throw into a speech. But this report finds that "There appears no clear pattern of association between male circumcision and HIV prevalence - in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher." It is customary for reports to ignore those countries where HIV rates are higher among circumcised men.

Zille and any misguided followers she may have should also read an article showing that sexual risk behavior is generally higher among young people in the US than in South Africa, yet HIV prevalence is many times lower among young people in the US. In South Africa, prevalence among 18-24 year olds was over 10%, compared to less than 1% in the US. Yet, young people in the US become sexually active earlier than those in SA; number of lifetime partners is higher in the US; and use of condoms is lower in the US. There are often greater age differences between females and their partners in SA, but that could only account for a relatively small proportion of transmission.

That article concludes that effective HIV prevention demands an accurate perception of the spread of HIV. This is something Zille lacks. But she's not the only one. Among those also lacking an accurate perception of HIV transmission in African countries are UNAIDS, WHO, Johns Hopkins Medical School, the London School of Hygiene and Tropical Medicine and many others. She's in 'good' company, well-funded company. However, Zille's latest outburst will not reduce HIV transmission and will probably do a lot of damage to SA's HIV reduction efforts.


No comments: