Saturday, August 18, 2012

Media Coverage of AIDS Remains Consistent

There's a prescient article written in 1987 by John Potterat which seems to have fallen on deaf ears (and eyes). Entitled 'The AIDS Epidemic and Media Coverage', Potterat disputes the claim that there is about to be a massive heterosexual epidemic in the West. He links the claim to reports from the Centers for Disease Control (CDC) in Atlanta which suggest an alarming increase in cases classified as heterosexually transmitted. Yes, 'classified' as heterosexually transmitted.

The media reports this 'increase' at face value. However, CDC changed the way it recorded HIV infections that were claimed to be heterosexually transmitted. At one time, such a claim would have been further investigated because almost all turned out to be transmitted some other way, through men having sex with men, intravenous drug use, etc. It was recognized that transmissions from women to men through heterosexual sex were rare; but the practice of following up these claims was abandoned. Transmissions from men to women through heterosexual sex were increasing, but at nowhere near the rate claimed for infections in heterosexual men.

So much effort was put into exaggerating the risk to all heterosexuals that the far higher risk to women who had sex with HIV positive men was seriously neglected. The reclassified cases were mostly men, which should have warned those commenting on the issue at the time. Potterat recommends thinking of AIDS, not as a classic sexually transmitted disease, but as one to be associated with specific sexual practices. While receptive anal intercourse is very risky, insertive anal intercourse is not. Vaginal intercourse is risky for women, but not for men.

This is not to say that men can not be infected with HIV through insertive anal or vaginal sex, just that they are not likely to be. It means that the virus is not going to spread quickly among heterosexuals, though it will be more common, a lot more common, among female than male heterosexuals. The branding, implied or otherwise, of various groups said to be at risk, was misplaced. It continues to be certain practices that are risky, not certain groups. HIV transmission rates could stay low among sex workers, men having sex with men and even intravenous drug users if certain practices were avoided and certain others were adopted.

Things are very different in developing countries. The vast majority of HIV positive people in high and medium prevalence countries are heterosexuals. This does not mean they were all infected sexually, but this is what UNAIDS and the conventional wisdom about HIV argues. But supposing conventional wisdom about HIV in developing countries is correct (unlike that in Western countries!), the big question is why heterosexual transmission is so efficient, when it is known not to be efficient in Western countries. While more women than men are infected in high and medium prevalence countries, about 40% of HIV positive people are male (possibly around 8 million men in Kenya).

Well, in a country like Kenya, the Modes of Transmission Survey actually shows that a good many of those men were probably not infected through heterosexual sex. Some are men who have sex with men, some are intravenous drug users, mostly men, and some are prisoners, who are mostly men and who are probably as likely to have been infected through non-sexual as sexual routes, if they were infected while in prison.

This leaves quite a small group of men to infect all those women, perhaps only about half of all the men infected. And that's where additional questions start to arise. Are we supposed to believe that most Kenyan women are highly promiscuous? After all, with such high HIV prevalence rates in some demographic groups, many others must have been exposed, though not infected.

And yet, in survey after survey, 'promiscuous' behavior appears to be far higher among men than among women. You could imply, the HIV industry does, that the women are promiscuous liars. But the same industry implies that many of the women are having sex with someone who is not their husband or long term partner because they are receiving money or some other compensation in return.

It would be odd for so many relatively young women, the highest rates of transmission are generally in younger women, to be engaged in any kind of transactional sex just at the time they are getting married or having their first, second or third child, wouldn't it? But many of those infected are of child bearing age, are pregnant or have had children. Without evidence, and the evidence usually points in the opposite direction, isn't such a prejudiced view intolerable?

Look at it another way: for transactional sex to be economically viable, wouldn't you need a relatively large group of customers and a relatively small groups of people supplying the services? However, the UNAIDS scenario is one where there are probably roughly equal numbers of males and females, perhaps even more females (and the males are less likely to be infected). But only infected males can infect females. So there must be this small group of infected males who are successfully infecting large numbers of females each. And as for the 'transaction', laws of supply and demand would suggest that the women are receiving very little indeed, aside from the obvious infections.

CDC allowed us to be deceived in the 1980s and we are still being led to believe that heterosexual HIV transmission is common and increasing. Could there be something they are still not telling us about HIV transmission in developing countries? The 'promiscuous African' theory doesn't really explain many anomalies, such as the minute return that transactional sex would attract where there are (allegedly) so many willing suppliers of sex being just one example.

We could also ask how many infections in high prevalence countries have been classified as heterosexual when they are not? Why are so many women infected who have only had one, HIV negative sexual partner? Where women were infected through breastfeeding their babies, how were their babies infected? How are HIV positive babies infected when their mothers are HIV negative? Or are we supposed to believe that there  is something about HIV positive heterosexual men that African women find irresistible?

Potterat shows that the various AIDS campaigns in Western countries that claimed we were all at risk didn't work; it's just that the predicted heterosexual epidemic was based on evidence that those who promulgated it knew was manufactured. Many women are probably still not aware that they face far higher risks than men if their sexual partner is HIV positive or is at risk of being infected. But could various campaigns in developing countries also be based on manufactured evidence? They don't appear to be working very well, with large drops in prevalence being mainly attributable to high death rates.

[For more about non-sexual HIV transmission, see the Don't Get Stuck With HIV site.]


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