When people find used hypodermic needles in areas where children play in Western countries, they are upset. Quite rightly so. They don't like the thought that their children are being exposed to injury and diseases, possibly even serious or deadly diseases.
But even many Westerners seem to believe that HIV 'dies' within seconds, minutes or some fairly short period, outside of the body. This is not what the US Center for Disease Control (CDC) says on the subject, although it may have said that at one time. Their current answer to the question 'How well does HIV survive outside the body?' is difficult to interpret.
But no matter how you interpret the risk, no one wants a possibly contaminated needle piercing their skin or that of their children. As well as the physical injury, there is also a risk that the needle is contaminated with hepatitis and it is almost certainly contaminated with bacteria.
So the CDC's comment about 'incorrect interpretations' of risk causing 'unnecessary alarm' seems injudicious. I know the question is about HIV but the answer really needs to address risk as a whole. Potentially, HIV can survive for days and even weeks, under the right conditions. Contact with contaminated needles and other instruments should be avoided and where this is not possible, medical advice is required.
However, the idea that the HIV does not live outside the body is widely held, by professionals and lay people. And in countries like Kenya, Tanzania and Uganda, it is far more dangerous to be unaware of the risks. The chances of medical or cosmetic equipment being contaminated in countries with high prevalence of HIV, hepatitis and other diseases can be very high.
You might think that there would be a lot of awareness of these risks and how to avoid them but I have rarely spoken to anyone who has considered the risks they face from contaminated instruments in health or cosmetic facilities.
UNAIDS dismisses the importance of any form of non-sexual HIV transmission, let alone transmission in health facilities. They grudgingly accept that a few percentage points of HIV transmission in East African countries may come from such routes. But they hardly mention cosmetic instruments, razors, tattooing equipment and the like, at all.
As a result, such transmission may be occurring at high rates and people are doing nothing about it. When they take their child to the hairdresser, or go themselves, they could be picking up scabies, hepatitis, HIV or some kind of bacterial infection. To help people avoid these risks, the best thing to do would be to inform them.
Risks in health facilities are more difficult to handle. Doctors, nurses and other health personnel can be pressed for time and it is not easy for patients, or those accompanying patients, to intervene. At best, personnel will be annoyed, at worst, they will refuse to treat the patient, give them poorer quality treatment or make them wait a long time.
The WHO has published data showing that as much as 14% of injections in developing countries are contaminated with HIV and they have unpublished data showing that this figure can be a lot higher. A large proportion of hepatitis B and C is transmitted through contaminted needles. And an estimated 70% of all injections are not even necessary.
When there is even the hint that someone in a Western country may have come into contact with contaminated equipment, there is an investigation to establish how procedures could have resulted in such a risk. And anyone who may have been affected, even going back years, and through thousands of records, is contacted and screened.
Not only does this sort of investigation and screening of possible use of contaminated equipment not take place in developing countries but UNAIDS and others seem keen to deny that such things, which happen in the best resourced health systems in the world, could possibly happen in the worst resourced health systems in the world.
Showing posts with label hepatitis C. Show all posts
Showing posts with label hepatitis C. Show all posts
Wednesday, January 19, 2011
Saturday, August 21, 2010
Prejudice Wins Over the HIV Industry
It has been well established that HIV is transmitted through sexual contact, through contaminated blood and other bodily fluids and from mother to child. However, UNAIDS and the HIV industry have a rather anomalous view of the disease. They have decided (or decreed?) that HIV is primarily spread through heterosexual sex in African countries (and from mother to child). But in other countries, so the story goes, HIV is primarily spread through contaminated blood, by intravenous drug users and unsafe medical practices, through men having sex with men and among commercial sex workers and perhaps their clients.
If HIV is mainly spread through blood-borne transmission, one would expect it to follow a similar pattern to other blood-borne diseases, such as hepatitis C virus (HCV). Two researchers have found that to be the case in a number of Asian countries. Countries with low HIV prevalence also have low HCV prevalence and countries with high HIV prevalence have high HCV prevalence. This means that countries with low HIV prevalence might see rates increasing at some stage in the future.
If HIV is mainly spread through heterosexual sex, as it is said to be in African countries, one would expect it to follow a similar pattern to other sexually transmitted infections. But this is not the case. Sexually transmitted infections are very high in many countries where HIV prevalence is not very high. Also, sexual behaviour that is said to increase the risk of HIV transmission tends to be a lot more common in countries that have relatively low HIV prevalence.
Differences between male and female sexual behaviour are also telling, where such differences have been detected by empirical enquiry, as opposed to speculation and assumption. Whereas males are more likely to engage in unsafe sexual practices, females are more likely to be infected with HIV. Men also tend to have more partners than women. But there is nothing to suggest that what is mainly a blood-borne disease in some countries should be mainly sexually transmitted, and rarely blood-borne, in others.
So, UNAIDS and the HIV industry are wrong in (at least) two important respects: firstly, it is unlikely that HIV is transmitted primarily through unsafe heterosexual sex in African countries because there is no evidence that levels of unsafe heterosexual sex there are high enough; and secondly, it is unlikely that HIV is rarely transmitted through unsafe medical procedures and other possible blood-borne routes. Conditions in African medical facilities are poor, just as they are in many Asian medical facilities.
In fact, in African countries where many people have (or at one time had) access to medical facilities, HIV rates are the highest in the world: South Africa, Zimbabwe, Swaziland, Lesotho, Botswana and others. In countries where many people have little or no access to medical facilities, HIV rates are far lower. For example, Kenya, Uganda and Tanzania, especially the rural parts of these countries. And in almost all areas with high HIV prevalence, more women than men are infected, often far more women.
So UNAIDS and the HIV industry have spent years tying themselves in knots trying to explain why a disease that is both sexually transmitted and blood-borne is mainly sexually transmitted in some countries and mainly blood-borne in others. This is especially difficult when neither levels of sexual behaviour nor conditions in medical facilities bear out such a conclusion. But if you supplant evidence with prejudice in developing a health strategy, you are bound to end up with such anomalies.
This sort of institutional racism results in the rather obtuse view that Africans engage in inordinately high levels of sexual activity, despite evidence to the contrary. HIV prevalence has reached hyperendemic levels in many Southern African countries, so the HIV industry insists on sexual behaviour change. Why these racists have also concluded that virtually no HIV transmission occurs as a result of unsafe medical practices is a complete mystery. But as a result, the industry feels that no effort need be made to improve conditions in medical facilities.
HIV, which is difficult to spread sexually, quickly spread to every country in the world throughout the 80s and 90s. In most countries, prevalence has remained below 1%. But in some countries, over 25% of sexually active adults are infected. No adequate explanation has been given as to how this could happen if HIV is mainly sexually transmitted. On the other hand, there have been several outbreaks of medically transmitted HIV (that have been properly investigated. In addition to Romania, there were also outbreaks in Libya, Kazakhstan and Russia that were caused by unsafe healthcare). The combination of sexual and blood-borne infection could help explain how these hyperendemics occurred.
This is not a conclusion. All we can conclude is that non-sexually transmitted HIV plays some part in countries with high HIV prevalence. The part that non-sexual transmission plays may have been more significant in the past, certainly in countries that have had the capacity to improve medical and other facilities. But rates of HIV transmission in some hyperendemic countries are still too high to be explained by sexual transmission alone. This means that a lot of work needs to be done to ensure that medical facilities and other places where blood-borne risks exist are made safe.
But first, UNAIDS and the rest of the HIV industry need to agree to investigate the extent of non-sexual HIV transmission. They need to agree to prevention programs that target non-sexual transmission, in all its forms. Unless people are aware of the risks they face, they will not know that they need to avoid these risks, let alone know how to avoid them. Surely levels of institutional racism and sexism that allow millions of people to become infected with HIV and to die of Aids are serious enough to deserve the world’s attention?
If HIV is mainly spread through blood-borne transmission, one would expect it to follow a similar pattern to other blood-borne diseases, such as hepatitis C virus (HCV). Two researchers have found that to be the case in a number of Asian countries. Countries with low HIV prevalence also have low HCV prevalence and countries with high HIV prevalence have high HCV prevalence. This means that countries with low HIV prevalence might see rates increasing at some stage in the future.
If HIV is mainly spread through heterosexual sex, as it is said to be in African countries, one would expect it to follow a similar pattern to other sexually transmitted infections. But this is not the case. Sexually transmitted infections are very high in many countries where HIV prevalence is not very high. Also, sexual behaviour that is said to increase the risk of HIV transmission tends to be a lot more common in countries that have relatively low HIV prevalence.
Differences between male and female sexual behaviour are also telling, where such differences have been detected by empirical enquiry, as opposed to speculation and assumption. Whereas males are more likely to engage in unsafe sexual practices, females are more likely to be infected with HIV. Men also tend to have more partners than women. But there is nothing to suggest that what is mainly a blood-borne disease in some countries should be mainly sexually transmitted, and rarely blood-borne, in others.
So, UNAIDS and the HIV industry are wrong in (at least) two important respects: firstly, it is unlikely that HIV is transmitted primarily through unsafe heterosexual sex in African countries because there is no evidence that levels of unsafe heterosexual sex there are high enough; and secondly, it is unlikely that HIV is rarely transmitted through unsafe medical procedures and other possible blood-borne routes. Conditions in African medical facilities are poor, just as they are in many Asian medical facilities.
In fact, in African countries where many people have (or at one time had) access to medical facilities, HIV rates are the highest in the world: South Africa, Zimbabwe, Swaziland, Lesotho, Botswana and others. In countries where many people have little or no access to medical facilities, HIV rates are far lower. For example, Kenya, Uganda and Tanzania, especially the rural parts of these countries. And in almost all areas with high HIV prevalence, more women than men are infected, often far more women.
So UNAIDS and the HIV industry have spent years tying themselves in knots trying to explain why a disease that is both sexually transmitted and blood-borne is mainly sexually transmitted in some countries and mainly blood-borne in others. This is especially difficult when neither levels of sexual behaviour nor conditions in medical facilities bear out such a conclusion. But if you supplant evidence with prejudice in developing a health strategy, you are bound to end up with such anomalies.
This sort of institutional racism results in the rather obtuse view that Africans engage in inordinately high levels of sexual activity, despite evidence to the contrary. HIV prevalence has reached hyperendemic levels in many Southern African countries, so the HIV industry insists on sexual behaviour change. Why these racists have also concluded that virtually no HIV transmission occurs as a result of unsafe medical practices is a complete mystery. But as a result, the industry feels that no effort need be made to improve conditions in medical facilities.
HIV, which is difficult to spread sexually, quickly spread to every country in the world throughout the 80s and 90s. In most countries, prevalence has remained below 1%. But in some countries, over 25% of sexually active adults are infected. No adequate explanation has been given as to how this could happen if HIV is mainly sexually transmitted. On the other hand, there have been several outbreaks of medically transmitted HIV (that have been properly investigated. In addition to Romania, there were also outbreaks in Libya, Kazakhstan and Russia that were caused by unsafe healthcare). The combination of sexual and blood-borne infection could help explain how these hyperendemics occurred.
This is not a conclusion. All we can conclude is that non-sexually transmitted HIV plays some part in countries with high HIV prevalence. The part that non-sexual transmission plays may have been more significant in the past, certainly in countries that have had the capacity to improve medical and other facilities. But rates of HIV transmission in some hyperendemic countries are still too high to be explained by sexual transmission alone. This means that a lot of work needs to be done to ensure that medical facilities and other places where blood-borne risks exist are made safe.
But first, UNAIDS and the rest of the HIV industry need to agree to investigate the extent of non-sexual HIV transmission. They need to agree to prevention programs that target non-sexual transmission, in all its forms. Unless people are aware of the risks they face, they will not know that they need to avoid these risks, let alone know how to avoid them. Surely levels of institutional racism and sexism that allow millions of people to become infected with HIV and to die of Aids are serious enough to deserve the world’s attention?
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