Thursday, December 6, 2012

WHO to Continue Dithering Over Depo Provera Risks?

Lest we forget what HIV related institutional racism looks like, there are frequent reminders. The UN's IRIN/PlusNews runs a good example this week, entitled 'Uganda: Profiles of infidelity, HIV vulnerability'. If you formulate your favorite prejudice so that it looks superficially like a hypothesis, it's not very difficult to find anecdotes that seem to supply superficial evidence. The authors interview four African women who obligingly illustrate the 'all women are victims; all men are promiscuous' prejudice.

According to the article, "Married or cohabiting couples are at a higher risk of HIV infection in Uganda than their single counterparts, with some studies finding that as many as 65 percent of new infections occur in long-term relationships." What they don't mention is that they have no idea what proportion of that 65% of infections are sexually transmitted and what proportion are non-sexually transmitted. But of course: "The prevailing culture, a hybrid of traditional mores and more modern, western values, accepts - even expects - men, and increasingly women, to have a "side dish" - a euphemism for a sexual affair." So we can just guess.

It's easy enough for us to accept the above because mainstream and specialized media sources generally say the same sort of thing, though their remarks may be couched in different terms. We are not encouraged to question the underlying views about women or Africans, nor even to suggest that you could find people in any country who would talk similarly about their experiences of sex, gender, relationships and many other matters. This is not to cast doubt on any of the anecdotes, nor of all the stories we hear about gender inequalities, gender based violence, promiscuity and the like. But these issues prevail everywhere, not just where HIV prevalence is high.

None of these stories explain why HIV prevalence is so high in some parts of Uganda. But nor do they address any of the social issues mentioned, which tend to be alluded to most when they can be associated with HIV. Gender based violence, for example, is abhorrent, occurs everywhere, and needs to be addressed whether HIV infection is involved or not. But to address HIV transmission, it needs to be clearer exactly how it is being transmitted in order to even know who is most at risk. Knowing that most of the people infected are married or are in long term relationships does not tell us how the virus is being transmitted.

I don't wish to single out IRIN/PlusNews as if they are the only biased and prejudiced news outlet. And, rather surprisingly, they also have an article this week giving some recognition to the fact that injectable hormonal contraceptives, such as Depo Provera, have been associated with a doubling of transmission from HIV positive women to men, and a doubling of transmission from HIV positive men to women. The article fails to point out that WHO simply did not warn people, but it goes further towards warning people than WHO themselves have done. Of course, it doesn't sound obviously racist to fail to warn women about these risks, until you find out that most users of injectable hormonal contraceptives are Africans and African-Americans.

Apparently WHO are going to discuss the issue this week, after making such a mess of it in May and January of this year. Even if they do make the risks clear this time, it is not at all certain that this will have any impact on the organizations that have been ruthlessly pushing these products, despite knowing the dangers. The best WHO have come up with is to warn people who are HIV positive, or who are considered to be at risk of being infected, to also use condoms. That's bad enough considering those pushing the method say injectables are a useful option where condoms are not used much, for whatever reason. But who is at risk? According to the article about infidelity in Uganda, almost everyone is at risk. Branding everyone as promiscuous renders targeting impossible.

Several people mentioned in the article said that WHO have, so far, tried to muddy the waters as much as possible and control what is said about Depo Provera and other such products. But a representative of AVAC tries to muddle out of the mess by claiming that they are "fundamentally communicating uncertainty". In fact, they are demonstrating how easy it is to lie and to deceive people whose risk of being infected with or of transmitting HIV is high (or is perceived as being high). WHO and the rest of the HIV industry are continuing to stigmatize African people for what is said to be their promiscuous sexual behavior; they want injectable contraceptive use to continue to rise so that organizations and businesses can realize their own goals, ideological, financial and whatever other form they may take.

Incidentally, AVAC calls itself a "non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic". This is a long and tortuous way of saying they are a pharmaceutical industry front group; rampant institutional sexism and racism are not going to get in their way and an increase in transmission of HIV is but a small price to pay.

As part of his continued pursuit of philanthropy at all costs, Bill Gates has adopted population control (to put it mildly) as his development paradigm. His wife has argued that Depo Provera and similar products are popular in African countries without mentioning how aggressively marketed they are. The Gates Foundation has partnered up with Pfizer, who make Depo Provera, just in case anyone should doubt the place of injectable contraceptives in Gates' plans for Africa, however destructive they may be.

Assuming that HIV is almost always transmitted through heterosexual behavior in African countries (though not elsewhere) is not only highly insulting to Africans, and especially to African women; it also results in other factors that facilitate HIV transmission being ignored, such as use of Depo Provera and other injectable hormonal contraceptives, unsafe healthcare and various co-factor diseases (for example urogenital schistosomiasis, which may quadruple the risk of HIV infection for women living in certain areas). WHO need to lose their role as lackey to Big Pharma and return to thinking of health as a right, not a commodity.

[For more about non-sexual HIV transmission and injectable hormonal contraceptives like Depo Provera, see the Don't Get Stuck With HIV site.]


No comments: