Sunday, August 16, 2015

Zimbabwe: Thought Embargo at HIV Inc to Continue Indefinitely

Naturally, there are some men who have sex with men in prisons, and not just in Zimbabwe. But that is not just because men are more likely to have sex with men when incarcerated for lengthy periods with men, denied conjugal visits and other rights. It's also because having sex with someone of the same gender can itself attract a prison sentence.
However, what the health minister fails to realize is that there tend to be very poor health services in prisons. If he had inspected health services in prisons he would have come to a very different conclusion. Indeed, had he inspected health services outside of prisons he would also have come to a different conclusion about Zimbabwe's massive HIV epidemic.
Prevalence in Zimbabwe had already reached about 15% in the early 1990s (compared to about 1% in South Africa). But it shot up to almost 30% before the end of the decade, then dropped back to early 1990s levels in less than 10 years. The figure has remained at roughly half its peak for the last decade or so.
The death rates required to bring prevalence from 30% to 15% in less than 10 years must have been phenomenal. Did the esteemed (and I'm sure astute) Parirenyatwa notice a sudden rise in prison populations during the 1990s, followed by a profound drop, with a subsequent flatlining thereafter? Or a sudden rise in male to male sex? Or a sudden rise in 'unsafe' sex among heterosexuals?
I don't think so. But I also doubt if the health minister has a clue what was going on in the country's health services then, or perhaps now. Massive increases in HIV transmission during the 1990s was very likely a result of a decrease in levels of safety in health facilities, along with a probable increase in usage of health facilities.
Minister, HIV is most efficiently transmitted through unsafe skin piercing procedures, such as injections with reused injecting equipment, surgical instruments, etc, also through unsafe body piercing and tattooing, and even through unsafe traditional practices, such as scarification, blood oaths and others.
Just how unsafe would cosmetic and traditional practices be in a prison? We can only guess. How safe would they be elsewhere? It's unlikely anyone has checked. If they have, they would have found it difficult to publish the findings.
It's easy to blame high HIV prevalence on 'promiscuity', male to male sex, carelessness, stupidity, malice and other phenomena, so beloved by journalists and others milking the HIV cow, far too easy. But ministers, journalists, academics, and even those who have reached lofty heights in international NGOs and the like, are still permitted to consider the roles of unsafe healthcare, cosmetic and traditional practices. I invite them to do so.


Wednesday, August 12, 2015

'African' Sexuality: Consensus or Prejudice?

An article by Damien de Walque, entitled 'Is male promiscuity the main route of HIV/AIDS transmission in Africa?', seems curiously behind the times. He refers to the "pervasive if unstated belief in the HIV/AIDS community...that males are primarily responsible for spreading the infection among married and cohabiting couples".
Disturbingly, de Walque goes on to conclude that, because women are as likely as men to be the infected partner in discordant relationships (where only one partner is HIV positive), both male and female promiscuity must be the main route of transmission. This is by no means the only possible conclusion; far more women than men are infected with HIV in high prevalence African countries, but this could be a result of other risks, particularly non-sexual risks.
However, women being almost as likely as men to be the infected partner in discordant relationships was not a new discovery when de Walque was writing in 2011. Gisselquist, Potterat, Brody and Vachon published an article in 2003 entitled 'Let it be sexual: how health care transmission of AIDS in Africa was ignored', which presents evidence from the 1980s showing that women are almost as likely as men to be the positive partner in discordant relationships. They also show that neither is promiscuity the main route.
The article by Gisselquist et al looks back at papers from the 1980s demonstrating clearly that the bulk of HIV transmission in African countries is not sexually transmitted. Data collected about sexual behavior does not support the view that Africa is exceptional. Rather, data about other risks, such as unsafe healthcare, cosmetic and traditional practices was either not collected, or was ignored.
Even the abstract gives a good sense of what was going on in the 1980s (and is still going on). I'll cite it in full, adding italics for emphasis:
"The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988.We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures."
Consensus among influential experts should be based on available data; not only did these experts ignore a lot of available data, they failed to collect a lot of data that could have led to a very different consensus. But several long-held preconceptions, for example, about 'African' sexual behavior, may have had undue influence on the consensus of these experts. It is these preconceptions that I am interested in.
By claiming that UNAIDS is going to change its name to UNAZI (as far as I know, they are not going to), I wished to draw attention to the fact that the still current claim that HIV is almost always transmitted via heterosexual contact in African countries (but nowhere else) is based on the preconceived views of some very prejudiced 'experts'. UNAIDS acquired a consensus of experts who had decided, before the institution was established, that they were going to concentrate almost exclusively on heterosexual transmission, and diminish the role of unsafe healthcare and other non-sexual transmission routes.
The big lie about HIV in 'Africa' is that 80% (sometimes 90%) of prevalence is from 'unsafe' heterosexual sex, and most of the remaining 20% (or 10%) is from mother to child transmission. This lie emerged in the 1980s, from 'experts' who knew that it was a lie. The entire HIV industry is still based on this lie three decades later. As a result, most African people are unaware that unsafe healthcare, cosmetic and traditional practices may be a far bigger HIV risk than sexual behavior.


Thursday, August 6, 2015

UNAIDS Becomes UNAZI - Focus At Last?

UNAIDS reached 20 and became 21 without anyone really noticing. HIV prevalence had peaked in some of the worst affected countries by the time the institution was established, but many epidemics had only just begun.
For example, HIV prevalence in South Africa was very low in 1990, probably less than 1%. Along with several other southern African countries, prevalence rocketed for much of the following 10 to 15 years, eventually making this zone the worst affected in the world.
HIV epidemics tend to concentrate in certain zones, rather than in certain countries. A large area in southern Africa constitutes one of these zones, taking in much of South Africa, Zimbabwe, Zambia, Botswana, Swaziland, Lesotho, Namibia and parts of Mozambique and Malawi.
But some zones are not best described by national boundaries. The areas surrounding Lake Victoria, for example, make up another zone, bringing together a large proportion of the HIV positive population of Kenya and Uganda (and, formerly, Tanzania).
Many HIV zones are cities, such as Bujumbura and Nairobi, hotspots, surrounded by relatively low prevalence areas. But some zones are more rural and isolated from big cities, such as the Njombe region of southern Tanzania, where prevalence is higher than anywhere else in the country.
All the northern African countries make up a very low prevalence zone, with most western African countries making up a higher prevalence zone. Central Africa and the western Equatorial area are fairly low prevalence, but eastern Africa used to be the highest prevalence zone, and there are still several million people living with HIV there.
So the United Nations Aids Zones Initiative is, presumably, going to make distinctions between 'Africans', who have all been lumped together by UNAIDS. Rather than referring to, say, Kenya's epidemic, there will be the Lake Victoria Zone, the Mombasa Zone, and so on. After all, prevalence in some parts of the country is lower than in many rich countries, such as Canada.
A country like Tanzania, where 95% of the population is HIV negative (and only about 2% of the population are receiving treatment), will now be able to spend health funding on diseases that affect many people, diseases that have long been ignored. Health services there and in other countries should benefit considerably from the creation of UNAZI.
But the most important change will be in the received view of HIV, the view that it is almost always transmitted through heterosexual sex in 'African' countries (though nowhere else in the world). UNAZI will not be able to claim, as UNAIDS did, that there are certain zones on the continent where heterosexual practices are somehow exceptional!
We can look forward to an immediate reduction in the stigma that goes with branding anyone infected with HIV as promiscuous (or as a helpless victim of promiscuity). Whatever explains the concentration of HIV in these zones will be unrelated to sexual behavior; the explanation is far more likely to relate to unsafe healthcare, even unsafe cosmetic and traditional practices (although the first is the main suspect).
UNAZI will be much more than a change in name, or a change in focus. It will also be an exit strategy, a way of attending (belatedly) to the main causes of HIV epidemics, without admitting that UNAIDS and their chums have been lying for so long, of course. UNAZI will probably only last long enough to 'turn off the tap' that UNAIDS never acknowledged, and then quietly re-merge with WHO.


Wednesday, August 5, 2015

Institutionalizing Violence Against Women (and Men)

It is not news that injectible Depo Provera (DMPA, a hormonal contraceptive) doubles the risk of HIV negative women being infected, and doubles the risk of HIV positive women infecting their sexual partner with HIV. Nor is it news that injectible Depo is mostly used in developing countries, and among non-white people in the US. Therefore, it tends to be used in places where HIV prevalence is higher, and among populations with higher prevalence in low prevalence countries.
Why use injectible Depo when this is well known? Defenders of the product claim that using it cuts other risks, such as unplanned pregnancies, particularly among HIV positive women. They feel this mitigates the risk of transmitting the virus, or of becoming infected. Strange logic, but such is the mindset of the HIV industry, and those who (very strenuously and aggressively) defend the use of injectible Depo.
If various NGOs, public health programs, research programs and others wanted to carry out their work ethically, they would tell the women (and hopefully their sexual partners) about the doubling in risk of HIV transmission, but the warnings given are vague. Therefore, women (and men) are put at increased risk of being infected with HIV, or of infecting others. Many of these same NGOs, their funders and associates would also claim to be opposed to violence against women. But failing to inform them about the increased risk constitutes violence against women (and men).
Stupider still is the proposal to use PrEP (pre-exposure prophylaxis, antiretroviral drugs taken to prevent infection) to reduce the risk that injectible Depo will increase HIV transmission. Why not just use a different hormonal contraceptive, preferably an oral form? Well, one of the arguments for not using an oral form is that some sexual partners may object to women using oral contraceptives, especially if they are married to the woman. It is argued that women can be given Depo Provera once every three months, without their sexual partner knowing.
But will the partner not wonder why the woman is taking oral PrEP? And if they try to find out why she is taking it, may they not also find out that the woman is HIV positive, believes her sexual partner to be HIV positive, or is taking injectible contraceptives? Are we not back to square one?
Where are the narcissistic 'feminist' stars of film, music and other arts when you need them? They are too busy screaming about what sex workers want (or should want) to see real violence against women, happening right in front of them. Many of those being (aggressively) persuaded to use injectible Depo Provera are sex workers (or are believed to be by those doing the persuading). What about their right to know the risks from injectible hormonal contraceptive to themselves and their partners?
It is claimed that using injectible Depo Provera can protect women from violence; but it also constitutes an act of violence against them and their sexual partners. In addition, the 'protective' value of Depo Provera (against violence, not HIV) is lost if the woman also takes PrEP (to protect her against HIV). The use of injectible Depo Provera is an act of institutionalized violence against women (and men). It should not be used as a vehicle for selling pre-exposure prophylaxis.


Sunday, August 2, 2015

Paying for Sex and Paying for Chastity: All the Same?

Offering money to young girls in return for an undertaking by them to have less sex, or to take precautions against infection with sexually transmitted infections and unplanned pregnancy, strikes me as inherently contradictory. If you want to make money out of your body, what difference does it make whether you achieve that by agreeing to have sex, or by agreeing not to have sex?
Imagine you wish to make money in these ways: you have clients who pay you to have sex; and you have clients who pay you not to. The two types of client are perfectly compatible. Instead of making eight dollars a day (100 Rand), week or month, you can make sixteen, or you can use the payment as leverage to charge some clients more, or as a subsidy to charge some less.
These 'conditional cash transfers' seem to be based on a number of assumptions. For a start, they seem to assume that HIV is almost always a result of sex, generally extra-marital sex, and generally 'unsafe' sex. They also seem to assume that protecting themselves against being infected with HIV is within the control of the recipient of the money.
What about non-sexually transmitted HIV, through unsafe healthcare, cosmetic or traditional practices? Don't people infected in that way need money too? Shouldn't they be encouraged to avoid health facilities where conditions are dangerous, also practitioners who have a poor record for safety?
By the way, the recipient of money is always female. Therefore, it is further assumed that the male with whom the female has sexual intercourse is usually the 'index case', the one more likely to be HIV positive. (All men are sexual predators and all women are sexual victims, at least in the world of HIV.)
But, as it turns out, most young males in South Africa and other sub-Saharan African countries tend to be HIV negative. Far more females than males become infected, some in their teens, but far more in their twenties, and many in their thirties. So who is doing all this infecting?
This requires another assumption: the girls/women are having sex with men who are older than them, often much older. There are several problems with this attempt at rescuing current HIV 'policy' and thinking: many females do not have sex with men who are much older than themselves; many 'older' men are not HIV positive; and many females are infected even though their sexual partners are roughly the same age as themselves.
Worse still, some girls/women are infected even though they either have not had sex, or they have always taken precautions. In fact, using condoms is more strongly associated with higher HIV prevalence than not using condoms. Those trying to dig themselves out of this hole claim that people who know they are HIV positive are more likely to use condoms. But this claim is not well supported by evidence.
'Intergenerational' marriage and sex, where one partner (usually the male) is older than the other, used to be the darling of the anti-sex brigade. But very little research was carried out into whether it really resulted in higher rates of HIV transmission. When some research was carried out it was found that it may be associated with lower rates of transmission.
Back to the drawing board? Well, no, actually. As well as persuading girls/women not to have sex (or the wrong kind of sex, or sex with the wrong kind of person, etc), there are conditional cash transfers for men who agree to be circumcised. It works, too. Not very well. Not many men will agree to be circumcised for a few dollars.
Unsurprisingly, more men will agree to be circumcised if they are paid more money, and fewer if they are paid less. But most of the men who agree to the operation would have already agreed to it without the payment; they were already convinced that circumcision would be the answer to their prayers (or what they thought were their prayers).
There is cash to stay in school, even though this is not associated with lower HIV incidence. The payments may continue because school is a good thing. But didn't we know that already? Didn't we already know that all children should go to school and that there should be equal access for all children, regardless of their gender, tribe, religion, etc?
There is cash to support prevention of transmission of HIV from mother to child. What about reducing infection in mothers? Many are infected when they are already pregnant, even late in their pregnancy, or just after giving birth. Many infected have husbands who are negative. These women are unlikely to have been infected through sexual intercourse, despite the constant pompous and racist prognostications of the HIV industry.
Sometimes the payment, or some of it, goes to the family. Great, so poverty is a bad thing; and another thing we just wouldn't have known if it hadn't been for this research? The World Bank made a big hoo hah recently about how wonderful eradicating human parasites is, how much better off children are, with improvements in health, academic achievement, etc.
But human parasites are debilitating and result from appalling living conditions. They are also easily and cheaply treated. Aside from the clever medications, provision of water and food of a quality appropriate for human consumption can also significantly reduce the problem. Why so much research to tell us what we already know? Why so much research telling us that a lot of what we are doing are wrong, yet the research, and much of what we are doing, both continue.
Something all of the above failed approaches have in common is that they show that HIV is not very closely related to sexual behavior. It is not just that attempting to influence someone's sexual behavior often fails; successfully influencing someone's sexual behavior also fails to reduce HIV transmission.
Conditional cash transfers that assume HIV is almost always a result of sexual behavior don't just frequently fail to influence sexual behavior, they fail to prevent HIV transmission. Mass male circumcision has been shown to reduce HIV transmission from females to males, only slightly, and only under certain conditions; but it increases transmission from males to females.
These same researchers have been working on the same unpromising initiatives for many years, even decades: Karim, Pettifor, Jukes, Thirumurthy, etc. However, their racist bilge doesn't fail because it is racist, it fails because it is based on assumptions that are not borne out by their own findings. Except in the minds of journalists, there is no 'money, sex, HIV' triad in Africa; HIV is also transmitted through non-sexual routes, such as unsafe healthcare, cosmetic and traditional practices. Let's try dealing with that.


Tuesday, July 28, 2015

WHO to Warn About Unsafe Healthcare Transmitted Hepatitis, but not HIV?

UNAIDS, WHO, CDC and other institutions continue their insistence that HIV is almost always transmitted through heterosexual sex in African countries (though nowhere else), and that unsafe healthcare, cosmetic and traditional practices play a vanishingly small and declining role in transmission.
It was suggested to me recently by someone who questions the above views that these well funded institutions will eventually have to change their tune. However, he felt that they would not admit that they are wrong, or that they have known since the 1980s about the risks posed by unsafe healthcare and other non-sexual HIV transmission routes.
Unfortunately, the WHO is not very explicit about the problem: there are many health professionals who are unaware about the risks of reusing skin piercing equipment, especially injecting equipment. These health professionals do not warn their patients because they are unaware that they should not reuse syringes, needles, even multi-dose vials that may have become contaminated.
People may be surprised that there are health professionals who are unaware of these risks, or that they take these risks even if they are aware of them. But every year there are cases of infectious, even deadly diseases, being transmitted to patients through careless use of skin piercing equipment. Tens of thousands of people are put at risk, and that's just in wealthy countries.
As for poor countries, especially sub-Saharan African countries, where the highest rates of HIV are to be found, no one knows how many people have been put at risk, how many have been infected with hepatitis, HIV or other blood borne viruses, or how many are still at risk. People are not being made aware of the risks they face, so they can not take steps to avoid them.
The US National Institute of Allergy and Infectious Diseases (NIAID) still carries the rather limp "HIV cannot survive for very long outside of the body", instead of warning people that they should not allow the blood of another person enter their bloodstream. It is irrelevant how long these viruses survive; people need to know that contaminated blood may be entering their bloodstream so that they can take steps to avoid this.
Unsafe healthcare, cosmetic and traditional practices carry huge risks, especially in countries where blood borne viruses such as hepatitis, HIV and others are common. People can avoid infection with these blood borne viruses by avoiding potentially unsafe healthcare, unsafe cosmetic practices, such as tattooing or body piercing, and traditional practices, such as circumcision or scarification.


Wednesday, July 1, 2015

Depo Provera and Circumcision: Violence Against Women Masquerading as Research

Although there are plenty of instances of institutionally sanctioned violence against women, this blog post is about two very prominent instances: mass male circumcision programs [*Greg Boyle, cited below; one of the most up to date publications on the subject, which cites many of the seminal works] and the aggressive promotion of the dangerous injectible contraceptive, Depo Provera (DMPA).
Why are mass male circumcision (MMC) programs instances of violence against women? Well, three trials of MMC were carried out to show that it reduced female to male transmission of HIV. They were show trials, with the entire process monitored to ensure that it gave the results that the researchers wanted. These trials have been cited countless times by popular and academic publications.
Less frequently cited was a single trial of MMC that was intended to show that it reduced male to female transmission of HIV. None of these four trials were independent of each other and the female to male trials produced suspiciously similar results, despite taking place in different countries, with ostensibly different teams. But the single male to female trial showed the opposite to what the researchers wanted: circumcision increased HIV transmission, considerably.
During all four of the trials, male participants were not required to inform their partner if they were found to be HIV positive, or if they became infected during the trial. If there had been any ethical oversight, those refusing to inform their partner would have been excluded from the trial. This is what would have happened in western countries, including the one that funded the research, the US.
Given that many women and men believe that circumcision protects a man from HIV, these MMC programs are giving HIV positive men the means to have possibly unprotected sex with HIV negative women. Many women and men were infected with HIV during the four show trials and almost all of those infections could have been avoided. How participants became infected during the trials has never been investigated, which is not only unethical, but also renders the trials useless.
Despite Depo Provera use substantially increasing the risk of HIV positive women infecting their sexual partners, and the risk of HIV positive men infecting women using the deadly contraceptive, this is the favored contraceptive method for many of the biggest NGOs (many of the biggest NGOs are engaged in population control of some kind). Therefore, its use is far more common in poor countries (especially among sex workers) and among non-white populations in rich countries.
These two instances of violence against women (and men) are funded by the likes of CDC, UNAIDS and the Gates Foundation. Many research papers extolling the virtues of MMC and Depo Provera are paid for by such institutions, copiously cited by them in publications, and constantly wheeled out as examples of successful global health programs. Yet, they are both responsible for countless numbers of avoidable HIV infections.
There is currently a lot of institutional maundering about violence against women and certain instances of it, but some of these same institutions are taking part in the perpetration of it; they are funding it, making money and careers out of it, promoting themselves and their activities on the back of what is entirely unethical. Why do Institutional Review Boards, peer reviewers and academics, donors and others seem happy to ignore these travesties? Who is it that decides that this is all OK, when it clearly is not?
Why are these not considered to be unethical: aggressively promoting the use of a dangerous medication, and an invasive operation that will neither protect men nor women? Is it because those promoting them are making a lot of money out of them, because the victims are mostly poor, non-white people, because the research and programs take place in poor countries, because ethics is nice in principle but too expensive in practice...? Or all of the above and more?
* Boyle, G. J. (2013). Critique of African RCTs into male circumcision and HIV sexual transmission. In G. C. Denniston et al. (Eds.), Genital cutting: Protecting children from medical, cultural, and religious infringements. Dordrecht, The Netherlands: Springer Science+Business Media doi: 10.1007/978-94-007-6407-1_15


Thursday, June 25, 2015

Africans Several Steps Ahead of 'Global' Health?

Many articles about ebola continue to mention a two year old boy who was probably infected with the virus some time in December of 2013. The articles refer to the boy as the 'index case', as if his being infected set off the recent epidemic in West Africa.
In fact, working back from confirmed cases, the trail goes cold before December 2013. There is no data about the virus and the investigation becomes pure speculation at this point. There is no evidence that the boy was infected by a bat, nor is there evidence that bats or other animals in the area carry ebola.
Articles mentioning this two year old boy, bats, 'corpse touching' at funerals and even sexually transmitted ebola (of which no cases have ever been confirmed), are commonplace. It is not just the media that revel in them, but also many scientific and medical articles.
But the people of West Africa seem oblivious to many of the warnings they have been receiving about ebola. And maybe they are right?
In Guinea, cases of malaria and deaths from malaria far exceed numbers of people infected with ebola and deaths fromebola. More importantly, the number of deaths from malaria has increased because people have been avoiding health facilities, fearing they might be infected with ebola.
Worse still, their condition may be mistaken for ebola and they could end up in an ebola treatment unit, with other suspected ebola cases, some of which turn out to have the virus.
To fear health facilities in Africa is perfectly logical. Healthcare conditions in most African countries are appalling. Not just ebola, but HIV, TB, hepatitis and other diseases have been spread by unsafe healthcare practices, such as reused injecting and other skin-piercing instruments.
CDC, UNAIDS, WHO and other health agencies may be convinced by their own propaganda, but people in Guinea, Sierra Leone and Liberia are not. And, it seems, they have entirely valid reasons for ignoring this 'official' advice. Unfortunately, that means many people will suffer from and die from easily treated conditions.
But 'global' health is in crisis because those most likely to suffer from 'global' health conditions are probably least likely to trust health facilities in their country. The interference of various international agencies (or local offices of international agencies) is only likely to increase this mistrust.
Nigeria has problems with 'quack' doctors. Nigerians escaped a serious ebola epidemic, but the second largest HIV positive population in the world resides in Nigeria. Nigeria has also swallowed the dubious claims of UNAIDS and others that HIV is almost always transmitted through heterosexual sex in Africa countries.
The ebola epidemic has shown that people find it hard to trust 'global' health agencies. Warnings about various sexual practices and HIV have also fallen on deaf ears. But perhaps ordinary people are right to ignore 'global' health agencies. Perhaps bush meat and 'corpse touching' are either not as common or not as risky as we have been told. And perhaps the appalling conditions to be found in health facilities are much more risky than we have been told.


Monday, June 15, 2015

South Africa - Never Mind HIV, We've Got Penis Transplants

One ebola case, out of tens of thousands identified over nearly forty years, may have been sexually transmitted; the evidence is slim, but CDC and others really want this one case to be used to stress that people should be made aware of this highly remote possibility (if it is even remotely possible).
Strong evidence that a significant proportion of transmissions of ebola is a result of unsafe healthcare is quietly ignored; CDC and others don't wish to warn people that the healthcare systems expected to deal with such outbreaks are far too weak to keep people alive, and are likely to be part of the problem in the cases of ebola and HIV.
South Africa has transplanted one penis on to a man who lost his through a botched circumcision. The US government is ploughing a few billion dollars into circumcising tens of millions of African adults (and an unknown number of children), so they will not be in a hurry to warn people about the hundreds of botched circumcisions reported every year (nor the uncounted thousands that remain unreported).
The English Guardian has a lengthy article about this single penis transplant, and has had a few, equally salacious articles, about botched circumcisions that occur in traditional, non-sterile settings. That same smug, self-satisfied newspaper has had next to nothing to say about appalling conditions in healthcare facilities in places where HIV prevalence is very high, or about the possible role of unsafe healthcare in transmitting HIV, hepatitis C and B, ebola, TB and various other diseases.
The craze for circumcising African men is based on the view that HIV is almost always 'spread' by men, through 'unsafe' sex, which almost every 'African' engages in, almost all the time (a view based entirely on prejudice). The press is completely unmoved by the fact that circumcision of men may increase HIV transmission from males to females, considerably.
The media goes crazy about the 'possibly sexually transmitted' ebola case, even exaggerating it into a dead certainty that it was sexually transmitted; and they are happy to promote the view that Africans engage in types and levels of sexual behavior that should be curbed by various (failed) measures, paid for by donor money. But this is just a continuation of what various colonizers began.
The racism behind the view that HIV is almost always transmitted through heterosexual contact in (some) African countries, but no non-African countries, has always remained unremarked by the press. The prejudice behind singling out uncircumcised African men and HIV positive women for intense vilification is rarely mentioned.
The fact that about 7% of HIV positive women in South Africa, the country with the largest HIV positive population in the world, report being sterilized forcibly, receives occasional mention. But readers seem to prefer articles about penis transplants and one possibly sexually transmitted case of ebola, it appears.
The health services are unable to cope with any illnesses and throwing money at HIV will not result in reasonable numbers of well trained and equipped staff, adequate supplies and, most of all, levels of cleanliness and hygiene that eliminate the possibility that many patients will end up being infected with something in hospital that is far worse than what they were admitted with.
There is nothing new about this denialism, but it needs to be recharacterized; health services are not just inadequate, they are dangerous. are certainly not alone in bemoaning the fact that many women in South Africa are infected with HIV relatively late in their pregnancy, sometimes after giving birth, even many months after.
Nor are Aidsmap alone in failing to consider the possibility that some of those women, perhaps most of those women, were infected with HIV through unsafe healthcare, reused syringes, needles, various types of equipment and various processes that require a far better level of hygiene than will be found in extremely high prevalence provinces, such as KwaZulu Natal and Mpumalanga.
The pharmaceutical industry does very well out of HIV and several other diseases that have hit the headlines in the mainstream press, and are deemed worthy of enormous funding. Many NGOs have been built by HIV money and will only thrive and prosper as long as a few diseases are considered worthy of massive funding.
The press loves a story about a penis transplant in a country too poor to prevent thousands of unnecessary deaths every year, of women giving birth, babies, children and adults with easily treated and prevented diseases. Appalling conditions in health services in most African countries does not merit the attention of the press, they are far too commonplace. If a story from 'Africa' has even the remotest connection with sex, publish it; if not, forget it.


Thursday, June 11, 2015

Cambodia Healthcare Transmitted HIV Inquiry Watered Down

Some of the recent articles about the massive outbreak of HIV caused by reuse of syringes, needles and other skin piercing instruments in health facilities in Roka Commune, Battambang Province, Cambodia, make it sound as if being unregistered is the main problem; unregistered practitioners, unregistered clinics, etc.

But as this article about unsafe injections in US health facilities makes clear, it is the behavior of well qualified people in legitimate facilities that can threaten the health and lives of patients, especially in poor areas. Being registered may result in practices and practitioners being scrutinized from time to time, if there are mechanisms and personnel for such scrutiny.

But in Cambodia there are numerous unlicenced practitioners and facilities because there is a chronic and long term shortage of trained and qualified personnel. There are also shortages of equipment and supplies. The cost of healthcare is simply too high for most people, so they resort to unlicenced practitioners and practices.

But that does not mean things are completely safe in legitimate facilities, where some or most of the employees may be relatively well trained and qualified. Nor does it mean that there are adequate measures taken to inspect premises or practitioners, nor consequences for unsafe behaviors.

The current 'investigation', which seems to be progressing at a snail's pace, is being carried out in conjunction with UNAIDS and the World Health Organization. But these organizations specialize in disinformation about health facility transmitted HIV. The current approach in Cambodia is to point the finger at one unlicenced practitioner, and his practice, rather than health services in their entirety.

Now it seems the investigation into how almost 300 people became infected with HIV is being further watered down by concentrating on the issue of licences, which suggests that it is not scrutinizing the potentially unsafe behaviors of those working in healthcare. It even appears that some of the clinics being closed down are run by Chinese nationals or ethnic Chinese Cambodian nationals, using unsafe healthcare to deflect attention from anti-Chinese prejudice (something UNAIDS is unlikely to question).

The Cambodian government, UNAIDS, the WHO and others are missing the most important point about the 300 people so far identified as being infected with HIV through unsafe healthcare: it is not unlicenced practitioners or facilities that spread diseases, it is unsafe behaviors, such as reuse of syringes, needles and other equipment; people have a right to SAFE healthcare, not just any old healthcare.


Saturday, April 25, 2015

Ebola and ‘African’ Sexuality: Life in the Old Fantasy Yet?

Not one single case of sexually transmitted ebola has ever been demonstrated, in nearly 40 years. The presence of the virus in some form in semen has been demonstrated. But the possibility that the virus can be transmitted via that semen has not. And the author is even, to some extent, aware of this.
So why do the media rant on about sexually transmitted ebola? Could it be a continuation of some of the racist views of Africans that date back many decades, perhaps centuries? Several decades (at least) before HIV was identified, it was assumed that prevalence of certain sexually transmitted infections in African countries, such as syphilis and gonnorhea, was a result of 'promiscuity'.
More enlightened researchers published papers, also decades ago, arguing that there was absolutely no evidence that levels of 'promiscuity' were higher in African countries than elsewhere. Some of them also argued that the conditions of health services, along with the living and working conditions to which people in colonial Africa were subjected, were far more significant factors than sexual behavior.
Some of them were reacting to the efforts of the various different eugenics movements to provide 'scientific' evidence for their extraordinary views. However, once HIV was identified and found to be more common in some African countries than anywhere else, the myth of 'African' promiscuity returned. And it remains, explicitly or implicity, in HIV policy, journalism, and in much of the academic writing.
The characterization of African people as promiscuous goes hand in hand with the characterization of African men as sexually incontinent, animalistic, uncaring about those around them, particularly their own family members, and completely unamenable to change.
African women are seen as being entirely incapable of resisting the will of the men around them. They are mere victims, misused and discarded, to be 'rescued' by decent westerners, if they are lucky. They are then subjected to the pity of their rescuers, the journalists who write about them, and others who think this sort of thing 'just shouldn't happen'.
The author claims to have met with members of a women's 'secret society'. We are informed that such societies are "ancient cultural institutions found all over Sierra Leone". We can't gainsay that if we've never been to Sierra Leone, after all, they are secret, although we might ask how secret they are if the author could meet with them.
But, far more important than the claim that ebola is transmitted sexually (and it might be, occasionally), is the tone of the article, about how much women suffer, with the strong implication that this is the fault of Sierra Leonean men. But poverty, bad health, low levels of education, poor living conditions and terrible labor conditions are a fact of life for most people in Sierra Leone, male and female.
Education may be, as the headline says, crucial. But whose education is crucial? Whose knowledge? Whose data? Whose research? This academic seems to have recorded the result of decades of racist informed education, and now presents it to us as the unassailable views of Sierra Leonean women, at least, the ones who belong to these common 'secret' societies.
However, there are promiscuous people everywhere, but most people are not promiscuous. There are violent and abusive people everywhere, and the perpetrators may well be more likely to be male than female. But most people are not violent or abusive. Most men are not. And most women are not mere victims of everything that goes on around them.
This is not to say that there are not huge imbalances and great injustices, with many women suffering, often at the hands of men. But whatever strategy may bring relief to the suffering of women and men, it will not be one based on a puerile and reductive belief in the incredible baseness of African men, coupled with the complete inability of African women to defend themselves in any way.
Ebola, HIV, hepatitis, TB and many other diseases can be transmitted in various ways. One of the modes of transmission for all of them is unsafe healthcare, believe it or not. In the case of HIV, such transmission has been strenuously but entirely unconvincingly denied. Sex is one of several modes of transmission for HIV, but it is unlikely to be a significant mode of transmission of ebola.
But transmission of ebola through unsafe healthcare practices appears to be slipping through the net, as academics indulge in their fantasies about an assumed 'African' sexuality, along with a great love for seeking (female) 'victims' that they can rescue, study, and hopefully write scholarly(ish) papers about. These academics are not just deceiving themselves, they are deceiving those they claim to be concerned about.


Friday, April 24, 2015

Medical Costs: Protectionism Harms Children

This is reposted from the Watoto Kicheko blog.

One of the big expenses that parents (and orphanages!) face in developing countries like Tanzania is the cost of medicines and treatment. Even healthy children need vaccinations and have lots of other health needs that can only be met using pharmaceutical products. Medical costs run high.

You might think that developing countries would pay less for lifesaving medicines and vaccinations, but you would be wrong. Medical costs are often disproportionately high in poorer countries. Pharmaceutical companies negotiate prices in secret, and countries often have to sign a confidentiality agreement in the process.

Medical costs disproportionately high in developing countries

Apparently "Tunisia pays more than France; South Africa pays almost three times more than Brazil." But it's hard to compare what countries like Tanzania pay for medical costs because of the secrecy surrounding this industry, all cloaked by vague claims about 'commercial sensitivity'.

Medical costs - one of our sick girlsThere's a vaccine for pneumonia, but it is too expensive for most people in developing countries, and even for NGOs operating in the majority world. Pfizer and GSK, who spend massive amounts on publicity, have failed to negotiate openly and fairly.

Medical costs addressed by MSF campaign

Medicins Sans Frontieres (Doctors Without Borders) are currently running a campaign called #AskPharma to draw attention to these inequitable practices. An estimated one million young children die of pneumonia every year and Medicins Sans Frontieres want to start by getting the price down to $5 per child for the three shots they need.

This is still a large amount of money and could easily buy the food for ten meals in Tanzania. Conditions such as TB and HIV infect and kill far fewer children acute respiratory infections in this country, yet the medical costs for these are often covered, or partially covered, by international intitives (albeit still at an excessive price).

Top deadly diseases of children and infants

The top killer of children in developing countries is acute respiratory infections. Other big killers are malaria and diarrheal conditions, both of which are preventable. It should be cheap to prevent them, but diarrhea kills another 1.5 million children, globally.

The World Health Organization (WHO) reminds us that "About 44% of deaths in children younger than 5 years in 2012 occurred within 28 days of birth – the neonatal period. The most important cause of death was prematurity, which was responsible for 35% of all deaths during this period."

Many Watoto Kicheko children were born prematurely, and are far more susceptible to pneumonia and other Medical costs - drippreventable disease as a result. This issue is very close to our hearts.

Pneumonia is a horrible sickness, I have had it myself. But I was lucky to be in the UK, where medical costs and treatment are covered by national insurance. Few people die of pneumonia in the UK, or other wealthy countries.

Watoto Kicheko children face high risk from pneumonia

But it is especially common among children who are weakened by malnutrition, other childhood illnesses, lack of breastfeeding, etc. Therefore, it is something that we at Watoto Kicheko are always watching out for.

Please help raise awareness by supporting the Medicins Sans Frontieres campaign. Doing so will also help the children at Watoto Kicheko, by helping to reduce medical costs.


US Funded Circumcision ‘Research’ & ‘Interventions': Human Rights Abuses?

The Kenyan Daily Nation newspaper reports that at least 30 boys have been forcibly circumcised, some of them as young as six years old, in Eldoret. It is said that an 'NGO' called Impact Research Development Organization was behind these forcible circumcisions.

Impact Research Development Organization (IRDO) is quite secretive, with several websites and Facebook pages that give very little detail about who they are, how they are funded, and to whom they are accountable. One of the latest incarnations,, is still under construction. The owner of the domain is given as 'Safaricom', effectively an anonymous identity.

But one of the Facebook pages may answer some of those questions: in a photograph of about thirty black people, twentynine of whom are male, there is the unmistakable white face of 'Dr', 'Professor' (of epidemiology) Robert C Bailey, of the School of Public Health, University of Illinois at Chicago.

Aggressively pushing mass male circumcision as an antidote to HIV and a host of other possible ailments for more than twenty years, Bailey's name has appeared on many of the published papers promoting the operation, with even the wildest of claims remaining unchallenged by most other academics.

His 'NGOs' may have undergone several name changes for good reason. He is one of the biggest recipients in Kenya (where about 85% of men are already circumcised) of the hundreds of millions of dollars said to be available for mass male circumcision programs. But the fate of some of those millions of public dollars is not always transparent.

Another of his 'NGOs' is called the Nyanza Reproductive Health Society (NHRS). The NHRS is similarly secretive and merely recycles the same sort of publicity blurb as IRDO. Kenya's Standard newspaper covered the allegations of misuse of funds by NHRS a few years ago.

The Nation author seems impressed with the fact that the children were said to have been 'lured with sweets', which is probably the mass male circumcision campaigners' pediatric version of luring people with bullshit about how circumcision, not only 'protects' you from HIV and other STIs, but also ensures greater attractiveness to women, better orgasms and 'hygiene' (as if intact men are unable to clean their penises and circumcised men don't need to!).

Although circumcision is contrary to the cultural practices of the communities that the victims come from, incidents like this don't appear to have resulted in any greater recognition of how serious a crime this is. In contrast, there is a lot of international money and attention for preventing female genital mutilation, especially where this is in keeping with the cultural practices of the communities where it is practiced.

Is it because those involved are male that this is not really seen as mutilation? It is clearly a denial of the right to bodily integrity. Carrying out an operation that involves removal of healthy flesh without consent is always wrong; it is always mutilation, regardless of the gender of the victim.

Perhaps because the money comes from the US, where male circumcision is very common, it is felt that Kenyan people should just put up and shut up (as they seem to have done so far). This is an issue for Kenyan people of all ethnicities to address themselves, whether they practice circumcision or not.

Kenyan children have a right to be protected from such abuses, as do Kenyan adults, male and female. It's time to question large amounts of money being made available to carry out dubious 'research' projects, with Kenyans being used as cheap research fodder.


Tuesday, April 14, 2015

How Ordinary Tanzanian Men Can Help Reduce the Number of Orphans

 [Reposted from the Watoto Kicheko site and blog]

One of the most effective ways of keeping newborns, infants and under fives alive is by making sure that their mother does not die. That means supporting women who are planning to have children, who are pregnant, or who already have young children.

I would suggest that one of the best potential sources of support for mothers-to-be and mothers, is fathers. A lot of NGOs make a big deal of working exclusively with children, infants or mothers. But ignoring fathers, or even worse, branding them as in some way wayward, is not helpful.

Including fathers more in pregnancy and birth has not yet developed very much here in Tanzania. Some women will tell you they don't want their husband there, and some men will tell you that they don't want to be there, during the delivery.

But one of the biggest sources of opposition to fathers being present when their wives are giving birth in Tanzania, and even when they go for antenatal care, may be health facilities themselves. Health personnel in East Africa currently have a disproportionate influence on the treatment patients receive, with the wishes of the patients often being sidelined.

I have been present for the birth of my two sons here in Tanzania, the first time in Dar es Salaam and the second in Moshi. I have yet to meet a nurse who thinks it is a good idea for fathers to be present when their wife is giving birth. It is possible to persuade doctors, but many people can't afford a consultation with a doctor, and rely on the professionalism of nurses and other staff.

Perhaps Tanzanian fathers don't realize that their mere presence could strongly influence the sort of treatment their wife receives? Nurses would feel under more pressure to treat pregnant women with respect, which they do not always do when there is no one to stand up for them. Or fathers could be there just to ensure that their wives get the minimum level of attention they need, when they need it.

Tanzanians are well aware that health facilities are in bad condition, and that will not change in a hurry. They are also aware that health personnel are often far too stretched to prioritize simple courtesy. Indeed, many patients and those accompanying patients will admit that they fear being shouted at by nurses and health personnel in front of other patients, and are often too intimidated to say anything at all.

If fathers attend at least one antenatal care visit and express their wish to be present when their wife is giving birth, they can start to exert a lot more influence over the care their wives receive. Better care is safer care, and safety is paramount; safety is one of the main reasons for giving birth in a health facility, with a health professional present, it is one of the main reasons why maternal, newborn, infant and under five deaths have declined in the past few decades.

But they haven't declined nearly enough yet. Recent figures show that 26 newborns die out of every 1000 live births; 51 infants die out of every 1000 live births; and 81 under fives die out of every 1000 live births. Infants and under fives, who should be facing fewer serious health risks as they get older, are more likely to die, as if they cease to matter so much once they are no longer newborns.

Maternal mortality stands at 454/100,000 live births, and that rises to much higher levels in certain hospitals. This includes the Muhimbili Maternity Hospital, the biggest and most prominent in the country, where mortality is about three times higher than average.

It's hardly surprising that only about half of all births in Tanzania take place in health facilities!

Just being with your wife when she is giving birth can improve the care she receives. Just being in the delivery room with her can remind those attending to her that there is a reason for the father to be there; he is concerned about his wife's safety as she gives birth.

If women survive birth and leave the hospital as healthy as they were when they arrived, they will be able to give their newborn and their other children the attention they need. Newborns, infants and under fives will be healthier, and more likely to survive, go to school, grow up and have healthy children themselves.

Antagonistic attitudes towards men are detrimental to the lives of all those we profess to care about. The attitudes of NGOs and of health professionals, as well as the attitudes of men and women, need to change.