Friday, September 27, 2013
[Crossposted from the Don't Get Stuck With HIV site]
In the light of several recent news reports, the Don't Get Stuck With HIV site has created a new page on possible risks associated with use of skin-piercing products such as Botox and Malanotan. Injection of anabolic steroids and other performance enhancing drugs can carry similar risks, especially if they are administered in an unsterile environment, and/or administered by untrained or inexperienced providers. The UK Government has issued a warning, saying that steroid users are at higher risk of HIV and viral hepatitis. The Don't Get Stuck With HIV page offers easy to follow advice to people considering such treatments.
Similar information and advice on injections in general is available throughout the Don't Get Stuck With HIV site; healthcare risks aside from injections are discussed here. There is also information on risks from other cosmetic treatments, such as tattooing, ear and body piercing, manicures and pedicures and hair styling and shaving. However, beauty treatments that pierce the skin may be more risky than some of these other cosmetic treatments because instruments such as needles go deeper below the skin than tattoo needles, for example.
A recent article on the BBC website draws attention to the concerns of a health watchdog about the safety of Botox injections in the UK. They are also questioning the safety of anabolic steroids, tanning agents and dermal fillers. These treatments can be obtained in salons, or they can be self administered. The article warns that sharing equipment can carry a risk of infection with HIV, hepatitis or other blood borne diseases. The UK's National Institute for Health and Care Excellence (NICE) is currently preparing guidelines on these issues.
Botox is a prescription only drug. However, an Australian news network ran an article late last year about a 'backyard botox' clinic, a specific clinic in Western Australia where infection control practices were found to be lacking, highlighting some of the health risks involved. It is said that the risk of infection with blood-borne diseases is small, but nevertheless real. Some practitioners may offer such treatments in the home, where conditions are likely to be unsuitable.
In 2008, the BBC reported that a growing number of people in the UK are injecting themselves with an unlicensed hormonal tanning drug called Melanotan. It is possible that this drug is being sold illegally online, in salons, in gyms and in health and fitness centers.
Tuesday, September 17, 2013
Sunday, September 15, 2013
[By Dr David Gissselquist - Cross-posted from the 'Don't Get Stuck With HIV' website and blog]
To defeat HIV/AIDS in Africa, UNAIDS recommends: “Know your epidemic.” The best way to do so is to investigate to trace the source of infections – especially in children with HIV-negative mothers, virgins, and married people with HIV-negative spouses and no outside partners.
But that’s not what UNAIDS urges African governments to do. Instead, UNAIDS urges governments to use its Modes of Transmission (MOT) model to estimate numbers of infections from various risks.
But the MOT model contains a glaring error. Because of this error, whoever uses the model ends up estimating far too many infections coming from spouse-to-spouse transmission.
In Uganda, for example, the MOT model estimates that 60,948 married adults got HIV from their spouses during 2008. This is two-thirds of the model’s estimated total new infections from all risks in Uganda in 2008.
The MOT model got this number by supposing that 5.9% of married adults (421,000 adults) were HIV-negative with HIV-positive spouses, and that 14.5% of these spouses at risk got HIV from husbands or wives in 2008 (60,948 = 14.5% x 421,000).
But the number of spouses at risk is far, far less. Uganda’s 2004/5 HIV/AIDS Sero-behavioral Survey reports that 6.2% of husbands and 5.2% of wives were HIV-positive. But – and this is the important fact the MOT model ignored – most HIV-positive husbands and wives were married to each other. Only 2.8% of wives and 1.8% of husbands were HIV-negative with HIV-positive spouses.
Overall only about 2.3% of married adults (averaging 2.8% of wives and 1.8% of husbands) were HIV-negative with HIV-positive spouses – only 222,000 vs. the 421,000 estimated in the MOT model. If 14.5% of these 222,000 adults got HIV from their spouses in a year, that would account for 32,100 new infections (14.5% x 222,000), far less than the 60,948 estimated in the MOT model.
Why is this important? Because if fewer infections are coming from spouses, how did so many Ugandans get HIV in 2008? In other words, the MOT not only over-estimates HIV from spouses, but also underestimates infections from other risks.
What risks are underestimated? Hold on now! Don’t run away with sexual fantasies about young people and some married adults having too much fun with non-spousal partners. Indulging in racist and stigmatizing sexual fantasies is something too many official AIDS experts like to do. But the evidence does not support such fantasies. The best information on sexual behavior does not come close to explaining Uganda’s epidemic.
Setting aside sexual fantasies, the underestimated risks are more likely to be those that UNAIDS’ staff and other health professionals want to ignore – skin-piercing procedures with unsterile instruments, such as injections, dental care, manicures, etc. This is true not only in Uganda but also in more than 15 other African countries that have used the MOT model to get ridiculous figures on numbers of HIV infections from spouses.
Remember how we began: The best way to “know your epidemic” is to trace infections. Let’s challenge HIV/AIDS researchers -- finally -- to do their job. Although it’s decades too late, tracing is still needed to find all the important risks and to stop Africa’s generalized HIV/AIDS epidemics.
[Note: This blog summarizes evidence and arguments in: Gisselquist D. UNAIDS' Modes of Transmission model misinforms HIV prevention efforts in Africa’s generalized epidemics, available at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2315554.]
Saturday, September 14, 2013
[Crossposted from Blogtivist]
Early in April 2008, President Jakaya Kikwete is quoted as saying "I am told that people kill albinos and chop their body parts, including fingers, believing they can get rich." This kind of statement, which has appeared many times over the seven years of reporting on attacks on albino people, always needs to be read with care. Other accounts, vague as they tend to be, suggest that there are people who do the killing and maiming, people who buy the body parts and people who pay for those parts or 'potions' made from those parts.
Those are three very different ways of 'getting rich'. The first represents a serious crime, with the expectation of substantial reward. The first does not require that there be any 'superstition' involved, though it doesn't preclude it. The second is also a crime, but the expectation is that there are enough superstitious people to buy potions and other services using parts of albino people. The person providing these services doesn't need to be superstitious either, though they may very well be. The third crime very likely requires the 'client', the person paying for the service, to be superstitious.
It's very important to distinguish between these different crimes in order to understand how such attacks could begin and continue for years. Each type of participant takes different kinds of risk, risks of being apprehended, financial risks, etc. Some attackers have, apparently, said they were sent by a witchdoctor to find a victim and promised money in return. The witchdoctor needs some degree of certainty that their clients will pay large sums of money. The client is the only one who must be superstitious, or somehow deluded, about the power of witchdoctors and the services they provide.
Media accounts emphasize the issue of superstition and often remark how widespread superstition is in some areas or, especially, among certain groups of people: "Superstitious miners and fishermen in the [Lake Zone] region hoping to get rich quick have been accused of fuelling the demand for the potions." This statement has been frequently paraphrased, and even copied and pasted, as if superstition gives some kind of insight into these killings. Sure, superstitious people can be found, everywhere. But most superstitious people do not generally carry out brutal attacks, maimings and killings. (Nor do most witchdoctors, fishermen, miners or 'businesspeople'.)
Not only are media accounts incomplete, vague and often rather unconvincing, but they have tended to repeat the same sorts of gossip and rumor for seven years, with few noticeable insights that one might expect from investigation, research or analysis. If we want to understand how these attacks began, how can we do that? What kind of data and analysis can we use? Remarks about witchdoctors, miners and fishermen are nothing new, and long predate attacks on albino people. More importantly, none of these groups are noticeably rich, not that anyone has demonstrated, anyhow. Commentators like to imply some kind of organized crime, but how organized is it? How 'lucrative' is it?
Looking for as much information as I could find online about attacks on and killings of albino people in Tanzania between 2006 and 2013, I came across a fairly small quantity of empirical data and a somewhat larger quantity of speculation. While there was a fair amount of disagreement about much of the empirical data, there was a fair amount of agreement about the speculation. This could be the opposite to what one might expect, unless the entire media became contaminated by some of the more 'pornographic' among the early reports.
After all, it should be possible to say with a fair amount of certainty how many albino people there are in Tanzania, how many were attacked and how many were killed, where and when these events occurred, and the like. Those are examples of empirical data. Who may have been involved in these events and what their motives were would seem, I think, more a matter of speculation, at least until some investigation and research has been carried out.
Yet almost all sources agreed, right from the very start, that witchcraft (or something similar, or thought to be similar) was behind the attacks; and witches, people perceived to be witches (and similar sorts of people, and those thought to be similar enough) were demanding albino bodies and parts of albinos; their 'clients' were demanding potions (and similar, you get the picture) that would make them rich (yes, almost all the articles said that wealth was what the clients wanted). Therefore, there were also these 'middlemen', sometimes referred to as 'businessmen' (both terms being suitably vague), who were carrying out the brutal maimings, murders and other crimes.
I have searched numerous articles and documents to create a table of all the attacks where victims were named, and/or enough detail was given to show that there probably was an attack or violent or threatening event, matters that could be further investigated, so that a more accurate picture of these dreadful murders and attacks can be built up. I have also tabulated some data about numbers of attacks, numbers of named victims, numbers of articles, numbers of victims claimed by the media, etc.
Whereas sources are in reasonable agreement that at least one hundred of these incidents took place (some say there were many hundreds, and that most are undocumented), that about 70 albino people were killed and about 30 were maimed (or otherwise injured), I have only been able to find accounts of 71 victims, some of them fairly scanty. Only 46 of these victims (65%) have been named, although some have only been partially named (only first or second name). 24 out of those 71 victims identified, or partially identified, were killed. Only ten of those who died have been named (or partially named).
The cumulative number of deaths estimated by the media, which seems to be almost entirely speculative, especially in the first few years, waxes and wanes. Some of the earlier articles say there were 4 murders in the three months to December of 2007, but the Tanzania Human Rights Report for 2007, published some time later, claims there were 20 during this period (prior to this, there was only one documented, in April 2006). The numbers estimated for 2008 range from 19-30, which may or may not suggest a halving in killings during 2008. By the end of 2009 numbers have jumped to 35, and then to 53 early in the year, this being the highest mentioned for 2009. In 2010, the figures rose to 71, without rising above 72 by 2013.
The number of incidents reported by the media in those years makes a very different pattern. From 1 in 2006, reported in the LHRC report published about a year later, there were 3 in 2007 (all reported in Under the Same Sun's document listing 34 victims, mostly survivors). The highest number of identifiable incidents was reported in 2008, 17 in all. Numbers fell to 11 in 2009 and 8 in 2010, only to rise to 15 in 2011 and drop to 7 in 2012 and 8 in 2013. So there were two peak years for incidents described in the media. The number of articles describing these events took a third pattern, rising from 1 in 2007 to a peak of 20 in 2008 and 22 in 2009, then falling to 4 in 2013.
If, as much of the online media claims, there were about 70 murders of albino people in the last 7 years, an average of 10 a year, why has the media feeding frenzy failed to document the majority of them? Western murder victims usually have a name; but only one in 7 Tanzanian albinos said to have been murdered has been named (or partially named). About one fifth of those maimed or suffering some other kind of injury have no name either, despite being victims of crimes such as attempted murder, abduction, rape and false imprisonment.
Media coverage of attacks on and murders of albino people in Tanzania has been appallingly sloppy. So I am prepared to believe that there may have been additional, undocumented attacks and murders. But it is also hard to avoid concluding that the conviction that albino body parts can bring great wealth, whether to criminals, witchdoctors or their clients, is partly based, perhaps largely based, on media reports. The involvement of 'witchdoctors' and the promise of wealth are two of the most enduring concepts in the media, appearing in almost every one of the eighty or so articles I have used for this study.
Attacks, maimings, murders, rapes and other crimes are carried out by criminals, and they deserve to be prosecuted and punished for their crimes. But the media should become more cautious when certain kinds of crime appear to display a pattern. Given the constant mention of 'great wealth', it would have been more responsible to play down this aspect of the crimes; not by failing to mention the oft cited amounts that could be made, but by emphasizing that no clear instances of large sums of money changing hands have been documented; no rich witchdoctors were identified; the evidence, at best, points to rumor and gossip about money, nothing more.
Apparently there were four attacks in a period of 16 days earlier this year, resulting in two murders, two maimings and attacks on two other people. It's not too late to look back on the last seven years of reporting and set the record straight, and doing so may help to ensure these these attacks eventually cease to occur. So far, media coverage has been insulting to albino people, their families and friends, and to Tanzanian people.
Tuesday, September 10, 2013
[Cross-posted from Blogtivist]
Instead of merely using the word 'witchcraft' in one of the earliest mainstream media articles on a series of murders of albino people in Tanzania, the author could as well have issued an edict that henceforth, all articles on the subject use a term with 'witch' in it, or some other, equally obscure term. Because every single subsequent mainstream media article on the subject did use such a term.
Other terms that crept in include: witchdoctor, foreign witchdoctor, herbal medicine, herbalist, ancient tradition, black arts, black magic, satanism (satanic inspired), traditional healer, magic potion, ritual medicine, ritual killing/murder, muti, muti medicine, sorcery, cannibals, magic potion, child sacrifice, superstition, taboo, fetish, voodoo, devil worship, occult, etc [There's a partial list of articles consulted on this page.]
'Here be Dragons...', began the BBC, and the rest of the 'free' press joined in unison. In the years following 2007, which marked the beginning of the media frenzy concerning attacks on and murders of albino people in Tanzania, no convincing explanation was ever given for why people should be attacked and killed just because, apparently, they are albinos.
Indeed, no light was shed on how that first article found online (there are likely to be many articles that have not been found by this study) had already 'established' that the 'four deaths (of albino people) in the past three months' (later reports suggest as many as 20 deaths in 2007) were a result of the work of 'witch-doctors'; but there was already a call for arrests.
Not that any subsequent research has shown that witches/witchdoctors/traditional healers, etc, were not behind the attacks and murders. In fact, one of the biggest single barriers to understanding these attacks and murders is that none of the articles examined have bothered to make clear exactly what they mean by 'witch', or whatever other term they used. For years, old people suspected of 'witchcraft' have been persecuted and lynched; such lynchings still occur, but they are surely not the target of these articles?
The World Health Organization estimates that in "some Asian and African countries, 80% of the population depend on traditional medicine for primary health care". Not only are conditions in most public health facilities in Tanzania appalling and dangerous, but many people are not able to afford them, neither the fees (official or otherwise), nor any of the other costs involved, such as transport and drugs. There is little left for poorer people other than some kind of local healer. Are these the targets of all the media articles about attacks on and murders of albino people in Tanzania?
Difficult as it is to believe, the government soon declared a 'ban' on all kinds of 'witchcraft'. The undefined set of activities that this poorly defined 'group' engage in becomes a target of intense media interest. But not for the first time. Poor and vulnerable old women and men in rural areas, who are probably becoming isolated from their communities, are not the only targets of savage persecution, beatings and lynchings. Virtually anyone said to be involved in any area of 'witchcraft', whether they hand out traditional cures for illnesses or potions said to make their clients wealthy, has gone through all manner of threats to their livelihood over the years.
In the mid 1990s, the Kenyan government was somehow persuaded that various elements of another poorly defined set of activities, devil worship, were 'rife' in rural areas, in schools, in (recently established) churches, in public places, everywhere. A government commission, headed by senior representatives of better established churches, was set up to investigate and several years later they, apparently, presented a report to parliament. The report was never made public, but the media was able to salivate over its possible contents for years, and the issue of devil worship is alive in the minds of many people who lived through those years.
What has witchcraft got to do with devil worship? Well, they were all lumped together by the Kenyan commission, just like all the terms listed above. "President Moi appointed the Commission in 1994 in response to public concern about a perceived resurgence of witchcraft, ritual murders, and other ostensibly "Satanic" practices associated with aspects of traditional indigenous religions." That one sentence damns a whole host of groups.
The document continues: "The Commission's report included numerous reports of ritual murder, human sacrifice, cannibalism, and feats of magic allegedly done by using powers acquired through such acts." Attacks on and murders of albino people in Tanzaina, from very early on, were seen as 'ritual' murders. Even descriptions of those murders became more lurid, listing the various parts of bodies, including their skin, and what they would be used for, bleeding and drinking of blood, hacking limbs off live victims, etc. Who wouldn't immediately see 'witchcraft' in these bloody attacks and murders in Tanzania?
Given the sheer weight of media footballs to choose from, few may remember Tanzania's (human) 'skin trade'. But it was a big enough story to attract attention for several years in the late 90s and early 2000s. An article in 1999 refers to "a series of [at least three] brutal murders in which the skins and organs of the victims are apparently being sold for use in witchcraft". The article even claims that a "human skin can fetch a price of up to $9,000", just as the media later reveled in claims about how much money could be made from the parts and entire bodies of albino people.
Two years later it is reported that a gang, a ringleader called Adamu and twelve members, had been arrested in connection with similar murders, these also taking place in the Southern region of Mbeya (the majority of attacks on and murders of albino people took place in Mwanza, in the North West). The price range is now said to be "$2400 and $9600, apparently depending on the age of the victim". It is stressed that the ultimate market for these skins is West Africa and those involved are described as having become 'expert' at mutilating the bodies.
After another two years the issue is back on the BBC site; again it is stressed that the market is "outside Tanzania", and there is a "huge demand". Again, the murders are said to have taken place in the South of the country and there is mention of 'ritual' and 'witchcraft'. The total number of deaths is said to have been six. In common with the later attacks on and murders of albino people, it is implied that the skin is used by practitioners of witchcraft to bring wealth to the client: "This is also to educate people that they do not have to to use human skin to become rich".
None of the above tells us why albino people in Tanzania were subsequently mutilated and murdered, why the bodies of albino people were dug up and parts hacked off, why several people attempted to 'sell' an albino person for use by 'witchdoctors'. But it gives some idea of what the use of the term 'witch' and various other terms adds to an article about these horrific events: absolutely nothing. It simply labels the issue as a media football, to be kicked around along with other, similarly labelled bumf, a hotch-potch of rubbish that goes together to make up what counts as 'African' reportage.
It is estimated that over 100 albino people in Tanzania were attacked and over 70 killed since (probably) some time in 2006. Those who carried out the attacks, for whatever motive, deserve to be punished for what they did. But, despite hundreds of arrests claimed, hardly anyone has been punished. Reports are vague and unreliable, perhaps three or four people were convicted. One of those convicted was Kenyan, for human trafficking, as the victim was neither mutilated nor murdered.
So what's the problem? Witchdoctors are not that hard to find. If their work becomes a big secret they don't get many clients. The media loves to refer to how secretive they are, but given the sort of things that they have been implicated in over the years by the same media, who could blame them? Some may have become so secretive that they no longer get any clients at all; they may have found something safer to do. Just about anything would be safer, really.
More importantly 'witchdoctors' do not, according to evidence available, tend to charge a lot for their work; how could they, most of their clients are poor? So if 'witchdoctors' are not that hard to find, rich witchdoctors must really stand out. If there is any truth in the various rumors about how much they charge for 'potions' containing parts of mutilated and murdered albinos, some of them, probably a mere handful, must be noticeably well off. But no article found has produced evidence of a wealthy 'witchdoctor', only rumors, the media's stock in trade when writing about 'Africa'.
No article has produced evidence of a wealthy client, either. Artisanal miners and fishermen, mining and fishing being among the few sources of income in Mwanza, are frequently mentioned. But they, along with the hapless 'witchdoctors', have been blamed for many other things. Some sources mentioned politicians as possible clients of witchdoctors and predicted many further maimings and killings of albino people in the run up to the 2010 elections. Either there was no surge in violence against albino people, or the media merely failed to report it. So do politicians give large sums of money to 'witchdoctors' in return for success? Perhaps they now settle for potions that don't contain human remains.
Where is all the money involved in the often referred to 'lucrative' trade in albino body parts? Most articles stress the rural character of places where maimings and murders of albino people take place; they stress the poverty of the victims and the people around them; they stress the high levels of superstition and sometimes the low levels of education and the lack of opportunity in the area. How many rogue 'witchdoctors' were there, ever? And how many wealthy clients? Can the media, after all their 'investigations', over a period of so many years, tell us anything that is certain?
Or should we suspect that much of the talk of a 'lucrative' trade in albino body parts, talk that may have have contributed to so many maimings and deaths, was to a large extent the result of a media frenzy, that there are few wealthy 'witchdoctors' or clients, if any, that most, if not all of the perpetrators of these horrendous acts are still free, and that if anything could have been done to prevent such attacks it has not yet been done?
There were several further attacks and deaths this year. Late though it is, there needs to be a full inquiry into this phenomenon, one that takes into account the possible role of the media, the police and other officials, political, church and traditional leaders, everyone who may have something to add to finding out what went on, and what is still going on. We owe this, at least, to all the people who have already suffered and to those who may be protected by the results of a thorough investigation.
[I will be putting together data and sending it to the media outlets involved, calling for an inquiry into the shoddy coverage of the many attacks on and murders of Tanzanian albino people over the past seven years, and the failure of all those involved to identify the perpetrators and to protect other albino people from subsequent attacks and murders.]