Gender Sensitivity: Investigating Non-Sexual HIV Risks

Yet another article about the fact that far more women than men are infected with HIV in Kenya (as is the case in all African countries); this time, women account for 65% of all new infections. According to another document, "women aged 15-24 are four times more likely to be infected than men". Cue a collective wailing about 'gender mainstreaming' and other nebulous buzzwords.

But even taking the first figure, twice as many women are infected as men. So who is infecting them? Given probabilities such as one in 500 for transmission from men to women and one in 1000 from women to men, this would take an awful lot of 'unsafe' sex. And it would need to be spread over many years, whereas many females are being infected in their teens and twenties, when most of them would not have been sexually active for long.

Assuming that this is almost all a result of heterosexual sex, as the HIV industry does, would also suggest that women are far more sexually active than men, which is not the case according to research into sexual behavior. Not only do most men not frequently engage in 'unsafe' sex, but women do so even less frequently.

And for someone to be infected, whatever the probability of transmission, they must infected by someone who is HIV positive. But if most men are not HIV positive, we go back to the first question; who is doing all the infecting? In one part of Kenya, fewer than two men are infected for every 10 women.

Popular as it is to indulge in speculation about 'African' sexuality, how often 'they' have sex, what kinds of sex they have, how badly the women are treated and how bad the men are, much of what is written about such things is based on prejudice, not on the findings of valid research.

The fact is, no one has yet demonstrated how a virus that is difficult to transmit sexually has come to infect up to a quarter of the population in a few countries and half of all females in another few countries. Even less has anyone shown how a relatively small number of men managed to infect a large number of women, including women who have only had one, HIV negative partner.

So the Kenyan and other governments can write as many official documents as they like bemoaning HIV transmission figures, and calling as many of these documents as they like 'new', but none of them are new. Everything is done the same way as it has been done for years, despite this having no noticeable effect on the epidemic.

HIV is not just about sex. Authors of these documents may accept that but there is little substance behind their acceptance. HIV needs to be prevented, yet only an estimated 20% of HIV money goes to prevention, while nearly 60% goes into treatment and care. Much of that prevention funding goes to rather vague activities that relate to individual sexual behavior, activities that have been shown to be virtually useless.

Less than 3% of all funding goes towards ensuring that people have access to safe injections and other healthcare procedures. This is where all African strategic plans come apart (they are all very similar); they simply ignore non-sexually transmitted HIV. UNAIDS may deny it vehemently, but non-sexual HIV transmission contributes a lot more than the 2-2.5% that they claim for Kenya's epidemic. Even the WHO publicly accepts this.

Doing things differently means reducing the emphasis on sex when there is plenty of evidence for non-sexually transmitted HIV, among women whose only partner is HIV negative, infants whose mothers are HIV negative, virgins and people who have only had 'safe' sex. Recognizing the importance of gender means investigating the non-sexual risks that women face.

The most important type of gender sensitivity right now is to investigate the risks that women face and that men face less often, if at all. This should also reveal the risks that African women and men face, ones that non-Africans face less often. Sex may play a part in serious HIV epidemics, but not as big a part as in the collective fantasy that is the current HIV orthodoxy.

Mugabe Needs to be More Careful in his Choice of HIV Advisers

Zimbabwe's President Mugabe has been poorly advised when it comes to understanding HIV transmission: he claims that some of his own officials are contributing to the spread of HIV through promiscuity. Is he not aware that HIV is a difficult virus to transmit through heterosexual sex? It is far easier to transmit through unsafe healthcare practices or cosmetic services.

Instead of addressing important issues, ones that are ignored by the HIV industry, Mugabe is wasting time with admittedly well-funded initiatives that will have little effect, such as promoting 'abstinence', teaching about female condoms in beauty salons and rolling out male circumcision programs. He would be better off to concentrate on safety in beauty salons and in health facilities where circumcisions and other procedures are carried out.

While the world's media, politicians, academics and others obsess about African sexual behavior and the obscene levels it would have to reach (and therefore must have reached) to explain massive HIV epidemics such as that found in Zimbabwe and other countries, HIV transmission that doesn't relate to sexual behavior is allowed to continue, unabated and uninvestigated.

Others claim that sexual behavior is all about money and that you just need to give handouts so that the women don't involve themselves in transactional sex. Would the World Bank and others be able to get away with their insinuations and bald statements if they were talking about people other than Africans?

But there is no evidence that HIV epidemics in Africa are 'driven' by sex, of any kind. HIV may be transmitted sexually, but it has been demonstrated quite clearly that levels of sexual behavior, safe or unsafe, are of little relevance to HIV rates. Countries with high levels of types of sexual behavior considered unsafe can have low HIV prevalence. Whereas, countries with high HIV prevalence can have low levels of these same types of behavior.

If Mugabe is worried about promiscuity, male domination and lack of gender equality, unplanned pregnancies, sexual violence and abuse, or any other issues, he should get on with addressing them. But those issues were around long before HIV was identified; they won't just disappear along with HIV, if HIV ever disappears. Yes, "the role of men is unquestionable", but his Excellency needs to bear in mind that far more women than men are infected with HIV.

And while he is on the subject of prevention of mother to child transmission of HIV (PMTCT), Mr Mugabe should bear in mind that the best way to protect children is to protect their mothers, preferably before they become pregnant. If a mother's life is compromised, so is her child's. The president should investigate conditions in Zimbabwean hospitals and health facilities so that the safety of mothers, children and everyone else can be guaranteed.

Surveys of conditions in health facilities in African countries with serious HIV epidemics show that, right now, people's health can not be guaranteed. Blood is not always adequately screened before being transfused, non-reusable equipment may be reused, often because it's in short supply, precautions to avoid infection with various diseases are not always taken, dangers are not even recognized, at times. There are too few trained, motivated and properly paid health professionals.

Mr Mugabe appears to be badly briefed about the HIV epidemic in Zimbabwe, and in Africa in general. But then, the entire HIV industry has studiously avoided researching non-sexual HIV, investigating possible outbreaks of HIV in health and other facilities and in replacing their highly prejudiced and inaccurate view of sexual transmission of HIV with something that matches the evidence.

HIV: If All your Questions are About Sex, All your Answers will be About Sex

A paper published in the Journal of Adolescent Health in February alludes to the need to rethink sexual risk for HIV among young people in South Africa and the US in its title. But the significance of the results of the study seems to be completely lost to the researchers involved.

The research finds that "Young people in the US report riskier sexual behaviors than young people in SA, despite the much higher prevalence of HIV infection in SA." From this they conclude that "Factors above and beyond sexual behavior likely play a key role in the ongoing transmission of HIV in South African youth, and thus should be urgently uncovered to develop maximally effective prevention strategies."

That's great to know, but the research doesn't shed much light on what other factors could give rise to HIV prevalence hundreds of times higher than that found in most Western countries. They vaguely suggest that "Unique biological forces must be playing a role as well." The research doesn't probe such forces, presumably that's way outside its scope. But nor does it make any attempt to go beyond sexual risks.

In fact, the authors nail their colors to the mast in the first paragraph: "Considering that most of the infections in sub-Saharan Africa are the result of heterosexual transmission, popular opinion has continued to foster the belief that the HIV epidemic in Africa is fueled by promiscuous sexual behavior, or unique sexual mixing patterns. I would suggest that the researchers question the antecedent of that sentence. Where is the evidence that most infections anywhere are the result of heterosexual transmission?

However, much of this 'popular opinion' emanates from some very prominent HIV academics. And it's hardly surprising that the populace associates high HIV prevalence, particularly in African countries, with promiscuity and 'unique sexual mixing patterns'. The entire HIV industry, led by UNAIDS, is built on the assumption that almost all HIV transmission in African countries (though not elsewhere) is a result of heterosexual sex.

In other words, sexual behavior that is not particularly risky is still very likely to result in HIV transmission, but only in African countries. If people are at high risk of infection as a result of low risk behavior, that is tantamount to saying we don't really understand why some people are being infected in huge numbers, all of them Africans, while other people are infected in very small numbers. The researchers don't appear to have a clue.

They say "This high prevalence of infection in the general South African population means that young people do not have to engage in high-risk behaviors (i.e., multiple partners, lots of unprotected sex) to be at risk for HIV infection. Certainly sexual behavior is an essential element of HIV risk; nevertheless, high-risk behavior may not be a prerequisite for HIV transmission."

Yes, people are at higher risk of being infected in a country where prevalence is out of control. But what gave rise to such high prevalence of HIV when the virus is difficult to transmit sexually? If the researchers want to explain current transmission patterns, they need to have some basic grasp of the patterns that gave rise to the epidemic in the first place. They appear to lack this basic grasp.

The authors graciously list some limitations, but one they don't list is the fact that non-sexual risks were not examined: for all the people who were infected with HIV and all those who could have been exposed to the virus without being infected, the researchers don't know anything about their non-sexual risks. They don't appear to have considered non-sexual risks worth the effort.

They didn't even ask about anal sex, same sex partners or intravenous drug use. In the US, anal sex is the number one risk factor, with intravenous drug use being number two. When it comes to extremely high rates of HIV transmission, there needs to be an investigation of all risks, especially the most serious. This piece of research appears to have examined some of the least serious risks and decided that they must be serious despite all appearances, particularly in South Africa.

We don't just need to rethink sexual risk, as the authors claim: we need to rethink all risk. We urgently need to establish why one in ten South Africans are infected with this virus, which is so much easier to spread through contaminated blood that through sex, while only one in 1000 Americans are infected. Research that fails to address non-sexual risks for HIV transmission is a pointless waste of time and money and it allows millions to continue to be infected needlessly with HIV.

Racism Aside, Why are so Many Africans HIV Positive?

I commented on an intriguing article last February and I'm not going to write another commentary now. But for some reason, UNAIDS have only just managed to include it in their very carefully selected weekly collection of very carefully annotated articles, HIV this Week (one doesn't want to say anything that flies in the face of idiocy, does one?).

The article is entitled "It's not just who you are but where you live: an exploration of community influences on individual HIV status in rural Malawi" and it concludes that it's not just proximity to a major road that is highly associated with increased odds of HIV prevalence but also proximity to a public health clinic.

What would have been a eureka moment for people with basic reading and analytic skills, though, has put UNAIDS on the defensive. The UNAIDS author, evidently more highly trained in publicity and face saving than epidemiology, calls the findings 'thought provoking'. They note that rural residence 'seems' protective, which is what virtually every other similar study has shown.

But UNAIDS can't figure it out, because they are honor bound to bring sex into it. Why should living in a rural area protect you from a sexually transmitted disease? Oh, it's because extramrital sex may occur in urban areas. Phew, there was me thinking that people may face non sexual risks in additon to sexual risks when it comes to HIV, which is difficult to transmit sexually but easy to transmit through the sort of poor quality healthcare facilities found in all high prevalence countries.

UNAIDS finds higher HIV risk with proximity to health centers "puzzling". Because they are absolutely positive that HIV can not be transmitted any other way in African countries but through sex. This certainty is not acquired through any kind of investigation, of course. It is just the entire UNAIDS 'theory' of HIV transmission in African countries. (HIV is mainly transmitted through male to male anal sex and intravenous drug use in non-African countries.)

But the astute commentator contents her or his self by reflecting that "health posts are often located in small commercial centres that are themselves associated with increased sexual risk taking" and that "people with HIV infection may move to be closer to health centres for improved access to care". The commentator may be right. But isn't it about time to check? It doesn't take a long, carefully planned study like the one in question to find out what conditions are like in Malawian hospitals, or in other African countries.

In fact, someone at UNAIDS already knows what hospitals are like because they have published a leaflet for UN employees, warning them that "Extra precautions should be taken, however, when on travel away from UN approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere." Perhaps UNAIDS just haven't read the leaflet yet.

The commentator is interested that "income inequality, as opposed to absolute poverty, is associated with increased HIV in women" and asks "Why would this be so?" Predictably, their suggested answer is related to sex, via mention of trust, social ties, risk and what not, but mainly to sex and African women and we all know where that leads, don't we, etc.

Have UNAIDS saved their skin again? Perhaps so, but only at the cost of continuing to propagate the stereotype of the sex and money obsessed African, who really doesn't give a damn about much else. The truth is, HIV is not only transmitted through sex. UNAIDS just don't wish to investigate non-sexual HIV transmission. Therefore, the institution needs to be abolished and replaced with an institution that can produce a comprehensive and non-racist HIV strategy.

New Resource: Don't Get Stuck With HIV Website and Blog

Given that this blog covers the issue of non-sexually transmitted HIV so much, I'm very happy to be involved in the creation and maintenance of a brand new website and blog called 'Don't Get Stuck With HIV'. The two main areas of non-sexually transmitted HIV are health care procedures and cosmetic services.

Some health care risks are fairly obvious. For example, if skin piercing equipment is not sterilized properly it can result in infection with HIV, hepatitis or various bacterial infections, effectively, whatever the last patient had. Whether the treatment is received at a health facility or a dental clinic, in the back of an ambulance or in an emergency scenario, the more you know the about the risks, the more you can do to avoid them.

Even getting a blood test, donating blood and certain kinds of traditional medicine, especially those that break the skin, such as male circumcision, can carry risks. And it's not just blood that can be contaminated: pus, urine, vaginal fluid, anal mucus and others can also pose a risk.

Some cosmetic risks may not be so obvious. Many would guess that getting a tattoo is risky if the studio is not following strict guidelines on safety and sterilization. But even some hairdressing processes can be risky: razors and other sharp instruments can be used (and reused!) and some hair products can irritate the skin and cause small lesions, which could facilitate infection.

The advice on the site is mainly aimed at people in developing countries, especially in African countries where HIV prevalence is high. If there are many HIV positive people in a population, this increases the chances of health and cosmetic services being involved in the spread of HIV, hepatitis and other diseases, such as scabies. But even people in wealthier countries need to be aware of such risks.

There have been numerous health care related outbreaks of blood borne diseases in wealthy countries and they still happen, despite the efforts of health care and cosmetic professionals to avoid them. But in poorer countries there is little or no research on the subject; UNAIDS and much of the HIV industry have little interest in commissioning research. Far from it, they vociferously deny that non-sexual transmission plays any part in high prevalence HIV epidemics, all of which are in sub-Saharan Africa.

A good way of keeping up to date with non-sexually transmitted HIV and hepatitis, especially health care related outbreaks, is to join the Safe Injection Global Network, which also has a brand new site. Their weekly email newsletter includes both research and media articles on the subject and you can subscribe by emailing the editor with 'subscribe' in your subject line.

The Don't Get Stuck With HIV website also has a blog, which will discuss some of the relevant issues arising. People are invited to comment, discuss, make suggestions or take part in any way that would promote recognition and understanding of this vital area of HIV transmission. There is also a Facebook page available and a Twitter account, so you can spread the news about Don't Get Stuck With HIV and follow the cause.

We May Never Agree on the Science of HIV, But Let's Treat HIV Positive People Like Humans

To return to a theme that has cropped up several times on this blog, it can be difficult to understand why HIV positive people are the victims of so much hostility, stigma and persecution.

But when you reflect on how they are portrayed by the HIV industry, it is not so difficult. What then becomes difficult is how the HIV industry can be the instigator of some of the very phenomena it claims to abhor.

It's a bit of a cheap point, but HIV stands for HUMAN immunodeficiency virus. So where is the humanity? Worse still, why the systematic dehumanization of Africans by the HIV industry?

HIV positive people, and even those who are thought to be at risk of being infected, are depicted as promiscuous beyond what is credible, even possible, in humans.

Women are often portrayed as victims, even passive victims. Yet they are also portrayed as so desperate and so dependent that they will do absolutely anything relating to sex for some money, food or other goods. They are sometimes even so portrayed by those who elsewhere portray them as victims.

Men are portrayed as the main drivers of HIV epidemics, even in populations where there is a far smaller proportion of HIV positive men than women. If children and infants are found to be HIV positive when the mother is not infected, it is implied, even stated, that pedophilia must have been involved.

The mainstream media writes pretty much what it likes about people in high prevalence countries, which are all in sub-Saharan Africa. The most ludicrous claims remain unapposed, even when they are echoed throughout the entire media industry.

As well as portraying men as animals and women as either sex or money mad, or both, several recent articles claimed that some HIV positive Swazi people have taken to eating cow dung mixed with water because they lack food and can not take their antiretrovirals on an empty stomach.

As for HIV researchers, many of them don't seem to see Africans as human subjects. Numerous research projects have involved highly questionable practices, probably even unethical practices. HIV positive people have been allowed to infect other people and HIV negative people have been allowed to continue having unprotected sex with a partner that researchers knew was HIV positive.

Where is the humanity in what is supposed to be a humanitarian initiative? HIV is a virus, a sickness, a disease. It is also preventable in many instances. Because, in addition to being transmitted through various kinds of sex act, it is also transmitted through various medical and cosmetic procedures.

Why do so many people in powerful and influential positions, and so many institutions, use their knowledge and resources to beat people, to humiliate them, to stigmatize and dehumanize them? We may never agree on the science, but let's behave like human beings when addressing other humans who are HIV positive or are at risk of being infected.

Why Do HIV Scientists Think They Are Veterinarians When In Africa?

In a letter to The Lancet, Dr David Gisselquist raises a number of perfectly valid questions. There are millions of HIV positive women in Africa who have a HIV negative partner. How did these women become infected? The vast majority of these women have not had sex with anyone but their partner; and a substantial number of them have not had sex with anyone.

The issue Gisselquist is raising is not an entirely scientific one. The data available is clearly not sufficient to show how the women are becoming infected. So you have to make a choice between accepting that women who say they have only had one, or even zero partners, are telling the truth, or assuming that they are lying. If you choose the former, the question is pertinent.

But if you choose the latter, the women could have had any number of partners and any amounts of just about any style of sex imaginable, 'safe' and 'unsafe'. And this is exactly the way the HIV industry looks at HIV in non-Western countries, especially African countries.

This is the typical, highly racist view that most Africans, especially African women, are liars. In addition, they are unbelievably promiscuous and will sleep with just about anyone for money, gifts, status or whatever else happens to be rumoured at a given time. There is nothing scientific about assuming the women are lying or about making up a story to fit the data.

Gisselquist urges us to consider the possibility that Africans are not all dishonest, promiscuous, feckless, without a care for their own health, that or their partner or that of their children and other dependents.

When a HIV positive women has to reveal her status to her HIV negative partner and the entire HIV industry is telling him and everyone else that 80-90% of HIV is transmitted through heterosexual sex in African countries, what are her chances of being believed when she says she has not been having sex with someone else?

But the pointy-hatted brigade have published a 'reply' to Gisselquist's letter, signed by Edward J Mills and Nathan Ford. They start off by accusing those who say we have given far too little attention to non-sexual HIV transmission of having "an insufficient understanding of basic epidemiological principles".

But this is not about epidemiology when it comes down to it. Mills and Ford simply deny the possibility of non-sexual transmission playing a role, or even a partial role, in the massive HIV epidemics found in some African countries. And they make the astounding claim that "several epidemiological models have shown that an unfeasibly high number of unsafe injections would be needed to account for the HIV epidemic".

So instead of an unfeasibly high number of unsafe injections (and various other non-sexual risks that Mills and Ford completely ignore), they posit an unfeasibly high number of sexual exposures. The transmission probability for most kinds of non-sexual exposure is many times higher than that for most kinds of sexual exposure.

You don't need evidence to demonstrate that Africans do not engage in unfeasibly high levels of unsafe sex; the levels posited by various mathematical models and vague theories are just that: unfeasible.

And it's important to note that Gisselquist is not claiming that "men acquire HIV/AIDS through sex but women do not", as Mills and Ford state. He accepts that men and women acquire HIV through sex, sometimes. But far too little investigation has been carried out in high prevalence countries to rule out high levels of non-sexual transmission, probably through very common health procedures, such as hormonal birth control injections.

Far more women are infected with HIV than men in high prevalence African countries. And women often face far more non-sexual risks than men. This should trigger some careful investigations. Instead, it triggers a lot of frothing at the mouth about "diverting of attention" from what Mills, Ford and the rest of the HIV industry consider to be obvious: that Africans are just different, not entirely human, very stupid, selfish and careless.

HIV Scientists' main stumbling block seems to be in seeing themselves as veterinarians when they deal with Africans. If they ask people questions, they need to have the integrity to believe the answers they get. And if they wish to base their HIV prevention strategies on racist assumptions rather than on their own evidence, they should learn to distinguish between science and prejudice. These are not fine distinctions, by any means, but they are vital.

Treatment for All People, Not Just for the Profitable Ones

It's interesting to compare the hype surrounding strategies such as 'treatment as prevention', pre-exposure prophylaxis, vaginal microbicide and the like with the relative silence surrounding pediatric HIV. Marc Lallemant calls it a 'neglected disease'.

Pediatric HIV has been almost eliminated in rich countries. Hundreds of thousands of infants are infected every year and hundreds of thousands more die of AIDS. Only one third of infants who need antiretroviral treatment are receiving it. Without treatment, a third will die before they are one year old and even more will die in the following year or two.

Versions of antiretroviral drugs suitable for children are not seen as a tempting proposition for pharmaceutical companies, it appears. Not only do they want vast profits, they want easy profits and pediatric formulations are just not easy enough.

So it could be asked why anyone would consider a strategy such as 'treatment as prevention', which involves testing everyone for HIV regularly, perhaps once a year, and treating anyone found HIV positive immediately. Currently, people need to reach a specific stage in HIV progression to receive treatment.

Yet in developing countries, many pregnant women don't have access to antenatal care, about three quarters are not tested for HIV, many don't have access to the drugs needed for prevention of mother to child transmission. Even accurate information and adequate support for preventing transmission after delivery is not available to most women.

Developing countries just don't have the equipment, personnel, facilities or even the training to prevent the majority of pediatric HIV transmissions. They don't even have the capacity to diagnose HIV in most infants until it is too late for them to benefit from treatment. It's too expensive. And the all the noise we hear about 'treatment as prevention' is absent when it comes to infants, or even mothers with HIV.

One of the shocking features of diseases that are referred to as 'neglected' is that most of them are easily prevented and treated; most of them are not even expensive to address.

As with pregnant mothers, it would be far better to find out how people are being infected and develop a strategy to prevent infection, insofar as it's possible. But failing that, there is no justification for providing treatment for adults and denying it to infants, just because the former makes the pharmaceutical industry vast and easy profits and the latter does not.

Treat everyone who is infected with HIV, regardless of their demographic. But do not mistake that for prevention. We have failed to prevent millions of HIV infections over many years because we have refused to establish how people are becoming infected. We will continue to fail as long as we fool ourselves into thinking that 'treatment is prevention'. It is not, and it never will be. Nor is it a substitute for prevention.

Nice Work: UNAIDS Paid to Continuously Clean up its Own Mess

Whatever about the non-HIV/AIDS portion of Tanzania's health sector, and it's likely to be a very small portion indeed, the HIV/AIDS portion is pretty much funded and controlled by a powerful cabal of international institutions, such as UNAIDS, the World Bank, the IMF, a few elite academic institutions, Big Pharma and some private foundations such as the Gates Foundation.

And yet communications about the HIV pandemic, which affects sub-Saharan Africa more than any other area in the world, always seem to talk about what 'we' (the cabal in question) have resolved to do. It's as if the circumstances surrounding the pandemic simply materialized out of nothing, as if they (the cabal) are just some disinterested but magnanamous outsiders, trying to put things right.

For instance, members of the UN General Assembly High Level Meeting on HIV/AIDS are said to be committed to “intensify national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV”.

But stigma, discrimination and violence relating to HIV are a direct result of the way the virus has been characterized by the HIV industry itself. When HIV was identified, stigma was first directed at gay men, then at various other groups, sex workers, intravenous drug users and others. But in Africa, the stigma was directed at all Africans.

And it still is. The HIV industry insists that HIV is almost always transmitted through heterosexual sex in high prevalence African countries. They don't know what proportion of HIV is transmitted through heterosexual sex, therefore they don't know what proportion is transmitted non-sexually, such as through unsafe healthcare or cosmetic practices. But nor are they in the least bit interested in finding out.

Because it's much easier to blame individuals and their promiscuity. You only need to rely on people's pre-existing prejudice about African sexuality to swallow this story. When it turns out that women are far more likely to be infected than men, you have to keep rewriting the story, but you can still depend on existing prejudices.

The prejudice is so pervasive that even many Africans seem to believe it. I have been told many times that Africans really do have lots of sex. But there remains quite a disagreement about who 'spreads' HIV. Some say it's men, some say it's women, some say it's foreigners, perhaps tourists, migrants or internal migrants, some even go with the HIV industry favorite, truckers.

But firstly, there is no evidence that Africans have inordinate amounts of sex, safe or unsafe. Secondly, there is no evidence that people in high prevalence countries have more sex, safe or unsafe, than people in low prevalence countries. And it is well known that HIV is difficult to transmit sexually.

Even in countries with relatively high HIV prevalence, the virus is not spread evenly. There are high prevalence areas, such as Iringa in Tanzania, at about 15%; and there are low prevalence areas, such Kigoma, where prevalence is less than 2%. Would anyone be stupid enough to claim that people in Iringa have more sex, or even more 'unsafe' sex, than people in Kigoma?

In Kenya, the province with the highest birth rates and the lowest rates of condom use has the lowest HIV prevalence. The North Eastern province also has the lowest figures for access to health, education and other social services. It is the poorest province in the country by a long shot, according to almost every indicator, except for HIV prevalence.

There are low prevalence areas in Kenya and Tanzania where many people have not heard of HIV, and it does not affect them greatly. Most of them do not know someone who has died of AIDS. HIV tends to infect people living in or close to cities or highly developed and densely populated areas. Like health and other social services, HIV also needs an infrastructure.

And stigma, too, needs an infrastructure. Africans do not have an interest in naming a disease, describing its modes of transmission and labelling those said to transmit it. That's a job for a cabal, like the one described above.

If the HIV cabal is interested in confronting "the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV", they could start by questioning their own prejudices and asking where Africans got the idea that HIV is 'spread' by promiscuity and other 'bad' things. It's a virus, not a magic spell.

It has taken a lot of money and work to stigmatize whole populations in high HIV prevalence countries and that money has been controlled by the HIV industry itself. Wringing their hands and wailing will not reverse the damage they have done. HIV transmission will only be significantly reduced when we establish exactly how the virus is being transmitted. And we know where to start: HIV is not only transmitted sexually.

UNAIDS Want Equal Numbers of Male and Female HIV Infections?

Despite the fact that it clearly doesn't work, UNAIDS and the HIV industry are persisting with their incitement to racial hatred approach to HIV prevention. Following the UN/IRIN 'Swazis eating cow dung' article, which was echoed throughout the social and media networks without analysis or criticism, they are back to their 'African women are prostitutes' theme.

This time, the prostitution theme (or 'transactional sex', which could be interpreted to describe all sex) is set in the Swazi garment industry, where HIV prevalence stands at 50%. The industry mostly employs women and they receive very low wages for long hours, despite the value of their output to the US, whose 'African Growth and Opportunities Act' (AGOA) facilitates such sweatshop industries.

The trouble is, the two stories don't really go together very well. The one about HIV positive people eating cow dung because they are too poor to afford any other food suggests that HIV infects poorer people. But HIV prevalence tends to be lower among poorer people and higher among wealthier people.

And the story about sweatshops suggests that even those working in the formal economy are so poor, they need to supplement their income by having high risk sex for money. Those in the garment industry are poor and exploited, that's what instruments like AGOA are designed for, but they are by no means the poorest in the country.

The probability of transmitting HIV, even under the most risky circumstances, is far lower than one. So if 50% of women are infected, up to 100% of them have been exposed. Yet, not everyone in a population has sex, let alone 'unsafe' sex. Most of the women working in the garment industry are young. Low probability of an event occurring (HIV infection) means that the women must take a lot of risks, and this takes time.

Sex work has its risks, but sexually transmitted infections (STI) are not even the biggest worry for a lot of women. In many countries, HIV transmission is uncommon among sex workers unless they are also intravenous drug users. In other words, sex is not as big a risk for HIV as we have been led to believe. So why should sex appear to be such a risk in Swaziland, especially in the sweatshops?

The simple answer is, there is no evidence that women in high HIV prevalence populations have more sex, or more risky sex, than women in other populations where HIV is rare. It's easy for a journalist to pick up a few anecdotes about a woman who gets money for having sex in her spare time to supplement her sweatshop wages, just as it's easy to find someone to supply anecdotes about people eating cow dung (which they probably picked up from IRIN or one of the many media outlets that ran the story).

But this is just gossip and unless it sheds light on how women are being infected with a difficult to transmit disease in such shocking numbers, it is not going to reduce HIV transmission. There is something going on in Swaziland that is facilitating the spread of HIV and it is not just sex, which goes on everywhere.

What could it be? Well firstly, health services need to be investigated. Because they are clearly weak when it comes to simple functions, like guaranteeing a constant supply of drugs for HIV positive people whose lives depend on them. This is another thing the UN's IRIN covers frequently, weak health services. Health services don't even have enough staff, equipment, training or supplies to guarantee the minimum standards; how can they guarantee that they are not also inadvertently spreading HIV?

We know African health facilities are such dangerous places that the UN won't allow its employees to use the ones that ordinary Africans have to use. But do these sweatshops also have health services, such as routine immunizations, health checks and, even worse, STI testing and treatment? Assuming that the main risks people face are sexual could be bringing about the very scenario such procedures are supposed to prevent.

The chances that careless, underfunded, mandatory STI testing and treatment programs are spreading diseases, including HIV, are huge. It is highly suspicious that groups thought to be at risk of HIV are infected in unbelievable numbers when those who are said to be infecting them, men, are infected in far lower numbers, and much later in life.

It's quite possible that many women are being infected nosocomially, especially through unsterile injections relating to STI vaccination and/or treatment, and going on to infect their partners. This is in serious need of investigation, because an epidemic that infects half of all women in a demographic sector, even though it's a difficult disease to spread sexually, is not driven by sex.

If HIV being transmitted through unsafe healthcare is the explanation for the otherwise mysteriously high prevalence among young African women, the last thing Swaziland or any other African country needs is a mass male circumcision campaign. Yet that's what UNAIDS are demanding for high prevalence countries. Are they trying to do to African males what they have succeeded in doing to females?

Public Health, Private Interests, HIV and Circumcision

If you don't have time to read the articles below, or even this blog post, take a look at this BBC video. An effervescent medical device industry executive positively drools over their latest offering: an elastic band that fits over a plastic ring, used to circumcise men without the need for surgery, or even anesthetic.

The same executive might not feel so comfortable about a similar device for circumcising women. Of course, circumcising women is a revolting practice with no medical benefit. But rates of HIV tend to be very low among African tribal groups which practice female circumcision. And reducing HIV transmission is, ostensibly, the main reason for circumcising large numbers of men.

Even circumcision enthusiasts don't know why male circumcision appears to reduce female to male HIV transmission during heterosexual penile-vaginal intercourse (although it may increase male to female transmission, which is generally far more common in African countries). They are as much in the dark about any protective mechanism as they are about the value of female circumcision in reducing HIV transmission.

But their enthusiasm for carrying out the operation on millions of men, as people continue to die of diseases that can be prevented for a fraction of the cost of a circumcision, remains intact. Thankfully, Malawi has decided that the evidence for mass male circumcision is not convincing, but many African countries have bought into it.

Apparently in South Africa, where HIV transmission rates among circumcised men are still alarmingly high, 'sexual behavior has not changed', despite those having the operation receiving rigorous counseling and other 'prevention' training. Up until recently we were told how sexual behavior needed to change because men were so brutal and women were so vulnerable.

So the behavioral norms that were considered so horrifying at one time and were considered to 'drive' HIV epidemics are no longer horrifying?

Even the WHO suggests that about 16 people may need to be circumcised to prevent one HIV transmission over a period of ten years. That's a hell of a lot of circumcisions required to make a small dent in Southern and East Africa's high and medium prevalence epidemics. And that's if it actually has any positive impact at all in the long run.

But one of the most worrying aspects of the whole circumcision charade is the fact that it all seems to be stoked up by people who are not themselves at any risk of being infected by the virus or even of being corrupted by the behavior that is said to spread the virus. And their evident zeal is only sometimes stoked up by a desire to make lots of money, though I'm sure that helps.

It has been pointed out that in the case of another 'prevention' strategy, pre-exposure prophylaxis (PrEP), an estimated 45 people need to be taking antiretroviral drugs in highly profitable (for the pharmaceutical industry) quantities to prevent a single infection. Are mass male circumcision campaigns and PrEP really aiming at public health, or is there something else behind them?

While there is a lot written about HIV positive people engaging in 'criminal' behavior and the various legal instruments being discussed to curb such behavior, there has been less talk about crimes being committed against people in the name of reducing HIV transmission, or even various other diseases. In Kenya, quite a few people were put in prison for refusing to take their TB drugs in the last couple of years.

In Nigeria, people have been threatened with prison for refusing to immunize their children against polio. It's not always clear why some people resist polio vaccinations so strongly, but there is a hint that people want more than just a routine injection, for example, clean water and sanitation, a decent level of nutrition, even treatment and prevention for far more common ailments.

This is the country where Pfizer has had to pay out tens of millions of dollars in compensation for causing widespread deaths and disability during a drug trial that went wrong (Trovan). No one in their right mind has any reason to trust pharmaceutical companies, least of all Africans, who are often not even the beneficiaries of the drugs that are tested in African countries.

People have legitimate fears about public health interventions. It's very sad to see people dying unnecessarily, but they should have the right to question what they are being told, the right to be educated, not just compelled. And they should have the right to be told the truth about the diseases in question, as well as the intervention that is being imposed.

So far, people are not being told the truth about HIV or about mass male circumcision. HIV is not always spread sexually and mass male circumcision campaigns can have serious consequences, such as infections with other diseases and even the failure of the campaign to achieve a meaningful reduction in HIV transmission.

We don't know if those HIV positive people who refuse antiretrovirals in a test and treat program might one day be criminalized. Many who refuse are already stigmatized and persecuted. Similarly, if PrEP was available for everyone considered to be at risk of HIV infection, would those who refused to take it be criminalized (or just publicly shamed)?

Supposing UNAIDS did decide that mass female circumcision of some kind was the best way to reduce HIV transmission, or that such a campaign would complement other reduction programs? Would everyone accept the various opinions, data, cajoling and railroading, as many are doing with male circumcision, PrEP and various other public health campaigns? So why do we accept some interventions and not others that may be equally well supported by 'evidence'?

The Consequences of a False and Insulting Portrayal of Africans

Presenting a false and insulting portrayal of tribal people is, as Stephen Corry argues in the New Internationalist blog, inherently unethical. And the consequences can indeed be far-reaching. Corry lists "murders, dispossessions and long-term abuses of tribal peoples" which are "underpinned by racist thinking". Corry is attacking a TV program which portrayed an Amazonian tribe as "sex-obsessed, mean and savage".

So I hope followers of Corry will agree that presenting a false and insulting portrayal of the people of an entire continent is similarly unethical, though on a far larger scale. And it certainly has far reaching consequences. The HIV industry's portrayal of Africans as sex-obsessed, mean and savage, and their perpetuation of demeaning and stereotypical views, is the grounding for global HIV policy and HIV spending in African countries.

In fact, the theft of African land and resources by governments and corporations on a massive scale is just one of the consequences of the HIV industry's fabrications, just as it is for the kind of tribal groups that Corry writes about.

Because African men are effectively depicted as rapists and child molesters and African women as defenceless (but money-mad) victims, the view that HIV is almost always heterosexually transmitted in African countries, and hardly ever anywhere else, is now the mainstream view.

Take for example almost every HIV 'prevention' program that has ever been considered for Africa: Abstinence, Being faithful and using Condoms (ABC), mass male circumcision, sexually transmitted infection (STI) reduction, pre-exposure prophylaxis (PrEP), microbicides, treatment as prevention (sometimes called 'TraP', apparently), conditional cash transfers, and I'm sure there are others.

Almost all these prevention programs target people thought to be (and sometimes actually) highly sexually active, even though HIV is relatively difficult to transmit through penile-vaginal sex. These programs even target people who are not at all sexually active because African sexuality is thought to be so pervasive, no one escapes, not even the very young and the very old.

And at the same time, non-sexual transmission routes, such as through contaminated blood transfusions, reused syringes and needles or various other medical precedures, which are both common and extremely efficient at transmitting HIV, receive next to no attention or funding.

This is not to say there are no social problems in African countries. A recent article finds that there are problems with use of porn videos, illegal alcohol, unprotected sex, coercive sex, rape and various other things involving teenagers in a part of Kenya where HIV prevalence is highest.

But there is little evidence that these problems, which are very serious and do need to be addressed, are particularly closely related to the HIV epidemic there.

HIV is sometimes transmitted sexually and some types of sexual behavior are more risky than others. All of these problems need to be addressed, whether HIV transmission is involved or not. But this is not a reason to ignore non-sexual transmission, which could be taking place in the very STI clinics and health facilities that people end up being sent to. Vulnerable people need protection, but not just from sexual risks or even from the risk of HIV, alone.

It's always worrying when the World Bank tries to reassure the public of anything. So their article entitled "Cash Payments Can Reduce HIV/Sexually Transmitted Infections in Africa―New" should set off alarms.

Improving education, health, infrastructure, economic circumstances and the like is clearly desirable. But when the 'solution' comes from the institution that has spent decades giving out loans to struggling economies on condition that they reduce public spending on all those same goods, why should we accept their findings about such 'conditional cash transfers'?

The bank feels that women and girls especially are having unsafe sex in return for money because they are poor (and uneducated and suffer various other kinds of social deprivation), so they wish to address this problem by paying them to have safe sex, or even to have no sex.

But how about ensuring that people with preventable and treatable STIs get the education and treatment they need to avoid these diseases and prevent them from becoming endemic, as they currently are in many countries, not just in AFrica? How about improving people's economic circumstances, or simply ceasing to compromise people's economic circumstances so that they no longer live in highly risky environments?

The World Bank paying girls to attend schools in an education system that has been ransaked under the bank's auspicies and health facilities that have been rendered extremely risky precisely because of the bank's own strictures about spending, investment, recruitment and training, is utterly revolting, as well as highly insulting to the African victims of this travesty.

For Africans, especially in high HIV prevalence countries, the consequences of their false and insulting protrayal as sex-obsessed, mean and savage could not be more extreme: HIV positive people are reviled and patronized, while they suffer and die from a preventable virus; and HIV negative people continue to face avoidable risks merely because addressing the risks would draw attention to the pernicious lies that underpin global HIV policy.

AVAC, Big Pharma Front Group, Anticipates Healthy Returns from HIV

AidsAlliance.org has an article subtitled: 'how [Uganda] lost the global lead in combating HIV'. And it is a question well worth asking. Uganda, probably more than any other African country, said and did all the 'right' things, everything they were told to say and were well funded for by what became the multi-billion dollar AIDS industry.

The article, naturally, makes it sound as if it has only recently been realized that efforts in Uganda are not really having much impact on the epidemic. But even in the early 2000s it was clear that Uganda hadn't really had any success since the first few years of the epidemic, before the HIV industry had evolved.

In the early days, and not just in Uganda, those involved in healthcare recognised that HIV was spread in a number of ways, one of the most important of which was through contaminated blood, especially in the healthcare context. After all, it was in the 1980s that haemophiliacs in wealthy countries were infected in tens of thousands.

There were other massive outbreaks of HIV in healthcare settings, such as the one in Romania, where thousands of teenagers are now coming of age having lived with HIV all their lives. Thousands more have died of AIDS. Few will forget Libya's notorious outbreak, but there were still more outbreaks that received less press attention.

In addition to the current tens of thousands of Chinese people who were infected with HIV through contaminated blood, blood products and other healthcare procedures, there are the uncounted hundreds of thousands, perhaps millions of Africans, who continue to be infected because the AIDS industry ceased talking about and funding efforts to reduce non-sexual HIV transmission.

In the 1980s, the Ugandan government was rightly praised for raising the alarm about HIV and doing everything in their power to reduce transmission, however it occurred. But in the 1990s HIV was hijacked by political, religious and commercial interests in a scenario where if sex wasn't involved, it wasn't worth talking about. HIV prevalence decreased rapidly in Uganda in the 90s because death rates rocketed. But since the mid to late 1990s up to the present, HIV incidence and prevalence have remained fairly steady.

This means that the money pouring into the country, and pouring into other medium and high prevalence countries, is having little or no impact. No country has succeeded in controlling its HIV epidemic by ranting about, or even by throwing buckets of money at, sexual behavior; no African countries, no Asian countries, not even Western countries, and certainly not the US, which spends the most on such ranting but has the highest HIV rates in the Western world.

If only Uganda hadn't attracted the attention of the hoardes of politicians, business people, bureaucrats, religious leaders and assorted cranks, has beens and what not; the country might have continued to monitor conditions in health facilities and improve medical procedures that potentially involved exposure to blood or other bodily fluids contaminated with HIV.

Uganda is not the only medium prevalence country where HIV prevalence has stagnated for quite a few years. Kenya and Tanzania are in a similar position. In fact, prevalence in all three countries has barely changed in the last 10 years if you take into account the fact that death rates were only peaking in the early 2000s there, whereas rates peaked in Uganda in the 1990s. Reducing HIV prevalence through high death rates is hardly something to boast about.

But the article bemoaning how Uganda is 'falling behind' comes out with the same HIV industry rubbish about HIV being almost always sexually transmitted, claiming that this accounts for 76% of all infections and another 22% is accounted for by mother to child transmission. This leaves 2% for a combination of healthcare related transmission (such as blood transfusions, reused syringes, etc), men having sex with men, heterosexual anal sex and intravenous drug use.

The 76% figure is in serious need of investigation. This is the sort of figure that has been blowing any efforts to reduce HIV transmission off course for over twenty years. The article itself puts a finger on the problem, but without realizing it. It is because Uganda has been doing everything the AIDS industry expects of it that they have been failing. Just how many more years do they have to continue proving how wrong their strategy is?

Report after report shows that the people becoming infected in largest numbers are people who do not engage in 'unsafe' sex, that those who are infected are often those with one, or even no partners, they are often the ones who use condoms and know just about everything they have been told about how the HIV industry says HIV is transmitted.

Uganda is one of the countries where a lot of the early HIV research took place, where people were followed around, without necessarily being told they were HIV positive, to see how long it took them to infect their partner. Yet this Tuskegee style experiment appears to have left researchers in the dark as to how HIV is actually transmitted, rather than clarified the matter.

The article closes with a remark from Mitchell Warren, director of AVAC, the pharmaceutical industry front group which purports to advocate for prevention: “new prevention options – medical male circumcision, PrEP, microbicides and eventually vaccines – will play a critical role in reducing the cycle of new infections. As we look toward the next 30 years of AIDS, investment in prevention research has never been more important. Going forward we need funding structures that are flexible, agile, and generous enough to adapt rapidly to new opportunities.”

Roughly translated, this means that 'the pharmaceutical industry is very happy that HIV is not being eradicated and they expect to sell a hell of a lot of drugs and make even more billions than they have made so far, especially as they have persuaded those with the money that giving out endless rounds of drugs is all that is needed to solve the problem'. It won't reduct transmission, of course, but why would the pharmaceutical industry want to do that?

UN Publicity Machine Devours its own Entrails

With a breathtaking lack of self awareness, IRIN, part of the UN, has an article entitled 'Africa: The crazy things they say: politicians and HIV'. If this article is not an argument for the abolition of UNAIDS I don't know what is.

Yes, there are some political leaders in Africa who think strange things about HIV. And there are political leaders everywhere who think strange things about HIV. This is despite billions of dollars being spent around the world on the disease, some of which was aimed at informing people about it.

Established 17 years ago, a more spectacular failure among international instutions than UNAIDS would be hard to find, though there is plenty of competition.

Not only are some of the leaders and populations of the highest prevalence countries in the world systematically misinformed about HIV, meaning that little can be done to reduce transmission, but the institution continues to point the finger at Africans themselves for a disease that it was their sole mandate to address.

I have tried to articulate why I thought lying about how HIV is transmitted in African countries is a form of extremism. But the IRIN article does it far better. From a Swazi MP who said HIV positive people should be branded on the buttocks, to a South African president who severely curtailed treatment for hundreds of thousands of HIV positive people, the article just about sums up what UNAIDS has achieved.

The press is as bad as those leaders, spreading just about any rumor they think will sell their content, with the BBC recently leading the pack of racists with a 'story' about Swazis eating cow dung because they were too poor to afford food and needed something in their stomachs to reduce the side effects of antiretrivoral treatment.

One of the African leaders who started off pressing for effective measures to reduce HIV transmission was Museveni of Uganda. Under his leadership in the 1980s many things changed in health facilities, government departments, schools, universities and elsewhere, so that people were informed about HIV and enabled to avoid it.

But the 1990s saw the health issue of HIV being hijacked by the media, the pharmaceutical industry, politicians, religious leaders and others. HIV prevention messages were exclusively replaced by patronizing rubbish about what people should and shouldn't do in bed. Making HIV into a moral issue and one about promiscuity and illicit sex ensured that stigma, which was already a problem, became institutionalized and it has remained so ever since.

UNAIDS have rarely been heard to refer to any kind of non-sexually transmitted HIV except to deny that it exists. And they have to spend their time thinking up ad hoc explanations of why a virus that is difficult to transmit sexually is almost always transmitted sexually in (some) African countries and hardly ever in non-African countries.

If IRIN want a real story, they could look at why some people who should know better have strange ideas about HIV. But IRIN itself has always been part of the problem, being a mere mouthpiece for the UN aristocracy. The article modestly declares that it "does not necessarily reflect the views of the United Nations". True, not necessarily.

It's easy to point the finger at African leaders and sneer at their misunderstandings about HIV, and finger pointing is a specialty for UNAIDS. But it's worth asking why these leaders are so misinformed by an institution that has had little else to do with its billions but inform them. But kudos to IRIN for highlighting part of the problem, however inadvertently.

Role of Unsafe Injections in HIV Transmission Acknowledged

Not long ago UNAIDS launched one of those glossy publications of the sort that the UN as a whole is justly famous for. The launch was accompanied by the sort of publicity that few but the UN can afford. And the publication claimed that the 25% reduction in HIV infections among young peoplein high prevalence countries is due to sexual behavior change.

Well, they would do, because according to UNAIDS, HIV is almost always transmitted through heterosexual sex in high prevalence countries. But it would be a neat trick if non-sexually transmitted HIV were also reduced through sexual behavior change. And, given that even UNAIDS admits that some HIV is not transmitted through heterosexual sex, how do they account for reductions in non-sexually transmitted HIV?

They don't mention it much. Perhaps they hope no one will notice, or that no one will be impolite enough to mention if they do notice. But there are some who have very good reason to draw attention to the fact that a lot of HIV and other viruses are transmitted through unsafe healthcare, especially unsterile injections, disposable injection equipment that is being reused, often without any attempt made to sterilize it.

The SafePoint Trust disseminates information about unsafe healthcare, to those giving and those receiving the healthcare. They promote the use of non-reusable syringes, also called 'auto-disable' syringes, because they break after a single use. The statistics they have gathered together about syringe reuse are really shocking.

None of the information disseminated by SafePoint will be new to UNAIDS. They have access to and use the same publications as SafePoint. But UNAIDS deny that non-sexually transmitted HIV plays a significant role in serious HIV epidemics. Regardless of the weight of evidence to the contrary, they insist that 80%, even 90% of HIV is heterosexually transmitted in African countries and that much of the other 10 or 20% is transmitted from mother to child.

Among the many cited facts from SafePoint's leaflet, we are told that 20 million medical injections contaminated with blood from a patient with HIV are administered every year. From this, UNAIDS concludes that about 1-1.5% of HIV infections might come from unsterile injections. This is despite massive outbreaks of healthcare acquired HIV in non-African countries in the 1980s. And the WHO used to recommend the reuse of needles and syringes up to 200 times in vaccination programs, right up to the late 1990s.

Thankfully, many hospitals in Tanzania now use auto-disable syringes for some types of injection. But their use is by no means universal and you can still buy disposable syringes in pharmacies and shops. Also, injections are not always administered in sterile conditions, or by people who have been trained in medical safety.

The way UNAIDS and other luminaries of the HIV industry resolutely refuse to acknowledge non-sexual HIV transmission, and to persist with their highly stigmatizing ranting about African promiscuity and unsafe sex, is inexplicable. Even the mainstream MedPageToday has an article on unsafe practices in US hospitals, which are light years ahead of African countries in terms of conditions.

UNICEF has carried out a study of an initiative to improve injection safety, especially in relation to reuse of syringes for vaccination programs. Perhaps they can get in touch with UNAIDS and inform them that their intransigence is responsible for much of the continued non-sexual HIV transmission of the last 10 or more years? Perhaps also, the initiative will be extended to non-vaccine related injections, which make up the bulk of use of injecting equipment.

The Safe Injection Practices Coalition (SIPC) has launched a free online course for healthcare providers on unsafe injections, which should help inform professionals about the risks and how to eliminate them. This may take some time to get around in countries like Tanzania, where power and connectivity are not reliable. But it's a very good start. However, the course is likely to be aimed at a US or Western audience.

UNAIDS have not increased in relevance over the years and these initiatives certainly don't improve their credibility. But the institution might be entitled to a few brownie points by ensuring that some of the billions spent on HIV is now spent on non-sexually transmitted HIV. Then they might even have something to boast about. But the institution should still be abolished, for the good of those already infected and for those who will certainly be infected if global HIV policy continues to obsess about sexual behavior and ignore some of the most easily avoidable risks.

HIV Spread Through Deliberate Misinformation

A Tanzanian MP, Mr Ally Keissy Mohamed, has said in parliament that HIV positive people get infected deliberately. After all the research and money that has been poured into this single disease, how could someone be so misinformed about HIV as to think that it would even be possible for someone to 'get infected deliberately'?

Well, there is a very good reason. UNAIDS, the UN agency tasked with bringing together efforts to prevent and treat HIV, collecting and disseminating information about it, advocating for the rights of those affected and at risk, mobilizing resources, developing strategies and supporting countries to implement them, consistently misleads the world about how HIV is transmitted.

Or perhaps it would be more accurate to say that UNAIDS consistently misleads the world about how HIV is transmitted in Africa. In most Western countries, and even a lot of developing or middle-income countries, HIV is mostly transmitted by intravenous drug use or by anal sex. But according to UNAIDS, HIV is almost always transmitted through heterosexual sex in African countries.

There is plenty of evidence that HIV is not solely, perhaps not even mostly, transmitted through heterosexual sex in African countries but this is either flatly denied or ignored. UNAIDS claims that only about 1% of HIV is transmitted through contaminated blood transfusions and perhaps 1.5% through unsafe injections. Other medical and cosmetic procedures are generally not even mentioned in the literature.

So, many people 'deliberately' have sex, in the sense that having sex is consensual. But others don't have much choice whether to have sex or not, with whom, under what conditions and the like. This aspect of sex seems to have escaped the notice of the MP. You could say that others 'deliberately' go to health and cosmetic facilities, in the sense that they choose to do so. The MP can be forgiven for not knowing that HIV can be spread through a number of non-sexual routes.

UNAIDS skate over the problems with their blanket blame-game, even concerning vital issues such as mother to child transmission. But they deny entirely the significance of non-sexual modes of transmission, to the extent of manufacturing data to force their point and trying to discredit anyone who raises questions about the status quo.

People who are at risk of being infected with HIV through unsafe medical or cosmetic procedures are usually completely unaware of such risks. If they were aware, they might be able to avoid them and to protect their families and friends. But UNAIDS feels that warning them about non-sexual risks would 'dilute' their favorite subject, African sex and sexual behavior.

And Africans are then doubly misinformed. Because they are warned against having 'unsafe' sex. Yet most of the people in high prevalence countries are infected through ordinary everyday sex. Most of them only have sex with one main partner, the frequency of sex is similar for most people in African and non-African countries alike, etc. In other words, most African people don't engage in the incredible levels of dangerous sexual behavior that could explain massive rates of transmission.

This is the picture that the unfortunate Mr Mohamed was probably thinking of when he made his statement. The chairman of the National Council for People Living with HIV and Aids (NACOPHA), Mr Vitalisi Makayula, has described the statement as 'inhuman', but he himself doesn't get beyond sexual transmission. And Dr Emmanuel Kandusi, chairman of a prostate cancer pressure group, said there was an element of truth about the statement, but it was 'blunt'.

But Mr Mohamed was not right in any sense. Nor do Mr Makayula and Dr Kandusi shed much light on the problem. Dr Kandusi even cites UNAIDS's favorite reflex about HIV in Africa: that 80% (sometimes 90%) of transmission is from heterosexual sex. Another 18% is said to be transmitted from mother to child. That leaves 2% for unsafe medical practices and even for intravenous drug use and anal sex, the most common modes of infection outside of African countries.

A lot of credence is given to modes of transmission surveys, which claim to use empirical evidence. However, their figures come from carefully selected and highly biased research, not from any useful estimation of the relative contribution of each mode of transmission. The MPs and other Tanzanian social leaders have been misled, in the same way as all other Africans and non-Africans. The relative extent of sexual and non-sexual transmission of HIV is not known because UNAIDS does not wish to estimate it.

It is not clear why Africans are held in contempt by UNAIDS. But it is even less clear why Africans themselves don't question something that amounts to little more than racism. But the few who have tried to question the orthodoxy have been rubbished and branded as 'denialists'.

Sure, some of them were misinformed, for example, Thabo Mbeki. But who misinformed him? He could not understand why a virus should infect Africans in huge numbers but non-Africans in small numbers and why it should almost always be spread heterosexually in Africa but hardly ever anywhere else.

These are pertinant questions and making a laughing stock of those raising them only makes things worse. A Zimbabwean senator, Sithembile Mlothshwa, has suggested that scientists should "look into the issue of trying to inject men with a substance that will make them lose appetite" for sex. But it's not really surprising that people should come up with such crazy sounding 'solutions' when they are being fed so many lies, lies that don't even add up.

In fact, Mr Mlothshwa is in good company. Some HIV 'expert' not long ago suggested that if all Africans were to give up sex for one month every year, HIV transmission would drop substantially. This expert said it was what Muslims do during Ramadan, although they only give up sex during the day. Are we to believe that Africans are so promiscuous that they spend their days engaging in rampant sex, as well as their nights?

Another HIV commentator, Dr Sam Okuonzi, a Ugandan MP and 'health consultant', comes up with all sorts of confused arguments about the 'origin of HIV/AIDS'. And there are others, plenty of them, some who point to obvious inconsistencies in the orthodox view, others who go off on complete flights of fantasy that even UNAIDS would be proud of.

If the purpose of UNAIDS were to spread misinformation about HIV, they have done a very good job. Political, religious and social leaders, even health professionals and scientists in African countries seem to be oblivious to the fact that they are the victims of a racist propaganda. And the few who have challenged this propaganda have been ridiculed. It's UNAIDS that is ridiculous and it's time this useless and expensive institution was abolished.

[For more about pre-exposure prophylaxis (PrEP) and the disinformation machine that is the AIDS Industry, see my other blog.]

UN Employees Uniquely Susceptible to Non-Sexual HIV Transmission

Following a recent article about the development of a black market for donated blood that is developing in Tanzania, along comes another about similar trends in Nigeria. According to the Nigerian Independent, a considerable number of HIV transmissions are a result of unscreened blood. HIV contaminated blood carries an estimated transmission risk of 95%.

Official HIV industry publications have been claiming that 1% or fewer HIV transmissions are a result of contaminated transfusions but this article casts doubt on that claim. It suggests that 90% of blood comes from paid donors because the blood transfusion service is unable to keep up with demand.

Accepting blood from paid donors can carry high risks because the payment often attracts people who are more likely to be infected with HIV or various other blood borne diseases. It is thought that many donors are, for example, intravenous drug users. As a result, as much as 4-5% of HIV transmission may have resulted from contaminated blood transfusions.

It has been clear for a long time that HIV industry claims about 'universal precautions' against HIV transmission through contaminated blood transfusions, and even reused syringes and generally sloppy hygiene practices, are contradicted by reported conditions in high prevalence countries. (All high prevalence countries are in sub-Saharan Africa.)

But while UNAIDS argues that very few HIV transmissions result from unsafe transfusions and other medical procedures, they also publish a brochure warning UN employees that:

"We in the UN system are unlikely to become infected this way since the UN-system medical services take all the necessary precautions and use only new or sterilized equipment. Extra precautions should be taken, however, when on travel away from UN approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere. It is always a good idea to avoid direct exposure to another person’s blood—to avoid not only HIV but also hepatitis and other bloodborne infections."

The UN's advice is good but it is not clear why this advice is only given to UN employees. Non-employees, Africans, for example, are far more likely to be at risk. While those working for the UN generally don't have to avail of poor quality and downright dangerous services, most Africans have no option.

Therefore, it is heartening to hear of Tanzanian and Nigerian health experts and journalists questioning the commonly heard lie about HIV almost always being transmitted through heterosexual sex in African countries. They are to be applauded, but also encouraged to be more vocal in their questioning of the status quo. The words of UNAIDS wonks have been accepted as gospel for far too long and too many people have been infected, suffered and even died as a result.

Nigeria and other African countries may well have the right policy documents, mentioning comforting things like 'universal precautions'. But those policies are often ignored and are therefore useless. So it's interesting to look a little closer at how UNAIDS use this smug term. They say:

"When accidents do occur, the best approach is to follow what are known as universal precautions. This strategy assumes that everyone is potentially infectious—either with HIV or with another bloodborne disease, such as hepatitis. With universal precautions, no blood exposure is regarded as safe."

The document goes on: "Following universal precautions requires advance planning and preparation. UN first-aid kits, which must be available in all UN workplaces and in all UN cars, include gloves, which should be worn before you touch another person’s blood or open wound. The first-aid kits also include bleach, which can be mixed with water to clean up spills of blood or other body fluids. Because accidents can occur at home as well as at work, you should have a readily accessible first-aid kit in the home, as well."

More great advice, but quite contrary to the assurance that most HIV is transmitted through heterosexual sex in African countries and that only 1% is transmitted through blood transfusions and another 1% through other types of unsafe healthcare. If UN personnel need this advice, why don't non-UN personnel, poor and badly educated people who live in high prevalence countries with appalling health services, for example?

Report after report shows that many health facilities lack soap and water, gloves, safe disposal facilities, sterilization facilities and various other things. In fact, the vast majority of health facilities in Kenya and Tanzania do not have everything they need to ensure safety, either in the facilities or in their stores.

Are UN employees uniquely susceptible to non-sexual HIV transmission, in the way that Africans, we are told, are uniquely susceptible to heterosexual HIV transmission? Or do UNAIDS have an explanation for these double standards? If so, it's time they either warned Africans that they face very serious risks in health facilities or advise UN employees that they have exaggerated the risks that they face. Let's hope UNAIDS choose the former, rather than the latter.

Data Trumped by Idle Speculation and Pig-Headedness, as Usual

For many years, UNAIDS and the rest of the HIV industry have been sending out the message that everyone is at risk of being infected with HIV. However, it has never been true that everyone is at risk and there was never any reason for claiming this. The fact that HIV tended to cluster in urban areas, among wealthier, more mobile and better educated populations has been clear for a long time.

One of the latest papers to include detailed spacial data which demonstrates this clustering effect is entitled 'Localized spatial clustering of HIV infections in a widely disseminated rural South African epidemic', by Frank Tanser and colleagues. The data they produce is very interesting, but the same can certainly not be said of the conclusions they draw.

Unsurprisingly, they assume throughout that HIV is almost always transmitted through heterosexual sex in African countries, the so called 'behavioral paradigm'. And the study is in South Africa, the country with the largest number of people living with HIV in the world. As usual, the assumption is unexamined and unsupported in any way.

The study finds that high HIV prevalence clusters close to the National Road and that it is far lower in inaccessible rural areas. 40% of infected people live within 1km of the National Road. Also the "estimated density of HIV-infected individuals (total HIV cases per square kilometre) living within 1km of the road is 15.7 times higher than the mean density of infected individuals across the remainder of the study area."

Those infected are also better educated, wealthier and far more likely to be employed. No surprises there. And they are also less likely to be migrants. Migrants, especially internal migrants, are one of the groups often said to be at high risk of being infected and of infecting others. But the HIV industry has always been bad at identifying risk groups or, I should say, good at ignoring any evidence that may help identify them.

Whatever theories the paper's authors may have, indeed, whatever prejudices, all this data supports the view that HIV is not entirely spread sexually. The populations in this and other studies also have something else in common: they all live close to or have easy access to health facilities. Wealthy, well educated, mobile people with jobs tend to go to health facilities.

On the other hand, rural people tend to go to health facilities far less often, for various reasons, including poverty, lack of mobility, lack of health related education and the sheer lack of decent, affordable, accessible health facilities. Do these features of serious underdevelopment give people protection from HIV infection? Well, that's a hard question to answer if researchers like Tanser and colleagues don't even raise it.

The authors speculate about why the factors that may have been significant in HIV transmission during an early phase of the epidemic appear to be significant still and why this apparently heterosexually transmitted virus has not been more evenly spread among the population. Just how many warning signs do they need that their overall hypothesis about the virus being spread almost entirely through heterosexual sex is wrong and is little more than an anti-African prejudice?

As if things are not bad enough, this sort of idle speculation and pig-headed refusal to consider some fairly obvious alternatives to the behavioral paradigm is going to encourage those baying for 'treatment as prevention' and pre-exposure prophylaxis (essentially, means of substantially increasing the tonnage of drugs being thrown at the epidemic) to be rolled out in high prevalence countries.

The Sound of a One Legged Argument Kicking Itself

As I mentioned in yesterday's blog, a recent article finds evidence for the concurrency hypothesis 'compelling', despite liberal use of words that suggests a lot of doubt. The hypothesis is that lots of unsafe sex alone, involving numerous partners, low condom use, etc, does not account for high HIV prevalence; but if sexual relationships overlap with each other, HIV transmission will be very high.

A lot of work has been done to show that the concurrency hypothesis is entirely unsupported by evidence, particularly work by Eileen Stillwaggon and Larry Sawers. But in the article mentioned yesterday, Mah and Shelton dismiss anything challenging the hypothesis rather than addressing the failure of all the arguments that claim to support it.

Well, an article just published by Frank Tanser and colleagues finds that there is "no evidence to suggest that concurrent partnerships are an important driver of HIV incidence in [a] typical high-prevalence rural African population." But instead they argue that multiple partnerships are an important driver of incidence.

While Mah and Shelton denied that non-sexually transmitted HIV plays an important role in hyperendemic scenarios, without arguing the case, Tanser and colleagues don't even mention the possibility of non-sexual transmission. While obligingly neutralizing an argument that should never have been given much credence, and one that has been convincingly refuted by others, they seem to be taking a step backwards.

We have been hearing the oversexed African hypothesis for several decades now, it even predates the identification of HIV. So all Tanser has done is revived that tired old reflex as an explanation of massive rates of HIV transmission. But what is it about Africans that results in a virus that is difficult to transmit sexually spreading so fast in a population in which sexual behavior is little different from that found in many other low HIV prevalence populations?

Rates of new infections per year for both males and females in the study population are shockingly high But the researchers don't appear to have established how HIV was being transmitted. They have just assumed that transmission is all through heterosexual sex and then attempted to work out how risky heterosexual sex is among participants. But why is heterosexual sex so risky there? We are not told.

The authors find that "More than 24% of the adult population are infected with HIV and infection peaks at more than 50% in women aged 25–29 years and 44% in men aged 30–34 years." Given the fairly low probability of sexual transmission of HIV, 80 or 90% of women must be exposed to HIV if such high percentages end up infected.

The fact that male prevalence peaks in an older age group than female prevalence is sometimes explained by the 'fact' that older men have younger partners. But only some men have younger partners. Some have partners the same age as themselves. Like a lot of HIV related data, you could be forgiven for thinking that HIV in males is a different virus from HIV in females.

Despite flogging the dead horse of concurrency, which is worthwhile when you consider how much credence it still seems to have in the HIV industry, the authors remark that concurrency may have played a big part in earlier stages in high prevalence epidemics. But earlier treatment of the concurrency hypothesis suggest otherwise, so this concession doesn't exactly strengthen their argument for a return to the promiscuity theory of HIV.

And when it comes to their recommendations for HIV prevention strategy they really seem to weaken. They argue that 'messages' shouldn't be 'diluted'. Pumping out a fairly undiluted though highly stigmatizing message about HIV for many years has not resulted in UNAIDS having much success in reducing transmission, despite spending billions. In fact, the pharmaceutical lobby trying to increase drug use in the pretence that it will reduce transmission even refers to the institution's prevention work as a failure.

Telling people the truth about HIV transmission is not 'diluting' anything. If people are at risk they need to know about the risks and how to avoid them. UNAIDS have used the issue of 'dilution' as a reason for denying non-sexual risks, with the result that most people don't know that such risks exist, and therefore cannot avoid them. HIV prevention is not just an advertising campaign, even if it's never looked much different from one.

Concurrency Regurgitated: Dubious Evidence Found Increasingly Credible by Experts

For unbridled spite and anti-African prejudice, packed up in some academic sounding writing, it would be hard to beat Timothy Mah and James Shelton's 'Concurrency revisited: increasing and compelling epidemiological evidence'. Don't worry, it's not in the least bit compelling.

One of the main claims of the article is that the person engaging in concurrent relationships doesn't face as high a risk as all their partners. And this is supposed to explain why another study showed that, although men were five times more likely to report having concurrent relationships than women, women are far more likely to be HIV positive.

The gist of the pro-concurrency argument is that while multiple partnerships alone, even the sort of multiples estimated by those with similar prejudices to Mah and Shelton, do not explain extraordinarily high rates of transmission found in many epidemics, concurrency does explain them.

Concurrency is roughly defined as "overlapping sexual partnerships in which sexual intercourse with one partner occurs between two acts of intercourse with another partner". But because there is little useful evidence about rates of such behavior, in African countries or anywhere else, researchers usually resort to data which bears little application to that (or any other) definition of the word.

Authors promoting the concept as an explanation of high HIV prevalence claim that it is the only possible explanation. However it is not an explanation at all, even if you insist, as the HIV industry does, that HIV is almost always transmitted through heterosexual sex in African countries. It has never been demonstrated that concurrency levels are high where HIV transmission is high or that high levels of concurrency even result in high rates of transmission.

Mah and Shelton proceed to list various pieces of research that show that HIV is probably frequently transmitted non sexually; they just don't see the research as showing this. Earlier researchers 'presumed' that HIV transmission where only one partner in a relationship is infected occurred through extra-marital sex. They generally didn't check and when they did, they chose not to believe anything that didn't fit their prejudices.

People like Mah and Shelton could do with a bit of instruction in basic logic. If you assume the truth of your conclusion and use that as your premise, you will end up with a fallacy. Some of the researchers are even frank enough to use words like 'presume' and 'probably' in their cited remarks. But Mah and Shelton feign complete confidence in their conclusions, despite the high incidence of words like 'appear', 'suggest', 'likely', 'may', etc, throughout their paper.

A recent paper which shows prominent clusters of HIV prevalence around roads does not, as Mah and Shelton wish to suggest, support the concurrency hypothesis. But it is consistent with the hypothesis that infections cluster around health facilities and routes to and from health facilities. However, even after exposure to the many articles they cite in their bibliography, they still adhere to their half baked ideas, finding them "reasonable and salient".

Given their insistence that HIV is almost always transmitted through heterosexual sex in high prevalence countries (though nowhere else), the authors plump for male circumcision as the reason why HIV transmission rates in West Africa have always been far lower than in East and South African countries. This especially weak version of the highly questionable mass male circumcision drive taking place in East and South Africa is said to be 'plausible', which probably shows more about the minds (and scruples) of the proponents than anything else.

Just when you might have thought those tired old arguments had been put out to grass, along come Mah and Shelton to compound them with some even more clapped out considerations. In my next post I'll cover an article which shows that concurrency is not a significant driver of HIV transmission but that multiple partnerships are. And that old chestnut dates back to the days when even experts agreed that HIV wasn't always sexually transmitted. But that's how AIDS billions get spent.