Depo Provera Hormonal Contraceptive, 'Sayana Press' and the Population Control Bruderbond

In developing countries "the risk for maternal death during childbirth can be as high as 1 in 15". One might expect this horrifying statistic to be used as an argument for adequate and safe maternal healthcare. Instead, it is being used to sell Depo Provera hormonal contraceptive for Pfizer, administered via a device claimed to be 'innovative'.

The device in question, the 'Sayana Press', may reduce the risks of needles and syringes being reused, and (hopefully) of single doses being split between two people. But calling something 'innovative' does not guarantee its safety, and the hope is that the drug can also be self-administered, in addition to being administered by community based health teams.

However, Depo Provera has been found to double the risk of HIV negative women being infected with the virus through sex with an infected partner, and double the risk of HIV positive women transmitting it to a HIV negative sexual partner. In the case of Depo Provera, population control, reducing the number of births in developing countries, is being prioritized over protecting women from being infected with and with transmitting HIV.

The citation above from one of PATH's blogs starts off talking about the long walk some women have to 'access' contraception, the long queue they have to wait in, the use of a smaller needle, etc. But dressing this up as an exercise in 'enabling' women or genuine service provision is pure humbug.

The Don't Get Stuck with HIV Collective is in favor of access to healthcare, especially reproductive healthcare, as long as that healthcare is safe. Depo Provera is not safe. The World Health Organization has accepted that it is not safe, but has decided that reducing birth is more important than safety, and even than reducing HIV transmission.

The blog goes on about reaching women in remote areas. Women in remote areas are far less likely to be infected with HIV than women in urban areas, or women living close to major roads, health facilities and other modern amenities. But the use of Depo Provera may be the very factor that increases risk under such circumstances.

'Getting health services out to people' is only desirable when those health services are safe. True, many women want to limit the size of their families, presumably many men do, too. But giving people options must include knowledge about healthcare safety and awareness about non-sexual risks from unsafe healthcare, dangerous pharmaceutical products like Depo Provera, and even the many vested interests that various parties in the population control bruderbond may prefer to keep to themselves.

Insidious use of words like 'innovative', 'community', 'village' and the like are great when raising funds or carrying out PR activities, but it doesn't get away from the fact that, in the case of a dangerous drug like Depo Provera, it is not the method of delivery that presents the increased risk of HIV transmission, but the drug itself.

Healthcare is a human right, and an inherently good thing; but unsafe healthcare is the complete opposite of what people in developing countries with serious HIV (also hepatitis, TB, ebola, MRSA, etc) epidemics need. Depo Provera has been found to be unsafe. Creating demand for it, therefore, is not in the interest of people living in poor countries; it only benefits Pfizer, and the many organizations and institutions that have been attracted to the potential funding it represents.

Depo Provera: English Guardian Aligns Itself With Neo-Eugenicist Policies

The English Guardian may face something of a dilemma when covering the WHO's failure to give clear advice to African women who have been persuaded to use Depo Provera and similar injectable hormonal contraceptives, which appear to be associated with a doubling of HIV transmission from females to males and from males to females; birth control is close to the heart of he who would control population, Bill Gates, whose Foundation sponsors the paper's Global Development section. Not that the article appears in the Gates sponsored section; perhaps there is no such dilemma.

But Sarah Boseley sticks pretty close to the WHO's press release and says that women who use injectables such as Depo Provera should also use condoms. As with the 'advice' from WHO, Boseley notes the use of 'dual protection' against pregnancy, on the one hand, and infection with sexually transmitted infections on the other. For Boseley and WHO, this means using condoms along with Depo Provera. But what neither seem willing to point out is that condoms on their own provide such dual protection.

So why would anyone want to use these expensive and possibly dangerous hormonal injections if condoms on their own give dual protection? Well, according to WHO and other 'experts' in reproductive health (often just a useful term for 'birth control'), condoms are not 'female controlled'; many people don't use condoms if they can help it. So rather than recommending that people who wish to avoid both pregnancy and sexually transmitted infections should use condoms, they recommend that people use Depo Provera, despite knowing that many people who opt for injectable hormonal contraceptives (and various other methods) cease to use condoms?

The oral versions of Depo Provera and similar contraceptives are said to be unsuitable because women need to take them daily and they may forget, or their husbands may object, etc. Injectable versions are said to be women controlled and only need to be taken every three months. In reality, they are to a large extent controlled by those who supply them, often NGOs and other institutions who believe strongly in the population control paradigm of development. Whatever synonyms are used, the concept of control is always detectable.

Boseley claims that women 'choose' Depo Provera and similar products but these pharmaceuticals are aggressively marketed by some of the biggest NGOs working in population control. Use of injectables has increased considerably over recent years but it's difficult to work out whether that's a matter of availability or genuine choice. Given the political and financial clout that NGOs and institutions such as the Gates Foundation have over the lives of people in developing countries, it seems unlikely that birth control is as high on the agenda of people in African countries as it is for the various non-African parties on the bandwaggon. One might even wonder if anyone gives a damn what Africans think about such matters.

It's astonishing just how uncritical Boseley is, in fact. She parrots bits about the WHO's 'expert group', but it was not concluded that hormonal contraception is safe ("Current evidence is not strong enough to prove or disprove an increased risk of HIV from hormonal contraception"). Rather, it has clearly been decided that it is safe enough for Africans and other poor people; it is not much used by white, middle-class Westerners. These products have not been shown to be safe, far from it. But the most important consideration for the WHO is that their goal of population control is not compromised by worries about safety issues, which they have been aware of for decades.

The logical conclusion to be drawn from the WHO's findings is that, if people want to avoid unplanned pregnancy and sexually transmitted infections, they should use condoms. The WHO statement is not based on a logical conclusion; it is a political declaration designed to protect the interests of Big Pharma, big NGOs and big private institutions with a population reduction agenda, and of course, the interests of the WHO itself. As for UNAIDS, they have taken a back seat; HIV prevention has never been their strong point.

Boseley finishes with a few non sequiturs and then supplies a version of the population control enthusiasts' mantra: "About 25% of the 128 million married or cohabiting women in sub-Saharan Africa aged 15 to 49 want but cannot obtain contraception." This self-serving statement doesn't tell us who was asked the questions, who was asking them, what questions were being asked and who chose those questions; a far higher percentage of women (and men and children) face numerous life-threatening issues on a day to day basis. It is likely that some of those issues would carry a higher priority, such as lack of clean water and sanitation, accessible and secure food supply, adequate living conditions, and many others.

When you know how you will get through the next few years, you can plan the next few decades. Family planning is not the panacea depicted by WHO when you are faced with low survival rates for your children and life expectancy for yourself. Population control in the form of birth control and family planning can be dressed up to look like an obvious choice for people in developing countries. But large scale population control exercises are not, neither in intention nor in practice, matters of choice for their putative beneficiaries. Population control is the prerogative of those who also control vital resources and the like, and who wish to limit access to these for people who are at the bottom of the heap.

Consider the role of eugenicist and neo-eugenicist doctrine in developing countries over a period of many decades; population has risen rapidly, regardless. Far from people being given choices over matters such as family planning, self-determination has been systematically denied. But Western maneuverings have failed to control population growth; they have only brought developing countries to their knees, creating new problems and exacerbating existing ones. When the rich and powerful talk piously about choice, it's always worth remembering that they consider their choice to be the only viable one.

WHO Refuses to Give Correct Information About Depo Provera

The WHO has issued a statement stating that the injectable and oral versions of hormonal contraceptives, such as Depo Provera, are safe for HIV positive people and those thought to be at risk of being infected with HIV. This is an odd statement to make when they have known for a long time that this form of birth control has been associated with double the risk of transmission from HIV positive women to HIV negative men and double the risk of transmission from HIV positive men to HIV negative women, where the woman is using hormonal contraceptives for birth control.

The HIV industry, and the population control obsessed development industry before them, have always placed controlling the reproductive behavior of people in developing countries above their reproductive rights and safety. Regarding Depo Provera and similar hormonal contraceptives, fatuous arguments about reducing 'unplanned' pregnancies, reducing reproductive health problems and HIV transmission have been used when the very method itself places those using it and their partners at increased risk of being infected with HIV and other sexually transmitted infections.

WHO did not make their decision on the basis of a "thorough review of evidence about links between hormonal contraceptive use and HIV acquisition"; they held their 'high-level' meeting in private and compelled all those attending to sign a confidentiality agreement, a gagging order. The thorough review would have taken, by their own admission elsewhere, several years to complete. Why the secrecy? Why the deceit? Who has an interest in putting the health and lives of millions of adults and children in Africa at risk? Is this a commercial decision, a political one, a combination or something far more sinister?

Reminiscent of the 'advice' given to African men who have been duped into being circumcised, ostensibly to reduce the probability of being infected with HIV (even though they may be far more likely to transmit the virus as a result), the WHO statement reminds people that Depo Provera and similar need to be used with condoms. However, we know condoms work; why not just use condoms, or perhaps condoms in conjunction with a method that is not harmful? If condoms don't work, why advise the use of a hormonal contraceptive that very likely increases transmission in both directions (or an operation that does little good and a lot of harm?)? We know that Depo Provera use is associated with reduce condom use, but condoms prevent conception and the transmission of sexually transmitted infections, such as HIV and many others.

What is the point of WHO now that they have shown that they do not represent the interests of ordinary women, particularly poor women; the vast majority of Depo Provera users are in sub-Saharan Africa? What about all the NGOs who have creamed off the billions of dollars of HIV money over the last thirty years to promulgate their eugenic policies? Because eugenic is what they are; if you're poor, have fewer children. People need advice, support and information, accurate, reliable information. Otherwise NGOs, WHO, UNAIDS (see UNAIDS' statement on Depo Provera) and the like are pursuing their own agenda, regardless of the interests of those they purport to serve.

Through the administrative fog generated by these grotesquely overfunded institutions, little is clear about Depo Provera except that the above institutions can not be trusted. If you want to advice, you'll have to carry out your own research, but start somewhere else; the very bodies tasked with informing people have failed, indeed, have refused to publicly discuss the information that is available to them. Judge their statements by that failure and refusal. There has never been a better time for African countries to distance themselves from those who see Africans as mere instruments in the agenda of money-making and empire building.

[There are links to some more reliable information on injectable contraception on the Don't Get Stuck With HIV website and blog. More will be made available in the coming days.]

Circumcision Enthusiasts: Screw the Evidence, We're Going Ahead

HIV prevalence has been high in Kisumu since early on in Kenya's epidemic. Rates went higher there than anywhere else in the country and they are still about twice as high as the next highest area, and three times as high as the national figure. This meant that a lot of HIV research work has been done in Kisumu. But no explanation has ever been given of why rates should be so disproportionately high there.

Naturally, fingers were pointed at the fact that people in Kisumu must have a lot of unsafe sex. But what is it about Kisumu (or Luo) sex that makes it so different from sex in other parts of the country? Some people have more than one partner, a few have lots. Most don't use condoms very much and many have their first sexual experience when they are still teenagers.

But those things could all be said about most of the other tribes and cities and provinces of Kenya, and about some people in every country. Birth rates, a sure sign of unprotected sex, are highest in Northern, ethnic Somali inhabited areas. There isn't really anything extraordinary about Kisumu or Luo sex that anyone has been able to discover.

Also early on in the epidemic, it was pointed out that Luo men are not usually circumcised. It was suggested that this might make them more susceptible to HIV. Research has shown that HIV transmission can appear to be connected to circumcision status. However, though in some places circumcised men are less likely to be infected, in others uncircumcised men are less likely to be infected.

But this finding didn't make the people for whom mass male circumcision is their personal cursade very happy. The more research they did, the more ambiguous the effect of mass male circumcision appeared to be. But they are still at it. In fact, research suggests yet another thing that was recognised early on in the HIV pandemic: that HIV is probably not always transmitted sexually.

So part of the personal crusade involves explaining away data which suggests that not all HIV is sexually transmitted. A paper published in 2007 asking uncircumcised, sexually active young men about their sexual behavior found that 5% were HIV positive, which is higher than you would expect among people who have not been sexually active for very long, especially among males.

The risk factors are particularly interesting, not just because risky sex is likely to be driving a good deal of HIV transmission, but because some non-sexual risk factors are also likely to be involved. Both medical injections and traditional practices (saro, bloodletting) were implicated. Those who received injections in the last 6 months were three times more likely to be infected that those who had not and those who ever practiced bloodletting were twice as likely to be infected.

Another surprise was that men who reported washing their genitals immediately after sex were also less likely to be HIV positive. This gives some confirmation to the view that circumcision may not be necessary if men take measures to ensure penile hygiene. Little research has been done into this phenomenon but it is not clear why the authors of this research paper are still advocates of circumcision without knowing how and why HIV transmission appears to be correlated with circumcision status, sometimes positively correlated, sometimes negatively.

Catholics were more than twice as likely to be HIV positive as members of other religions and this was not related to condom use. In fact, condom use is not even a reliable indicator of risk.

The authors try to explain away the data about receiving injections by arguing "because this is a cross-sectional analysis, it is also possible that HIV positive men were more likely to report recent injections to treat HIV/AIDS related illnesses". But these are young men. Even the HIV positive among them are unlikely to be receiving injections related to their HIV status.

While 72% of eligible HIV negative people took part in the survey, only 22% of HIV positive people did so. This could skew the results considerably, though it's not possible to know in which direction they would be skewed. But despite this, and despite the indications that HIV is not always transmitted sexually (or 90%, as is usually claimed), the authors are still devoted advocates of mass male circumcision.

If Tanzania Had More Health Personnel, Would HIV Be More or Less Common?

Apparently "One-third of U.S. hospital admissions can expect a medical error, an infection or other adverse outcome". But sometimes up to 90% of these outcomes can remain undetected. This is in the country with the highest health spending per head in the world. What percentage of patients in Tanzania, say, could expect a medical error?

For a start, who is counting? There is generally no way of keeping track of such errors, even serious ones. There are too few health personnel, too few of them are trained and most hospitals don't have the capacity to keep such records or prevent such incidents.

On the plus side, if you could express it that way, most Tanzanians will never see a doctor and won't spend too much time, if any, in a health facility. The percentage of patients suffering adverse outcomes may be higher than in the US but the number of people involved is a hell of a lot lower.

An article about the pastor in Loliondo, Arusha Region, who claims to have a concoction that cures just about anything, points out that the people flocking to drink the potion are not just following the herd; they are desperate.

This is a significant observation. For people in rural parts of Tanzania, and that's over 80% of the population, all health services are elusive, requiring a lot of patience, faith and perserverence, perhaps even some money.

This magic potion is even said to cure HIV/AIDS. It costs less than a dollar, 500 Tanzanian shillings. Of course, people have to pay the costs of waiting for days, not working, paying for accommodation, food, transport, bribes and anything else that someone can screw money out of them for.

But this may not be so different from some antiretroviral (ARV) programs, where the drugs, if you can get hold of them, are free. And ARVs don't guarantee survival either. Under the right conditions ARVs are very powerful, but many Tanzanians don't live in such fortunate circumstances.

This article cites estimates that Tanzania needs 126,000 health workers but only has 35,202, a 76% deficit. The ratio of doctor to patient in some places is as bad as 1 to 62,000 but in Kigoma, that ratio is one to 308,000. Coincidentally (perhaps), Kigoma is also the region with the lowest HIV prevalence in the country.

Per capita health expenditure is $22 in Tanzania, 2.7% of the global average. Much of that, an estimated 75%, comes out of the pockets of people where the majority wouldn't earn much more than a couple of dollars a day. Most illnesses, clearly, go untreated.

When I think of health conditions in East African countries and then look at HIV prevalence, I wonder why HIV prevalence is not a lot higher. And I wonder why HIV prevalence is so much higher in other African countries where far more people have access to health care.

But looking at the figures for adverse outcomes in the US, I'm not so surprised. Good health facilities are dangerous enough, I hate to think of the uncounted hazards people face in bad health facilities. In countries with high HIV prevalence, health facilities could be among the worst places to go.

Can We Guarantee that Public Health is Truly in People's Interest?

There's been an outbreak of measles in Somalia and apparently it may be connected with rumours that the vaccine could cause HIV in children and interfere with their reproductive abilities.

What is your reaction to such a statement? Would you dismiss it as nonsense and say that public health programs aim to prevent and treat diseases, not spread them? Would you say that no one would try to influence the fertility of a whole population, for any reason, and even put their lives at danger while claiming that it is in the interest of public health?

That would be a naive reaction. Some of the wealthiest institutions in the world care a great deal about the fertility of whole populations, especially when those populations are poor. Let me name some: the US Government, the Bill and Melinda Gates Foundation, FHI, PSI, the World Bank, and there are many others.

We don't know what lengths these parties would go to for the sake of their agenda. The Tuskegee Syphilis 'experiment' may seem like something that happened a long time ago, but Ugandans taking part in more recent HIV research were followed to see how long it took for some of them to become infected and how long it took for some of them to infect others. Many of them are now dead, others are still suffering from the disease and transmitting it to others.

What does the WHO or UNAIDS care about who gets HIV, how many people they may go on to infect or how many people die, and whether painfully or not? UNAIDS still insists that HIV is almost always transmitted through heterosexual sex but an estimated 30% of HIV positive infants in Mozambique (who can be matched with tested mothers) have mothers who are HIV negative.

UNAIDS's response in such situations is to suggest that the infants were raped. It's pretty obvious what their attitude towards Africans is, when they know that infant rape is no more likely in African countries and that incidence of rape, even infant rape, could never be high enough to explain such massive rates of infant HIV.

Quarraisha Abdool Karim, one of the people behind the CAPRISA vaginal microbicide gel fiasco, is planning another way of influencing reproductive choices, in the interest of public health, of course. This time, the idea is to hand out sums of money 'to reduce HIV infection in High School Learners'.

This is interesting for public health experts working with TB. This disease if often caused by occupational hazards, such as mining. It might be too extreme to pay people not to breathe when they are working. But you could compensate them for not working on some of the more dangerous tasks. That would at least drive up the value of labour.

Karim's plan, by the way, is not without it's exclusion criteria. Those who are 'cognitively challenged' will be excluded. I wonder if those who could be considered morally challenged would also be excluded, but there's no mention in the brief details on WHO's site.

Several countries have reported involuntary sterilization carried out on people who were said to be HIV positive. But a program in the US, 'Project Prevention', plans to offer people money to be sterilized if they are drug 'addicts' or 'alcoholics'. If 'addict' or 'alcoholic' just refers to users of these drugs, this would be bad enough, though I wonder who is judging. But what if those judging are evangelical Christians?

And the project is hoping to move to South Africa where it will aim at HIV positive women. Why it won't aim at men, I don't know. There are far more male than female drug and alcohol users. But women are always an easier target. Project Prevention's final solution can eventually move on to men.

One of the people behind this 'initiative', Barbara Harris, says "How can anyone object to anything that can prevent innocent children suffering needlessly?" She could try asking UNAIDS personnel in Mozambique the same question. Apparently Project Prevention are already operating in Kenya, where people are offered $40 (about a month's wages, a fraction of what those in the US receive) to take long term contraception.

Doctors needn't worry, they are given $7 to perform the insertion. Let's hope they wear a new pair of gloves with each patient and avoid reusing single-use instruments. They haven't had a great record of taking such precautions in the past. Even simple procedures like this carry serious risks in countries with a miniscule capacity for health provision, one of those risks being HIV.

This charade reminds me a bit of the mass circumcision campaigns currently raging in Kenya. In a country where only a few dollars are spent per head on health, some institutions are willing to pay many times that to slightly reduce (if at all) the probability of infection with one disease out of hundreds.

Measles is a terrible disease and it is especially worrying that the outbreak in Somalia (and other countries) could have been avoided if it were not for some rumour, probably completely unfounded. But public health authorities do not have much credibility when it comes to being able to assure people that there is no hidden agenda. There usually is a hidden agenda and it looks as if global public health is busy sawing off the branch they are sitting on.

The article concludes: "it is sad that in this day and age our children must die because of ignorance and lies". But the rumours in Somalia are based on lack of information. Far worse are the lies and half truths based on thorough knowledge coupled with an unspoken (and unspeakable) agenda. Lies do not exclusively arise from ignorance; the most harmful lies are those from people who know the truth.