Thursday, July 29, 2010

HIV: A Story of Blame, Stigma and Criminalization

I may have given the impression in earlier blog postings that I think the Vienna Aids Conference was a complete (and rather repulsive) waste of time and money. Well, there was one good thing to rise from the ashes; the Vienna Declaration (on drug policy). The history of HIV/Aids has been a story of blaming men who have sex with men, sex workers, drug users and Africans. Those whose behavior has been blamed for spreading HIV have been stigmatized and often criminalized.

The true costs of the conference are probably far higher than its achievements could justify, it's unlikely they will every be made public. But challenging policy relating to intravenous drug users, who are at particularly high risk of being infected with HIV and other diseases, is an excellent outcome. You can sign the declaration to show your support.

Persecuting intravenous drug users and putting them in prison has not worked. Despite this, it is still the response in many countries in the world. Yet there are countries in Eastern Europe and Asia who have HIV epidemics that are mainly fueled by intravenous drug use. Outside of Africa, it is said that one third of infections come from illicit drug use. These countries don't have prevalence rates anywhere near those found in a lot of African countries (most of which don't have high levels of intravenous drug use), but they are rising fast. The Vienna Declaration states that such responses to intravenous drug use create barriers to effective HIV prevention, treatment and care.

Much of the spite that has been directed at drug users and that has informed drug policies comes from people who also insist that harm reduction programs, such as supplying users with clean equipment, actually increases the problem. There is decades of evidence to show that this is not the case, that this kind of harm reduction doesn't increase drug use and that it does reduce the spread of blood borne diseases. But evidence has never had much impact on spite and prejudice.

The epidemics in Eastern European and Asian countries that are currently relatively low, but may deteriorate if the terms of the Vienna Declaration are ignored, are extremely worrying. The HIV industry has shown that it is perfectly capable of looking on while epidemics go out of control. This time may be different, we'll have to wait and see. There are many countries that have HIV epidemics that are confined to groups such as men who have sex with men, commercial sex workers and intravenous drug users and have never spread beyond these groups. But it's too late for the worst epidemics in the world, those found in many African countries.

Many countries in Africa have what the HIV industry refer to as 'generalized' epidemics. Most of the people infected are not men who have sex with men, commercial sex workers or intravenous drug users. They are Africans. As surely as if the industry had used the labels 'queer', 'slut' and 'junkie', the industry has stigmatized all Africans by its 'typology' of epidemics. For the industry, Africans have too much sex, much of it is unsafe sex, the men have no respect for the women, the women have no respect for themselves and none of them care much about their children, either.

Consider another couple of epidemics. An assessment of sex workers in three Afghan cities found that prevalence of HIV was 0.19%, despite the fact that 'risky sexual practices were common'. An assessment was carried out in Lebanon involving sex workers, intravenous drug users and men who have sex with men. HIV prevalence was 3.7% among men who have sex with men. There were no cases of HIV among the intravenous drug users or among the sex workers.

These HIV figures for Afghanistan and Lebanon are not for the countries as a whole, they are just for 'at risk' groups, what the HIV industry sometimes refers to as most at risk groups. According to their typology of epidemics, these two countries have 'concentrated' epidemics, where most people infected with HIV are members of one or more most at risk group. HIV prevalence may well increase and the epidemics may, according to the industry's lore, somehow become generalized epidemics. This would be unprecedented, but perhaps it could happen.

But the question the industry hates to hear asked is why, in certain countries only, did a difficult to transmit virus become a 'generalized' epidemic? Why was the virus transmitted (and continues to be transmitted) rapidly among populations, regardless of their sexual behavior? In Swaziland, in the population as a whole, HIV prevalence is over 130 times higher than it is among sex workers in those Afghan cities. The industry has had to build up a whole mythology about African sexuality to explain how this could happen. This mythology is unashamedly racist and sexist, but many Western institutions and governments, and especially the Western press, are racist and sexist, through and through.

With a very minor exception, the issue of non-sexual HIV transmission was not discussed at the Vienna Aids Conference or, at least, there was no hyped press release for the hoards of reporters to repeat, unchanged, unchallenged and unanalyzed. The WHO's Injection Safety Newsletter had an article by Savanna Reid asking why the role of health care transmission was barely acknowledged during the course of the junket. There have been significant outbreaks of HIV that have been caused by unsafe medical practices over the years but, aside from a few exceptions, they have remained uninvestigated. Such outbreaks have occurred in African countries but none have been investigated, to date.

The HIV industry is aware that HIV is transmitted non-sexually in developing countries, they just don't know to what extent because they have never been bothered enough to investigate. When 40,000 people in the US were found to have been treated at a clinic that had low standards of safety, all of them were contacted and tested for HIV, hepatitis B and C. (Some cases of hepatitis were found, non of HIV). But in countries where health care standards are low and many people don't even have access to qualified personnel, such outbreaks are ignored. The industry says they don't want people to lose confidence in their health services, which would be laughable, except that it is the very point being disputed.

Perhaps at the next Aids industry junket, those infected with HIV should wear armbands with a symbol to represent how they were infected, whether it's through sex work, same sex relationships or intravenous drug use. Those infected non-sexually can wear armbands without any symbol because, as far as the industry is concerned, they don't exist. And as for industry officials, they definitely should wear armbands to signify their part in the epidemic. I just can't decide what symbol would be most appropriate. Suggestions?


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