Wednesday, December 7, 2011

Absence of HIV Does Not Equal Health

The issue of health conditions stemming from intestinal parasites, such as schistosomiasis (bilharzia), and their connection with HIV, has come up a number of times on this blog. There has been research into how these conditions may increase susceptibility to HIV in populations where they are endemic, and how they may increase the likelihood of HIV positive people transmitting the virus, sexually.

Much of what has been written on the subject is not particularly new, and even a recent review of the literature may yet receive as little attention as all the papers reviewed therein. But perhaps one day those concentrating on sexual behavior will realize that it is mostly ordinary, everyday sexual behavior, not rampant and risky sexual behavior, that is behind the bulk of transmissions in countries like Kenya, Uganda and Tanzania.

In addition to the hotly disputed (but grossly underresearched) contribution of non-sexual HIV transmission to serious epidemics, the contribution of non-risky sexual behavior also raises questions for the HIV industry. It has been apparent for a long time that the largest sexual transmission contribution to HIV epidemics comes from monogamous, heterosexual couples. Why should penile-vaginal sex result in so many infections when the probability of such transmission is quite low?

The HIV industry invented some red herrings that suited their penchant for salacious theories, all of which turned out to have little impact on HIV transmission, or to be too uncommon to explain any more than a fraction of transmissions (which is not to say that they didn't contribute anything at all). Examples are female genital mutilation, vaginal douching, multiple partnerships, concurrent partnerships, etc.

So, the review in question looks specifically at urogenital schistosomiasis, which is widespread in many African countries. Despite being common, this disease is also easily and cheaply treated. Some might wonder why prevention and treatment have not been made available decades ago, but that is another long story.

It is possible that the best chance schistosomiasis has of being eradicated now is if the HIV industry thinks it might help reduce HIV transmission easily and cheaply, given that they have spent billions on expensive and relatively ineffective interventions, and are quickly running out of money. But they may find (relatively) cheap ineffective interventions, such as mass male circumcision, that are more to their taste, and genital schistosomiasis may yet remain common, however implicated in the spread of HIV.

Much of the research into intestinal parasites and HIV show that the two are associated, but does not show causation. But why should people with these diseases have to wait for a causal connection with HIV to be proven before they receive treatment, or before attempts are made to eradicate the disease? The same question could be asked about other diseases that either make people more susceptible to HIV or more likely to transmit it.

Besides, causation has not been demonstrated for male circumcision/lack of circumcision either, yet half a million operations are claimed to have been carried out in the name of HIV prevention (many of them among the Luo of Kenya's Nyanza province, where schistosomiasis is also endemic). Some association between circumcision and lower HIV prevalence may have been shown, but a similar association may exist between female genital mutilation and lower HIV prevalence without anyone advocating for FGM as a viable HIV prevention intervention.

People have a right to health. We don't need economic arguments about cost effectiveness or proof of a causal connection between genital schistosomiasis and HIV before implementing eradication programs for all the parasitic and other neglected diseases for which preventive and curative measures have long been available.


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