The Economist's Delusion: Money Alone Can Stop HIV

A drug [for HIV] called money, says The Economist headline. According to the article, money is the answer to reducing HIV transmission. The reason why money is the answer? Because the article assumes that most HIV is transmitted by young girls having sex with older men in return for money. There are a number of flaws in this thesis; for example, not all HIV is transmitted sexually, not all sex is transactional sex, not all poor girls are prostitutes, not all 'older' men pay younger girls to have sex, most 'older' men are not HIV positive, etc. So why would giving money to the girls be a 'drug'?

Well, a 'scientific' paper says so. The paper concludes that "Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low income settings." Girls or parents in an intervention group were given varying amounts of money; some had to show that they were attending school; others didn't have to meet any conditions. But there are also a couple of flaws with this paper; it is not known how many of the girls were already HIV positive when they joined the program and, out of the girls who became infected, it is not known whether they were infected through sex or what kind of sex or whether they were infected through some other mode of infection, such as unsafe healthcare or unsafe cosmetic practices.

The paper starts off with the claim that "Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women." But what are these suggestions based on? I agree that many people in high HIV prevalence countries lack education and are impoverished, and often dependent; this may be particularly true of women and girls. But does much of the research data currently available, for example, the kind of socio-demographic data collected in Demographic and Health Surveys, give reason to think that poverty and low levels of education are correlated in such a way that there may be some kind of causality involved?

In fact, the contrary is often true. The relationship between economic status and educational level on the one hand, and HIV prevalence on the other, is often very unclear. And where it is clear, HIV prevalence tends to be higher in the wealthier and better educated quintiles. Fair enough, correlation is not causation; but lack of correlation does not support the sort of research that went into the above scientific paper. Only the unsupported assumption that HIV is always or almost always transmitted through heterosexual sex in African countries allows such research to be carried out, and such conclusions to be drawn from it.

Those who received money had one third of the risk of testing positive for HIV and one quarter of the risk of testing positive for herpes simplex virus, compared to those who did not receive money; there was no difference between those who had to attend school and those who did not. Among those who had already dropped out of school, there was no difference between those who received money and those who did not. Despite the small numbers infected among school-going girls, it is concluded by The Economist that money is a HIV 'drug'. What effect did the cash and/or the conditionality have on HIV transmission? We really have no idea. And if it did have any effect, it was small.

The Economist exaggerates shamefully: the researchers "conducted a randomised clinical trial of the idea that money, and money alone, can stop the spread of HIV." This allows the author to indulge in Western-style fantasies about African sexuality and money-grabbing women, sugar daddies and HIV. And it is concluded that bribery works when it comes to reducing the risk of HIV transmission. Would they also conclude that we need a sliding scale so that we bribe wealthier people with larger sums of money and poorer people with smaller sums of money? What about if people become infected with HIV, would they then be entitled to a larger bribe in return for not risking transmitting the virus to anyone else?

A good deal of Demographic and Health Survey data shows little correlation between unsafe sexual behavior and HIV prevalence. For example, those who sometimes use condoms can be more likely to be infected than those who never do. Circumcised men, despite all we may read on the subject, are often more likely to be infected than uncircumcised men. A recent paper even showed that paying for sex was inversely associated with HIV infection. There isn't even a simplistic relationship between sexual behavior and HIV, let alone between money and HIV.

The Economist may misrepresent The Lancet paper, but the latter is crying out to be misrepresented. It plays into the hands of those who hold insultingly racist and sexist views about Africans, especially those who are HIV positive and even those who live in high HIV prevalence countries. To carry out research like this you must already believe in a causal connection between HIV and transactional sex. All those involved in these exercises have demonstrated is the institutional racism and sexism that is to be found throughout the HIV industry. Of course, this is not to say that those directly involved are themselves racist or sexist; they may not be.

[For more about non-sexual risks for HIV transmission, see the Don't Get Stuck With HIV site and blog.]

Circumcision, PrEP and Vaginal Gel: HIV Prevention Show-Stoppers?

The highly unscientific but quite triumphalist term 'game-changer' appears frequently in the HIV literature. It has appeared in articles about pre-exposure prophylaxis (PrEP) after the iPrEx trial, and also in relation to three mass male circumcision trials. PrEP was said to reduce risk by 44% and circumcision by between 50 and 60%.

However, both of these figures were for relative risk. The respective figures for absolute risk were 2.3% and 1.3%. The term 'show-stopper' might be more appropriate than game-changer. The result of the trial of Tenofovir vaginal gel, also referred to as a game-changer, was said to be 51% effective; but little mention was made of the absolute risk reduction, which was about 5%. (See Joseph Sonnabend's very readable blog on relative and absolute risk.)

Why does this matter? Well, suppose the trial was between a group of people who were given a placebo, forming a control group, and a group of people who were given a herbal dose from the Old Man of Loliondo (look it up if you haven't heard), the second group being the intervention group. The difference between being given a placebo and given one out of many available herbal concoctions should be quite small. HIV incidence in both groups should be roughly the same. But suppose it was lower among those in the intervention group, and that 2 people became infected, compared to 4 in the control group. The absolute risk reduction would be so low that you might decide to spend your 24 Euro Cents for the herbal concoction on something else (though certainly not circumcision, PrEP or vaginal gel, which are at least hundreds of times more expensive).

I apologise to the Old Man and his acolytes, but he can take comfort in the fact that his concoction might easily reduce HIV infection risk as much as circumcision, PrEP or vaginal gel do. Indeed, it might even exceed their rather puny results, who knows? The relative risk reduction in the above example would be 50%. And if people were told that, they might think the Old Man is worth a visit. But they would be wrong. Even if the absolute risk reduction were a lot higher, people would be better advised to use condoms, much as they are when it comes to circumcision, PrEP and vaginal gel.

There have been numerous articles about how happy men and women are with circumcision programs, many of which have already been running for three or four years and claim to have operated on several million men to date. But there is also a recent article in a Zimbabwean paper questioning circumcision, even referring to it as a 'dangerous distraction'. In fact, the article uses the absolute risk reduction figure, so it's not surprising they question the wisdom of circumcising millions of men. It's just disappointing that more articles don't use this figure, or both figures, and question the exuberant press releases a bit more closely.

Apparently it was estimated that 750,000 HIV infections could be averted if 80% of adult males were circumcised. But this figure now seems difficult to support, especially as incidence is already dropping in some groups in Zimbabwe and in many other sub-Saharan African countries and has been for quite a few years. Gregory J. Boyle and Gregory Hill have specifically pointed out how the superficially impressive 60% relative risk reduction needs to be compared to the 1.3% absolute risk reduction. Hopefully, people will use these figures to make up their own minds before being railroaded into being circumcised or into persuading their partner or relatives to be circumcised. They also raise the rather embarassing fact that in quite a number of African countries, HIV rates are higher among circumcised people than uncircumcised people.

It's great that these questions are being asked, in an academic paper and in a newspaper. But none of the serious objections to circumcision, PrEP or vaginal gel are new to those carrying out research in these areas. There appears to be a cabal of HIV 'experts' who are doing everything they can to persuade people of the effectiveness of various public health interventions by selectively publishing favorable data and suppressing or giving far less attention to less favorable data.

[For more about non-sexual risks for HIV transmission, see the Don't Get Stuck With HIV site and blog.]

Condoms More Effective, Cheaper & Safer Than Male Circumcision & Depo Provera

Male circumcision as a HIV prevention intervention has often attracted the response that if you use a condom it's unnecessary and if you don't use a condom it doesn't work; so why not just use a condom? But similar remarks have been made about Depo Provera and other hormonal contraceptives; if you don't use a condom along with Depo, you risk being infected with sexually transmitted infections, such syphillis, gonorrhea, herpes and HIV. While if you just use condoms, you will be protected against those diseases and you will also avoid unplanned pregnancies; so why not just use condoms?

But there are deeper problems with both male circumcision and Depo Provera. The former almost certainly increases HIV transmission from males to females, and females are far more likely to be infected already; HIV prevalence in many groups is several times higher among females than among males. And Depo Provera may increase HIV transmission in both directions; the WHO is still out on that one and have said it could take years to give the product the all clear. So why don't they just recommend that people use condoms? Instead, they recommend that people use both Depo Provera and condoms.

One of the selling points of Depo Provera was that it would prevent conception for women who couldn't be guaranteed that their partner would use a condom. But if a condom is not used and both parties are at increased risk of being infected where Depo is used, using the hormonal contraceptive is more dangerous than not using it. There are alternatives to Depo Provera, but if they are not viable, available, accessible or whatever, it seems clear that it should not be used without condoms. Using neither condoms nor Depo Provera cannot be recommended, but using Depo Provera on its own is foolhardy. People don't weigh up the dangers and then decide that HIV is a less worrying risk than an unplanned pregnancy; they want to avoid both. Only population control hardliners believe in birth control at all costs.

There seems to be some confusion about Depo as a result of WHO's 'high level' meeting. There's an article about what may or may not have been discussed at the meeting to review the evidence about Depo Provera and it says that no conclusive decision was agreed. In a sense that's true but WHO have said that people should continue using the product, even if they are at risk of being infected with HIV or if they are already infected; however, they should always use a condom. The problem is, that's what they said before the meeting as well. In other words, the evidence they say they are going to take several years to consider has made no difference to the advice they give. Perhaps some are worried that evidence that can trigger years of research should also trigger a higher level of caution?

Articles on the subject of Depo Provera often mention that it is one of the most popular forms of modern contraception, but it has also been marketed very aggressively in African countries, at married women, at sex workers and at young, unmarried girls and women. Strangely, Depo Provera is nowhere near as popular in Western countries, except among certain ethnic populations. Hormonal contraceptive marketing is often dressed up as public health advice about family planning and birth control, which points to a dangerous conflict of interest. Marketing is not disinterested advice, quite the contrary, and it is not WHO's job to market pharmaceuticals, though people could be forgiven for thinking otherwise. But from whom do African women now get impartial advice?

Over a billion dollars, perhaps two billion, have been earmarked for an enormous and senseless mass male circumcision program; some say over 20 million men and boys will be circumcised. Many may be too young to be sexually active, too old to be sexually active, sexually inactive for other reasons, not facing any sexual risk, facing too high a sexual risk for circumcision to be of any benefit (for example, those who are engaging in anal sex with men or women), facing non-sexual risks that are far more serious, etc. Many more will probably give up using condoms in the belief they no longer need them, though some circumcision enthusiasts deny that this is a risk. Even some women already believe that circumcised men pose no HIV risk and that unprotected sex with them is safe.

Worries raised about Depo Provera are not the kind you can just ignore until several more years of research has been carried out; what if the research confirmed earlier suspicions about the product doubling risk of transmission in both directions? And with male circumcision, the evidence is slim; the 60% risk reduction is a reduction in relative risk. The reduction in absolute risk is almost negligible. Many hundreds of operations would need to be carried out to prevent one infection; but the increased risk through reduced condom use and other precautions will probably result in an overall increase in transmission.

It could be asked why international health institutions and other parties are pushing ahead with these two interventions when they both seem more likely to increase HIV transmission than reduce it. Doing nothing would seem preferable, although there are a lot of positive things that can be done. For example, prevention of mother to child transmission is successful but it needs to reach all mothers, and earlier rather than later. Reducing transmission through unsafe healthcare would also be very cost effective as it would also reduce transmission of numerous other diseases. And condoms are good for preventing sexual transmission of HIV and other diseases, as well as unplanned pregnancies. Instead, there are huge sums of money behind useless and risky circumcision programs and highly suspect Depo Provera and birth control programs; perhaps therin lies the answer.

[For more about non-sexual risks for HIV transmission, see the Don't Get Stuck With HIV site and blog.]

UNAIDS' Loss May Be Kenya's Gain

It sounds like Kenya is getting more serious about non-sexually transmitted HIV, at last, particularly where the virus is being transmitted through unsafe healthcare. So far, it has been mentioned that healthcare professionals face some risk of being infected, especially where safety procedures are not strictly followed. But there is also an even higher risk to the patient. If equipment is reused without adequate sterilization, one or more patients may be infected with HIV, hepatitis and various other blood-borne diseases.

There's a relatively lengthy article in Africa's Business Daily about the training that will be given to health professionals in the new School of Phlebotomy, opening soon in Nairobi. While risks to patients are not explicitly mentioned, it is clear from a number of comments in the article that they will benefit the most if this facility is successful in its aim of training 25 people every fortnight from April onwards. Some of the sponsorship comes from Becton Dickinson, one of the world's leading producers of injecting equipment. But worth far more than the money they are contributing is the acknowledgement that there is a problem with unsafe healthcare; and equally, that there is a cheap solution to it.

This acknowledgement, which follows years of denial by international HIV institutions, should fit well with another proposed change in Kenya, mentioned in my last blog post; the idea that HIV needs to be integrated into healthcare as a whole. To this end, the government health departments and the National Aids Control Program are in agreement that there can no longer be parallel health systems, for HIV on the one hand and for everything else on the other. This is wasteful and particularly untenable at a time when HIV funding is being cut. (Unfortunately for almost every other area of health, funding was cut in the 1980s and has never recovered.)

Despite all the gloom about reduced HIV funding and the need to rethink how the disease should be approached if most other health issues are not to continue to be ignored, there are some very promising trends in public health in Kenya. Better infection control through improved training, equipment and support is a very good start. But another highly successful area in HIV prevention has been prevention of mother to child transmission (PMTCT). There are far more women in need of this form of treatment than are currently receiving it, but very wide coverage could cut transmission to the sort of low levels seen in Western countries.

There are many expensive distractions, such as male circumcision and potentially harmful hormonal contraceptives, both of which could be suspended until they have been shown to be effective in the case of male circumcision and safe in the case of Depo Provera and similar birth control methods. On the plus side, greater use of condoms would obviate the need for both of these strategies; condoms are cheap and, as circumcision and birth control enthusiasts have been forced to point out, neither of the two expensive options are of much use on their own.

There is a lot of talk about the 'dual need' to reduce unplanned pregnancy rates and at the same time, eliminate the risk of transmitting HIV and other sexually transmitted infections (STI); condoms meet this dual need. Some may view condoms with suspicion, but Depo Provera without condoms carries a far higher risk than condoms on their own, or even, arguably, nothing at all. Birth control enthusiasts seem to think the risk of unplanned pregnancy is so important that an increased risk of HIV infection is a price worth paying; but efforts to reduce MTCT seem a little self-defeating if risks to mothers are being increased.

In fact, far better than passively waiting for mothers to become infected and then attempting to intervene with PMTCT is reducing infections among women, which suspension of the use of Depo Provera could contribute to, perhaps significantly. Male circumcision is also likely to increase HIV transmission from males to females (even if it reduces infection from females to males); so again, suspending the strategy until these matters have been clarified could reduce MTCT by reducing the number of infected women. The amount of money saved by not continuing with these highly suspect programs would be small compared to the amount saved by not infecting people by continuing them; and the effect is additive!

What about the high risk groups so beloved of journalists and those who need to attract the attention of journalists? Well, they will also benefit from improvements in the safety conditions in health facilities. Those who regularly attend STI clinics, such as sex workers, their clients, men who have sex with men and perhaps intravenous drug users; people regularly receiving healthcare for STIs, who may face far higher risks of being infected with HIV non-sexually than sexually. Just think about it: many of them end up in the same clinics. They may appear to be at risk of being infected with HIV through their work or lifestyle, but there are also additional non-sexual risks.

This may be the first time in the history of HIV that countries with high prevalence get to make their own decisions about HIV (and health as a whole) and set their own priorities. It is possible that Kenya is already way ahead of the now faltering international HIV institutions, who, in the absence of the massive levels of funding they have become used to, have taken to wandering around like clapped out old druggies in search of a pusher who may never return.

[For more about non-sexual risks for HIV transmission, see the Don't Get Stuck With HIV site and blog.]

Time To Rethink HIV and AIDS Spending

Back in March last year, in an article entitled "Aids to lose ‘special status’ in new plan", Dr Martin Sirengo of Kenya's National Aids Control Program said “HIV is no longer a big issue. It is just like any other disease because we now have the knowledge about it, we have the drugs, and nearly everybody knows about it”. Sirengo is perhaps exaggerating but more than 90% of Kenyans are not HIV positive and many suffer from diseases that could have been prevented or could be treated, if the government (and foreign donors) saw this as important enough.

Sirengo goes on to say that Kenya "is in the process of implementing a disease integration model that will eventually do away with emergency response to HIV/Aids and address it like any other chronic disease." Apparently the program was already underway then and was due to be fully implemented by 2012, resulting in the "demise of special rooms set aside for voluntary counselling and testing at health centres or even special pharmacies for HIV cases".

It's hard to know whether this 'integration' was driven by a desire to spend less money on HIV or if it was seen as a way to spread health funding beyond facilities that deal with HIV and pretty much nothing else. After all, HIV positive and HIV negative people alike suffer from and die from all sorts of conditions. But Sirengo says "These may be the first steps that could eventually lead to the dismantling of parallel, but expensive administrative structures set up to manage the pandemic."

At the time, Sirengo's comments were expected to meet with a lot of opposition from NGOs, government agencies and other parties benefiting from funding specifically for AIDS. He pointed out that specialist skills would still be needed, and that the approach was being gradually rolled out already. But sure enough, a whole group of institutions concerned with HIV and AIDS got together to protest.

It's worth looking carefully at the letter this group wrote, outlining why they see the proposed approach to HIV and AIDS as so objectionable and arguing that HIV is still an emergency. The letter is addressed to the Ministers for Public Health and Sanitation, for Medical Services and for Special Programs. It is pointed out how many people are estimated to be living with HIV, how many need treatment, how many receive treatment, numbers of new infections per year, deaths from AIDS, children born with HIV, etc.

The figures are frightening, but they don't immediately add up to an argument that the country, already starved of public sector spending on health for several decades, should spend so much money on parallel systems for one disease. The letter does not make it clear why testing people for HIV in one place and testing them for all or most other disease somewhere else is a good way of ensuring high levels of public health.

Rather, the big gap between what is required and what is available suggests a more urgent need than ever to use every shilling wisely. If a health facility can test for HIV, why should the same facility not also be able to test for other far more common diseases, including non-communicable diseases?

The letter mentions issues of stigma and discrimination, as if having parallel systems for a disease said to be between 80 and 90% heterosexually transmitted could in any way reduce these; on the contrary, separating HIV from other health issues is far more likely to fuel stigmatizing attitudes and discriminatory behavior. In fact, given that it is unlikely such a massive proportion of the disease really is spread sexually, treating HIV as different from all other diseases is a form of discrimination. People found to be HIV positive are effectively branded as being promiscuous.

However, the group is not opposed to some kind of integration. Rather than opposing the approach at all costs, they seem to interpret Dr Sirengo as using it as a smokescreen to reduce overall spending or as an excuse for continued underspending on health. They are right, sadly, in their claim that health is underfunded. But while HIV may not be overfunded, there appear to be a disproportionate number of institutions and facilities dedicated almost entirely to the virus when the majority of sick and dying people do not have HIV.

Anyhow, all this was before the Global Fund decided that it would be suspending disbursements for the next two years. And now, Dr Sirengo's comments have appeared yet again, this time in an article that says both donors and the government agree that 'downgrading' HIV's 'emergency status' is the way to go. It had been suggested that the Dr's remarks were his own and not representing those of the National Aids Control Program or the government; but even the Public Health and Sanitation Minister, Beth Mugo, is cited as being in agreement: "Integration is the way to go because it makes logistical and economic sense".

If there are about 110,000 new infections every year, and about 90,000 deaths, the costs of treatment and care will continue to rise. But one of the best ways of ensuring that the numbers of new infections go down is to identify who is at risk, what risks they face and what strategies most effectively reduce the risk. It will be painful for many groups working in the HIV and AIDS field to face up to the fact that it's not all about sex, but concentrating almost entirely on sexual transmission has failed; it's a good time to admit to being wrong.

Health facilities need to be safe places, where people don't pick up something worse than they had when they arrived, such as hepatitis or HIV. It would be inhumane to ignore the plight of those who are living with HIV; but it would be insane to continue to leave non-sexually transmitted HIV uninvestigated. And Dr Sirengo is wrong in one crucial respect; almost everyone does not know about non-sexually transmited HIV. If people don't know about non-sexually transmitted HIV, they will not recognize non-sexual risks and will no know how to avoid them.

[For more about non-sexual risks for HIV transmission, see the Don't Get Stuck With HIV site and blog.]

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.]