Sunday, August 19, 2012
Why would anyone want to claim that the risk of HIV transmission from a female to a male engaging in penile-vagnial sex is very low? Aside from the fact that it's true, which is not very important if your salary or grant depends on showing that it is not true. Well, women who have been convicted of infecting men through heterosexual intercourse may find it interesting. If the woman, for example, only had unprotected sex a few times with the man, the risk to the man is so low that it would be well worth investigating whether the man had actually been infected already.
If male to female transmission is far more likely, this means that women need to know the kind of risk they face in order to take precautions against infection; and men who are infected need to know that their risk of transmitting the virus is high, even though their risk of being infected is low. In other words, every heterosexual needs to know the relative risk of male to female transmission, female to male transmission and the additional risks where one or more parties have also engaged in anal sex, either male to male or male to female, intravenous drug use, and perhaps various other risky practices such as tattooing, professional or otherwise.
So at one time the New York City Health Department, not only surreptitiously changed the way they recorded new HIV infections to make it look as if male heterosexual infections were increasing, but they implied that such infections had always been higher than they actually were (Sonnabend and Berkowitz article). And apparently NYC's health department wasn't even the only place where this was done. Whatever the reasons for exaggerating a phenomenon that was relatively minor, heterosexual female to male transmission, public perception of the relatively high and increasing risk of male to female transmission was thereby diminished.
While the threatened heterosexual epidemic never occurred in the West, many people were infected there as a result of various high risk behaviors. At the same time, the worst 'heterosexual' epidemics in the world were taking place in developing countries. It was reasoned (by those who knew better), and still is, that if unsafe heterosexual sex resulted in relatively minor epidemics in Western countries, high rates of unsafe sex must be taking place in medium epidemics and astronomical rates of unsafe sex must be taking place in the highest prevalence areas, all of which are in sub-Saharan Africa (yes, the logic is obtuse).
Had questions ever been raised about the anomalous data being produced by NYC health department and others, and they should have been raised by people who were using and reporting such data at the time, claims of hyperendemic heterosexually transmitted HIV in developing countries might also have been questioned. If transmission is fairly efficient from males to females, but very inefficient from females to males, how could a heterosexual epidemic ever have got started; wouldn't it just have petered out in a few generations, being mainly spread from men to women and from infected women to a certain percentage of their children?
It appears that the distorted picture of HIV as a heterosexual threat has been retained, even though its predictive power was entirely discredited in Western countries, where the 'hypothesis' was nurtured and, apparently, shielded from the universal apathy of the mainstream media. It became an easy matter to go from massive rates of HIV transmission to imputations of massive rates of unsafe sexual behavior. Endless research has shown that there are few correlations between rates of sexual behavior and HIV transmission that stand up to scrutiny. Sexual behavior simply doesn't adequately account for the biggest HIV epidemics in the world.
But the view of 'African' sexuality, sexual appetite, attitudes towards women, family and the like that this 'behavioral paradigm' fitted into goes back a long way. It used to be called racism. But as the HIV industry developed, it was presented as an unremarkable part of a respectable scientific theory. The paradigm, of course, is invisible. But you can make it out if you look beyond it; to do this, you only need to ask 'is almost all HIV transmitted through heterosexual sex in African countries' and you can see the paradigm for what it is, a prejudice. You can try this exercise at home, it's perfectly safe.
The article by Joseph Sonnabend and Richard Berkowitz linked to above mentions an interesting incident that occurred in Germany in 1986: "a great deal of publicity was given to an apparent outbreak of AIDS in male U.S. military personnel stationed in West Germany which they attributed to sex with female prostitutes in major German cities. Eminent authorities made dire predictions. However, it was soon realized that no German men had contracted AIDS from prostitutes and that there were very few HIV-infected prostitutes in Germany. In the case of the servicemen, the price for telling the truth about homosexuality would have been dismissal and loss of medical benefits. It would be naïve to assume that men will always be truthful regarding stigmatized behaviors, such as homosexuality and IV drug use."
Just as it is easy enough to malign Africans, it is also easy to malign sex workers, something that has gone on for millennia. And when you paint virually all African women of a certain age as sex workers of some form or other, you end up with publications like the ones UNAIDS specialize in, explaining the various permutations of sex worker, their behaviors, clients and forms of compensation. To this day, sex workers in many non-African countries have been shown to be unlikely to be infected with HIV unless they face some non-sexual risk, such as intravenous drug use. Why should those engaging in heterosexual sex in African be so different? Well, the question doesn't arise unless you question the behavioral paradigm, of course.
Sonnabend and Berkowitz conclude with some good advice: "in building a picture of the relative risks of various sexual acts people are asked to be frank about the most intimate and private details of their lives. This is incredibly intrusive. To unquestioningly rely on such self reported data is sure to produce a distorted picture of the distribution of cases by risk category. On matters of sex, it's probably true to say that we can deceive ourselves, let alone those questioning us."
Systematically disbelieving Africans who claim they have not engaged in unsafe sex with a HIV positive person is as breathtakingly stupid as systematically believing Western men who claim they must have been infected through heterosexual sex. Just as such claims could easily be followed up in the US, as they used to be, they could also be followed up in African countries. We have a duty to the many heterosexuals in African countries who report no obvious risk for HIV to follow up their claims and find out what risks they really faced, non-sexual as well as sexual risks.
Jacques Pepin, author of The Origins of AIDS, demonstrates how HIV would never have become an epidemic if it hadn't been for unsafe healthcare practices in places like the Democratic Republic of Congo, which spread the virus far and wide. He then claims that levels of unsafe sexual behavior rose to incredible levels in countries where HIV became endemic, a claim for which he presents little evidence. But what he fails to do is deomnstrate that unsafe healthcare practices died out in the 1980s and 90s, at the time that HIV was spreading rapidly in many African countries.
Unsafe healthcare and unsafe sex are perfectly compatible and could work together to produce exactly the sort of epidemics that are now found in many sub-Saharan African countries. While the behavioral paradigm on its own doesn't explain massive epidemics, the combination of unsafe healthcare and unsafe sex could do. All over the world, some people have lots of sex, much of it unsafe. But most of people just have ordinary sex lives. That's as true in Africa as it is elsewhere. So, not only is the behavioral paradigm highly racist, but it is not even necessary to consider such claptrap. But then, many of the HIV 'experts' have known that all along, haven't they?
[For more about non-sexual HIV transmission and mass male circumcision, see the Don't Get Stuck With HIV site.]