Wednesday, June 11, 2014
In an otherwise interesting article by Paul Sharp and Beatrice Hahn about the origins of HIV, the authors make a familiar, but poorly supported claim: that "AIDS is...primarily a sexually transmitted disease". I always wonder if citations for such claims will actually present evidence, or if they just lead to a blind alley, eventually.
Sharp and Hahn cite a paper by Myron Cohen et al and one by Florian Hladik and M. Juliana McElrath. But Cohen et al only refer to Haldik and a lengthy report by UNAIDS from last year, which doesn't cite any supporting evidence. It says: "The vast majority of people newly infected with HIV in sub-Saharan Africa are infected during unprotected heterosexual intercourse (including paid sex) and onward transmission of HIV to newborns and breastfed babies. Having unprotected sex with multiple partners remains the greatest risk factor for HIV in this region."
This completes the mantra about 80% of HIV transmission being a result of heterosexual intercourse and much of the remaining being a result of mother to child transmission.
Hladik and McElrath refer to another report by UNAIDS, this time from 2007. Despite the constant repetition of an assumption about heterosexual transmission, I could not find any supporting citations. UNAIDS do frequently refer to their 'Modes of Transmission' surveys, but these are hopelessly flawed and do not support the assumption. Hladik et al decide that, although transmission via infected blood is possible such a phenomenon is beyond the scope of their review.
I could chase around and look at various UNAIDS publications that propagate what has become one of the most enduring myths about HIV transmission in Africa, that it is almost always a result of heterosexual sex, but there are too many such publications, and too many of them just cite other UNAIDS publications. One might hope for peer-reviewed articles, like the ones cited above, to break the vicious circle, the incestuous practice of experts citing other experts until they have created a web of questionable views that are then used to spawn global policies. But years of reading such documents has not led to any clear and independent assessment of the relative contribution of sexual and non-sexual modes of transmission to the most serious HIV epidemics. If I ever stumble upon such an assessment I shall certainly share it widely.
But I don't believe evidence will ever be produced to show that sex explains almost all HIV transmission in Africa, not even from all the experts and senior bureaucrats who have made it their life's work to cling to this view, because it simply is not true. There is too much evidence that HIV has been transmitted through unsafe healthcare and various other non-sexual routes. But UNAIDS have resolutely refused to investigate any of this evidence.
[For more about non-sexually transmitted HIV, view our Healthcare Risks for HIV and Cosmetic Risks for HIV pages. For more about some of the terrible consequences of adhering to this behavioral myth of HIV transmission in Africa, see our Male Circumcision and Depo-Provera (DMPA, hormonal birth control) pages.]