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.