Monday, July 19, 2010

Difficult Questions That Won't Be Asked in Vienna

Press releases say that about 20,000 people are expected to attend the Vienna Aids Conference this year. I don't know if they will all attend for the whole six days but if they do, it is likely that someone or some institution will be paying an average of $200 per day per person. They conference may not cost $24,000,000, perhaps it will only cost $10,000,000. But even so, that could supply 50,000 people in developing countries with antiretroviral treatment (ART), the drugs and other aspects of treatment, for a year. That's assuming that an average of $200 is being spent per person.

I wouldn't want to suggest that the Vienna Aids Conference is a useless waste of money, it may well have its value. But that much money and that many people in that city? Much of the discussions will be matters that have been both published and well publicized over the last year or two. In fact, a lot of money has already been spent on disseminating the data, reports, presentations, findings, opinions, maunderings, crackpot ideas and things swept up after previous conferences and stuck together with cello tape.

We know already from pre-conference releases that many of those attending buy into the 'behavioral paradigm', the view that HIV is primarily transmitted by heterosexual sex (in African countries) and that in order to reduce transmission, people need to change their sexual behavior. The behavioral paradigm is divisive, racist and sexist and even its closest adherents know that it is entirely without foundation. Yet, there are unlikely to be many people presenting at this conference, or any other Aids conference, willing to admit that their whole theory of HIV transmission is based on a falsehood.

We can only speculate about why the HIV industry seems hell bent on allowing HIV to be transmitted through non-sexual means, such as unsafe health care or cosmetic practices. And it is also hard to understand why they will probably continue to allow HIV to be transmitted sexually by failing to implement any effective prevention strategies. Perhaps the industry is concentrating on 'solutions' that make enough money to be attractive to those who hawk those solutions. They do seem to favor technical solutions, ones that involve expensive commodities. But alas, this is only speculation.

It is unusual to see articles in the mainstream media that even mention non-sexual HIV transmission, especially transmission through unsafe health care. But there was one in Media Global yesterday. This article mentions the WHO's estimate that between 5 and 10% of all HIV infections in Africa occur as a result of unsafe blood transfusions. It also mentions that a WHO researcher estimates that 17% of HIV infection in African countries is due to unsafe injections. Worse still, a substantial proportion of transfusions and the majority of infections are entirely unnecessary!

Putting these together, over 20% of infections could be coming from unsafe health care, perhaps almost 30%. To put that in perspective, only around 10% of new HIV infections in Uganda are estimated to come from commercial sex workers, their clients and their clients' partners added together. If 20-30% of infections are coming from unsafe health care, the percentage attributable to sexual transmission must be considerably lower than previously thought. Unsafe health care could even be the main route to transmission.

The HIV industry knows how to make a lot of noise. After all, it's a very well funded industry. It receives billions of dollars of public money every year and the world's media, public and private, hang on to every word that emanates from official HIV industry mouthpieces. They are not shy about trumpeting their successes, their needs, their problems and their highly suspect philosophy. But they are amazingly reticent when it comes to non-sexual HIV transmission. It's as if the very non-sexuality of it is as taboo as the sexuality is in other contexts.

Another thing the HIV industry is reticent about is prevention, but that's understandable. They have frittered away billions in useless programs and spent years researching others which will never fly. They have come up with tonnes of worthless strategies and now they haven't a clue what to say about HIV prevention any more. So they have come up with the idea of saying that treatment is prevention. And so it is, in a sense. If all HIV positive people were to be aware of their status and everybody at risk of becoming infected were to be tested regularly, perhaps every year, then treatment could play a big part in prevention.

But we are very far from that position. It's possible that 20% of HIV positive people know their status. But very few people test regularly. And many of the people who are at risk of being infected don't know they are at risk. The reason they don't know they are at risk is because the HIV industry will not speak about non-sexual risk, nor will they allow anyone associated with them to speak about it. So even their 'treatment as prevention' sleight of hand will fail for the very reason that they will not admit that non-sexual HIV transmission could be as common as sexual transmission and may be even more common.

The HIV industry machinery is concentrating on the usual, money. Some of the biggest sources of funding are being cut or flatlined. I think this is a mistake because the countries with the worst epidemics are most in need of more money, not less. But given how badly the billions of the last 20 years have been spent, is it wise to continue allowing the same people and the same institutions to receive whatever money is being made available? Is it wise to continue spending money on the same failed policies of the past? It's a bad time to knock everything down to the foundations, but which part of the HIV industry is worthy of being allowed to continue? These questions will probably remain unanswered, even unasked, at the Vienna Aids Conference. But if HIV is ever to be eradicated, there will have to be an answer.


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