Saturday, July 30, 2011

BBC Trying to Fill a Niche Vacated By News of the World?

One of the issues that crops up a lot on this blog is the kind of things that non-Africans would believe about Africans. There was a lot of media coverage (or 'wallowing', even) around albinos being targeted by witch doctors or traditional medicine practitioners in Tanzania.

The problem is not that the media covered these terrible events; the problem is that just because such events were uncovered, this doesn't mean they are just a part of Tanzanian or African life.

So a few months ago I came across an article that was specific about the gory details but silent about anything that would allow the veracity of the story to be examined. The article, run by Reuters and echoed by hundreds, perhaps thousands of others, claimed that three albino brothers were murdered, buried and exhumed so their body parts could be used for something or other.

At the time, I was working with albinos in Northern Tanzania, where this event was said to have occurred. I asked colleagues and friends, including albinos. No one had heard of this story and they had no way of knowing how to check if it were true. I even asked some Tanzania Albino Society (TAS) leaders, one of them being the chairman of TAS, said to have been interviewed for the story. No one knew anything.

I contacted Reuters, posted a message on the article and emailed the author. I received nothing except advice to contact the author. The article is still on Reuters' site. And hundreds of copies and echoes of the article are also scattered around the web for posterity.

In a similar vein, I saw a story during the week on the BBC website claiming that some Swazis taking antiretroviral drugs are so hungry that they eat cow dung to ensure that the drugs 'work'. The drugs are supposed to be taken with food.

The question isn't really about whether the story is true. Someone may have eaten cow dung, somewhere, at some time, or someone may have just claimed that they did. The question is about whether this is a story? If so, is it about Swazis, HIV, food shortages, poverty or prejudice? If you read the sort of things that Nazis said about Jews, it included references to feces, living in feces, being covered in feces, eating feces.

When you 'report' that people are eating feces, for whatever reason, are you trying to raise sympathy, or are you simply playing on the anti-African prejudices that many media outlets have been so happy to hone over the years?

The question is of vital importance. Since HIV has been pinned on Africa, African sexual behavior, African morality, and whatever else suits a story angle and media trends, many seem to have lost sight of the fact that HIV is a virus, one that makes people very sick and eventually die.

Articles appear to be more concerned with slavering over the details about genitalia, tribal practices, non-use of contraception and just about anything else except the fact that HIV is a virus, a sickness, one of many that infect Africans in grotesquely disproportionate numbers.

With rare exceptions, the media doesn't ask questions that they don't already have what they consider to be the answer. So they ask why some African countries have massive HIV epidemics, but not why any country should have massive rates of viral transmission when it is a very difficult virus to transmit, sexually, at least.

Because it is sexual transmission the media is interested in, make no mistake about that. And they have their answer: it's African sexuality, morality, behavior, etc. The men have sex with anyone they wish to have sex with, the women will do anything to have children or to get money for their families, it's all led by sexual desire, rampant brutality, inhuman behavior.

When babies and young children are found to be HIV positive even though their mothers are negative, it's attributed to the fact that they are raped by their father or by a family member. When old, no longer sexually active people get HIV they say 'even old people are at risk'. Pregnant mothers appear to get infected during or just after giving birth, and even when their sexual partner is not infected it is suggested that they simply must have had sex with someone who was infected.

The story about Swazis eating cow dung with their HIV drugs appears to be a symptom of how the media can write whatever they want, with the understanding that they are just pulling strings that people are well conditioned to respond to. The victims of anti-African prejudice are now guinea-pigs in Western drug trials and even charades that claim to relate to health, but are really just mass eugenics exercises.

I'm sure the BBC didn't give this article about Swazis eating cow dung a great deal of thought, and many of their articles look similarly thoughtless, media memes that have as little impact as some of the interstitials that appear on other news sites. But the fact that people can write and even read such an article and not protest means that the corporation has a rotten streak, whether through carelessness or design. Are they trying to fill a niche left vacant by recent changes in the media world?


Thursday, July 28, 2011

Next Year's Famine Victims Currently Being Groomed by Western Powers

If you look at the top 30 donors to the East African Famine, number one is the US. It is one of the richest countries in the world, although donations as a percentage of per capita income are nowhere near the highest.

But the US is also pretty good when it comes to land grabbing. This time it's Tanzania, where a substantial deal is being questioned by opposition MPs. But recently, it came to light that big, wealthy US educational institutions were snapping up land in various African countries that are, or have had, shortages of affordable food.

An estimated 162,000 Tanzanian smallholders stand to lose their land if the deal goes through. This means that more than half a million people would be impoverished as a result. And all so that some US energy company can produce what they refer to as food crops, but are much more likely to be used for biofuels.

'Affordable' food is the key term. There isn't a shortage of food in Tanzania as a whole (nor in Kenya or several other countries where people are starving). Indeed, some of Ethiopia's most productive land is also being grabbed, as millions there face starvation. Famines typically involve lack of access to affordable food, not lack of food.

One of the culprits mentioned in relation to Ethiopia is Italy, which also appears in the top 30 donor list, albeit at number 19. (The EC, number 2 in the list, is busy trying to ensure that India will no longer produce affordable drugs for HIV positive people by pressing them to sign an 'Economic Partnership Agreement'.)

The most generous also stand to reap far more than they sow. The UK is number 5 on the list and their history of land grabbing, which is still a huge contributor to the country's wealth, is legendary. They are one of the biggest grabbers in Africa, though they are more likely to boast about how much they 'contribute' in aid. Another big and long running land grabbing incident in Tanzania involves a British company called Sudeco.

It's interesting how a lot of the land being grabbed is being used for sugar cane. This can conveniently be referred to as a food crop but is far more likely to be used these days for biofuels. Western powers spend decades driving African sugar producers out of business by subsidizing their own producers and dumping their surplus on African markets. But now they seem to want African sugar again.

Canada is number 6 on the list. Much of Tanzania's gold, much of Africa's gold, is extracted by a Canadian company, which pays little or nothing in taxes or royalties. The US, UK and even South Africa, number 28 on the list, also extract gold at massive cost to ordinary Africans. Gold extraction puts huge tracts of land out of use, though direct contamination, water contamination and through forcibly excluding indigenous people, often people who once made a living from the gold.

Make no mistake, famines like the one currently developing in East Africa, are generally not 'natural' disasters. They occur and last because they are a consequence of large scale theft, government sponsored, multinational sponsored, philanthropic institution sponsored, even international institution sponsored, theft.

I don't wish to suggest that contributing money to the current famine is wrong, I would encourage people to contribute. But, bearing in mind what we are 'contributing' to next year's famine, giving money is not the only thing we can do. We can also ask public representatives tough questions about things that are often presented as 'business' or 'aid' or 'partnership', especially when they involve land and water use.

The majority of people in all East African countries depend very directly on land for their food and income. If that land is taken from them, or even if its use is dictated by those whose sole aim is profit, their lives and livelihoods are threatened. A famine is not an 'act of God', it's a consequence of human activities.


Tuesday, July 26, 2011

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.]


Monday, July 25, 2011

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.


Sunday, July 24, 2011

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.


Tuesday, July 19, 2011

For GM Lobbyists like Lynas, East African Famine is Gap in Market

Mark Lynas, who used to be an environmentalist, has become a rabid pro-GMO commentator. The title of his recent article in Kenya's Nation newspaper is:'To abolish hunger and malnutrition, Africa must embrace GM technology'.

Firstly, Lynas should know that if the world wanted to abolish hunger and malnutrition, they would have done so by now. Hunger and malnutrition are caused by lack of access to affordable and nutritious food. Even East Africa, where there is such a serious lack of access to food, has produced more than enough food in recent years.

But another thing Lynas should be aware of are the various factors that are causing food prices to spiral beyond what poor people can afford, especially in the last four or five years. Rich speculators are betting on the price of food staples rising in a world where many other sources of easy profits are more risky right now.

Growing biofuels, which require viable agricultural land and water, other things many poor people don't have access to, is also increasing the cost of food. A number of food crops are actually used to produce fuel so that rich Westerners don't have to reduce their fuel consumption.

And one of the most pernicious factors of all, land grabbing, should be very familiar to Lynas, if he has paid the slightest attention to his history lessons. Much of the best agricultural land in developing countries is not owned by poor people. That's precisely why most of them are poor.

Big multinationals, various non-African countries, speculators, wealthy individuals, pension funds and the like are all speculating in land in African countries. And even without those malign influences, much of the best land was handed over to top politicians and their families at, or soon after, independence.

That's quite a few items on the agenda that could be discussed before genetically modified organisms need even raise their ugly head. And all these items are long term trends, not something that just cropped up recently. The very threat of drought, food shortages and even famine have been noted over and over again by agencies whose job it is to warn of such possibilities.

This claimed 'need' for GMOs didn't just arise in the last few weeks, since the big news agencies, who seem so anxious to interview Lynas the expert, started taking notice and raiding their photo archives for choice photographs of dying people in dry and dusty locations. There's a stink of news manufacturing here, and a very nasty smell that is.

Lynas seems to see the problem of aid agencies simply coming up with more unsustainable strategies to deal with hunger. But that's no reason for imposing GMOs, which represent the most unsustainable strategy yet. They cost phenomenal amounts of money when you take in the long term commitments they represent and what the farmer loses by embracing them.

Farmers will have to pay inflated prices for agricultural inputs, accept the huge risks that have destroyed so many farmers in India and other countries, face lower yields after the first few years, once resistance develops to the pesticides and the fertilizer has contaminated the land and reduced yields further. And they won't be selling their produce in Europe, either.

It's strange how specific Lynas is in mentioning what he sees as "myths about biotech crops" being "part of a nefarious plot by multinational seed companies such as Monsanto to dominate the world food chain." As a former anti-GM activist and current Monsanto backscratcher, he should be aware that Monsanto's entire GMO effort is to dominate the world food chain.

All multinationals aim to dominate their field or fields of interest. Monsanto is no different in that respect. They don't even make any secret or that, except to Lynas, it seems. Does he think that Monsanto has suddenly transformed itself into a great big philanthropy engine, a jolly green giant?

If Lynas wishes to let on to be so disingenuous, others are not convinced. The Tanzania Alliance for Biodiversity (TABIO), an alliance of organizations concerned with the conservation of agricultural biodiversity for livelihood security and food sovereignty, has sent a vigorous response to Lynas's prognostications to the English Times (though I don't think it has been published yet).

This feigned innocence in reporting the GMO line as if it were an honest weighing up of the arguments doesn't wash. Lynas is not unaware of the faultlines in his 'reasoning'. That doesn't explain why he should wish to put his name to such rubbish, or be so widely reported to be doing so. But it will take a bit more than classic greenwashing to sell GMOs to anyone who has taken the trouble to study the issues.


Monday, July 18, 2011

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.


Sunday, July 17, 2011

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.


Saturday, July 16, 2011

Presentation at Kilimanjaro Clinical Research Institute

Hordes of articles are appearing right now about some promising results from the use of antiretroviral drugs (ARV) to prevent HIV, as opposed to treating it. This is called pre-exposure prophylaxis or PrEP. But the question is, who will benefit from this use of ARVs, which has mainly been tested on Africans?

ARVs are expensive, despite all the posturing about agreements and deals brokered by Bill Clinton and other notable self-publicists. They are so expensive that few countries with serious HIV epidemics and large scale treatment programs have ever been able to cover more than half of the HIV positive population, at most. Usually coverage is a lot less than half.

The biggest programs in East Africa only include a few hundred thousand people, out of millions infected. But HIV negative populations are many times larger than HIV positive populations. Over 90% of the populations in all the East African countries are HIV negative. How will people be selected for PrEP programs? According to the HIV industry most sexually active Africans are at risk of being infected.

Yesterday I had the pleasure of making a brief presentation about sexual and non-sexual HIV transmission to a group of people who work or study at the Kilimanjaro Clinical Research Institute, part of the Kilimanjaro Christian Medical Center (a powerpoint of the presentation slides is available on the KCRI site). The talk was about my usual concern, the 'behavioral paradigm'. This is the view that HIV is almost always transmitted through heterosexual sex in high prevalence African countries.

This 'paradigm' is not based on evidence. In fact, it is frequently contradicted, especially by UNAIDS's own data. But as the flagship of the AIDS industry, this means that resulting UN policy is almost entirely based on what amounts to an extremely racist view. How will that racism, which so far has resulted in a lot of money being spent on large-scale finger-wagging exercises, affect the rollout of PrEP?

One of the slides I used at the presentation was a screenshot of the mathematical model used to back up the industry's claim that most Africans are at risk of being infected with this difficult to transmit virus. The 'Modes of Transmission Survey' for Kenya, for example, suggests that 44% of the 1.5 million HIV positive people were infected by ordinary heterosexual sex. And members of other groups that would be considered to be at low risk in non-African countries are also mysteriously infected in huge numbers.

UNAIDS' argument for this is somewhat circular because the claim that members of the largest group of HIV positive people are infected by their regular partner is supported by the idea that most regular partners have, or at one time had, 'unsafe sex'. But these are just more assumptions based on the behavioral paradigm, not pieces of data that might support it.

It's hard to know whether this adherence to the behavioral paradigm is going to blow up in the industry's face, or whether it will just feed their ongoing demand for profits at any cost. If virtually every sexually active person in a population is at risk, will they all be offered PrEP? Or are UNAIDS going to claim that PrEP is not appropriate for groups that have been considered to be at high risk up to now?

There is also a problem right now about funding ARVs for people who would die without them. Who will stump up tens of times more funding for drugs for people who will not die without them, probably won't benefit from them at all and may even be harmed by them? If saving the lives of some HIV positive people is not considered worth the effort, is it worth the cost and effort to play around with the lives of huge numbers of people just so pharmaceutical companies can become even richer than they already are.

My worry is not just about the use of drugs to reduce HIV transmission. My worry is about the serious lack of clarity about why certain people, mostly Africans, are so susceptible to a virus that is difficult to transmit sexually, yet so many are infected. Simply throwing a lot of drugs at the problem is unlikely to make it go away. This problem needs to be explained without the use of the thoroughly discredited behavioral paradigm.

[For more about pre-exposure prophylaxis, see my other blog.]


Tuesday, July 12, 2011

Abstinence is just a Distraction and Will Not Eradicate HIV

Sexually transmitted infections (STI) are not highest in countries where the people are most promiscuous. According to figures on the 'Barking up the wrong tree' blog, Finland is number one in the promiscuity charts, followed by New Zealand, Slovenia and Lithuania. None of the countries in the top ten are in Africa and they are all likely to be relatively low on the STI charts.

In fact, high rates of STIs are more closely associated with crumbling health services than 'promiscuity' levels. If any avoidable and treatable disease, whether sexually transmitted or not, reaches endemic proportions in a country, that says a lot about its health services and the conditions in which people live.

But that doesn't stop journalists writing about promiscuity, immorality and groups of people who need to be targeted by whatever HIV prevention program happens to be hitting the headlines. Usually it's immoral men who are the target, even though far more women than men are infected with HIV in high prevalence countries.

Ironically, the South African health minister, Aaron Motsoaledi recommends male circumcision and public confidence in state run hospitals. Yet, elsewhere we read about the conditions in SA hospitals, which would not encourage anyone to have any kind of invasive treatment there, let alone circumcision. One of the biggest fears would be HIV and other blood borne diseases.

Some of the most popular punchbags have been truckers and other long distance drivers and sex workers. These two groups may well be promiscuous but articles about their behavior never seem to enquire into the whole range of HIV related risks they face. For example, both groups have been targeted by STI reduction programs. But HIV prevalence among sex workers in Tanzania and Kenya rocketed long before it was common in the general population. So did the STI programs inadvertently spread HIV?

In response to the motion "Can we treat our way out of the HIV epidemic?", a professor chairing the debate asked "what would happen if we targeted key populations such as sex workers, truck drivers and fishermen?" Well it depends on what they are targeted with. If it's more of the usual finger-wagging, I think the result will also be more of the same - nothing. But if some effort is made to find out why these groups are infected in such large numbers we might find our way out of the entire pandemic.

The First Ladies referred to in a recent article make a common mistake: they claim that "if the youth shun pre-marital sex and married partners are faithful to each other, Africa will get a generation of children free of AIDS". They are talking about a world where HIV is almost always transmitted sexually. This is not such a world. They may have a point about reducing sexual risk but that has never translated into reduced HIV transmission.

Despite all the talk about 'risky' sexual behavior leading to high rates of HIV transmission, research from Tanzania shows that high levels of risky behavior (multiple sexual partners and low condom use) often don't result in high HIV rates. None of the areas studied have especially high HIV rates, unless that's about to change.

The association of HIV with sex, morality, religion, etc, is not based on any evidence about how HIV is transmitted or about how transmission could be reduced. Efforts to reduce transmission in high prevalence countries have long been in vain. And as long as these ridiculous and stigmatizing claims continue to be made, HIV will not be eradicated. Abstinence is not the answer, no matter how much the HIV industry may love the concept.


Monday, July 11, 2011

Do Ugandans Still Believe All That Stuff About Abstinence?

In a letter to the editor of the International Journal of STD and AIDS, Gisselquist, Potterat and others note a finding from 2006 which estimates that "circumcising all African men by 2015 would reduce HIV incidence during the ensuing 2015–2035 period by a very modest 13%". And this estimate was made by some of the most rabidly pro-circumcision people in the industry.

Yet you still find articles, such as this one from Uganda, bemoaning the fact that governments are not doing enough to get as many men (and boys) as possible circumcised. Many of these articles are written about countries where safe healthcare can not be guaranteed and transmission of HIV and other pathogens through unsafe healthcare may spread more of the disease than it prevents.

Uganda itself is a good example of such a country. And the author doesn't seem to realize that 'up to' 60% means that the operation will give a lot less protection outside of randomised controlled trial conditions, where participants are given regular coaching about safe sex. Coupled with this, many men and women believe circumcision = no danger.

In addition to mass male circumcision, the author argues for 'combined' prevention, in particular, wider antiretroviral coverage. Those responding to antiretroviral drugs are significantly less likely to transmit HIV to their partners. But this apparent belt and braces approach may be deceptive. Circumcision already gives rise to false beliefs about protection, it may increase transmission from males to females and conditions in hospitals may make invasive procedures more risky than sex.

In truth, the fact that some evidence suggests male circumcision may give a little protection against HIV and other diseases does not address many of the very serious doubts. For example, in a number of countries, such as Malawi and Zambia, HIV rates are higher among circumcised than uncircumcised men. The figures bandied about are carefully selected.

The author of the Uganda article oversteps himself when he conflates childhood immunization against diseases like polio with infant circumcision to 'prevent' HIV: polio is an immediate danger against which polio vaccinations have had a huge influence in eradicating. Circumcision will not 'prevent' HIV in infants and children who are not sexually active. It may even prevent little or no HIV in sexually active adults.

Uganda may gain a lot more by improving its ailing health services. And while they are at it, they could improve education, infrastructure and other social services. This would help the country to address many of its immdiate needs. They shouldn't take their eye off HIV, of course, but mass male circumcision seems like a strategy of pure desperation.

It appears that a lot of Uganda's 'success' in reducing HIV transmission in the 1980s was due to improvements in injection safety. This would explain the utter implausibility of all the articles about abstinence and other changes in sexual behavior, which seem to be entirely without substance. Perhaps it's time for Ugandans, rather than the HIV industry, to take an unbiased look at the history of the HIV epidemic in their country.


Sunday, July 10, 2011

Mathematical Modelers: the Latter-Day Myth Makers

Although I'm not that comfortable with mathematical models, even I know that if you use obscene values you will get obscene results. So the model used by UNAIDS to persuade people that Africans have inordinate and unfeasible levels of unsafe sex is an interesting case in point.

Scratch the surface a little and you'll wonder whether UNAIDS is manned by robots, idiots or fascists (or perhaps all three are compatible). Almost everyone in the example population faces some kind of risk from HIV. And almost everyone is at relatively high risk of being infected sexually, even though sexual transmission is not very likely for the majority of people anywhere.

The most obscene figures, to my mind, are the ones for transmission through medical injections and blood transfusions. However you could argue that the most obscene figures are the ones that are not included at all, those for transmission through other healthcare risks, perhaps risks associated with traditional practices and with cosmetic practices, such as tattooing, hairdressing, manicure and pedicure.

Eva Deuchert and Stuart Brody published an article on mathematical models entitled 'Plausible and Implausible Parameters for Mathematical Modeling of Nominal Heterosexual HIV Transmission' in 2007. They warn that not all transmission is through heterosexual sex and that not all heterosexual sex is penile-vaginal; some is anal, which carries a much higher transmission risk.

The authors also mention the possibility that mathematical models can be intimidating to many readers, who may conclude that it's all so complicated that it must be true. But it is vital for anyone trying to understand how UNAIDS come up with such strange conclusions to spend a bit of time with the models. It is important to criticize the policies they so frequently claim resulted in reductions in HIV transmission and that these reductions were a direct effect of sexual behavior change.

Firstly, sexual behavior was not (or not wholly) responsible for the massive HIV epidemics experienced by a number of sub-Saharan African countries. And therefore, changes in sexual behavior could not have resulted in drops in prevalence. But secondly, far higher levels of 'unsafe' sexual behavior than have ever been identified (and probably higher than is possible for humans) would not result in the rates of HIV transmission found in the worst hit countries.

UNAIDS and others who believe their unwarranted assumptions about sexual transmission in (some parts of) Africa then need to impute all sorts of things to Africans in order to explain serious epidemics. They need to ignore any non-sexual risks and even the elevated risk from anal sex. And this means that, even if people wanted to avoid various risks, they wouldn't even know that what they were involved in was risky.

The authors also put their finger on an important reason why it only seems like sex workers face very high risks as a result of their sexual behavior: if they do have any symptoms that seem like sexually transmitted infections, they could face the higher risk of being 'treated' with unsafe infections. UNAIDS have never even acknowledge the mystery behind extremely high HIV rates among sex workers. It’s a mystery because HIV prevalence among sex workers in most countries is very low.

Similar remarks apply to truckers and all the other people who are said to be at high risk of HIV infection. If they are really as sexually active as they are said to be, they will probably be infected with a sexually transmitted infection, eventually. And then they face the even considerable risks that go with unsafe treatment. The rounding up of sex workers, truckers and other ‘risk groups’, especially in the 80s and 90s, may well have done as much to spread HIV as it did to persuade donors that their money was being well spent.

The public is so used to hearing about these strange Africans with their bizarre sexual behaviour, they don't even notice that they are being asked to believe that significant numbers of people have up to 47 sexual contacts per day, that 20% of unmarried women have 25 sexual contacts per month and that 2% of married women have 100 sexual contacts per month.

This crazy mathematical model that UNAIDS put so much faith in, along with a whole lot of other similarly crazy models, has very serious consequences. They are used to support HIV policies which achieve little but the reinforcement of stigmatizing attitudes. Those policies have not resulted in reducing HIV transmission and they never will. We need to look beyond the pompous tones, the pretty pictures and graphs and the impressive looking models and see UNAIDS policy documents for what they are: dangerous lies.


Tuesday, July 5, 2011

When Soap and Water Would do the Job Better, Why Circumcise?

It's not that long ago that Zimbabwe was experiencing one of the worst cholera epidemics in many years. This demonstrated the fragile condition of their health system, as well as their water, sanitation and hygiene infrastructure. Thousands of people died of this preventable and treatable illness.

But now the country is embarking on a drive to circumcise 1.2 million men by 2015. So let's hope they have got their health services back in shape. It seems foolhardy for a health service that saw so many die from lack of clean water to attempt to carry out an invasive operation when the benefits will certainly be small, if not negative.

Countries with very high levels of HIV prevalence, which Zimbabwe had until recent high death rates significantly reduced levels, probably need to check their health service's ability to provide people with safe health care. It is likely that unsafe practices, such as reuse of injecting and other invasive equipment, was responsible for a lot of HIV transmission.

Mass male circumcision is a curious thing to spend HIV prevention money on, especially considering how little money has been spent on this area so far. In fact, you could say that no money at all has been spent on prevention, although millions of dollars were spent on programs that purported to reduce HIV transmission.

Sizeable resources are being thrown at circumcision, of course. Perhaps this will allow the program to go ahead without causing more HIV transmission than it prevents. But what then? Women are infected in far higher numbers than men and male circumcision doesn't protect them. It may even increase the risks they face.

The article gives the usual 'interview' with someone who says he expected it to be painful but it wasn't at all. There's even a photograph of someone supposedly having the operation and reading a brochure about HIV/AIDS, or at least balancing it for the camera. Another article not long ago depicted someone reading a newspaper. I wonder if that will make Zimbabwean men rush out to get circumcised?

The population control experts, Population Services International (PSI), are involved. How they think this will reduce fertility I hate to imagine, but they receive huge amounts of HIV money to spend on all sorts of dubious projects. So it's no surprise that they should be behind mass circumcision. Apparently they have managed to find a surprising number of health personnel, which means they have diverted them from more vital health work.

Anyhow, the operation has been reduced to 15 minutes, which is said to be a good thing. And there's even one and a half hours of counselling. All that is a lot more than the majority of women get for their immediate and life-threatening conditions, which results in many women dying during or just after childbirth, and many infants and under fives also dying unnecessarily.

Even children are not spared this zealous campaign, with boys over 13 eligible for the operation and schools being actively targeted. Any worries about widespread circumcision resulting in men (and women) failing to take other precautions to avoid infection with HIV, sexually transmitted infections and unplanned pregnancy, precautions which are all still required, have been brushed aside.

International donors who shy away from highly beneficial programs to improve health systems, which would benefit whole populations and reduce all sorts of life-threatening conditions, seem to be falling over themselves to pay whatever mass circumcision campaigns cost. They seem unconcerned about any damage that will result and about the very small benefit of such an intervention.

Meanwhile, Uganda is beginning to notice the results of ignoring health services for too long. Maternal and child health are among the first areas to suffer. While Uganda is constantly praised for reducing HIV prevalence in the 1980s, they seem to have had little success since then, with rates remaining lower, but steady, ever since.

There are shortages of personnel in all facilities, also poor hygiene conditions, shortages of drugs and equipment, with the result that patients have to supply their own. But even still, they die from conditions that are easy to prevent and treat. Yet Uganda too will be pressed into a mass male circumcision campaign, which has already started in many areas.

Penile hygiene may be an important part of overall sexual health, for both men and women, but since when was it more important than basic health services that everyone depends on? Why are so many health resources and so much aid money being spent on an operation that will have a minimal impact on HIV transmission?


Monday, July 4, 2011

Do Different UN Agencies Talk to Each Other? Guess Not.

The United Nations Foundation is currently trumpeting their success in reducing immunization related infections of hepatitis, HIV and other blood borne diseases. This has been achieved through increased injection safety, especially through the use of auto-disable syringes, which cannot be reused.

This is excellent news. The Measles Initiative and GAVI (Global Alliance for Vaccines and Immunization) say reduction in infections has resulted from a reduction in the reuse of syringes. Reuse is now practically zero, apparently. In contrast, an estimated 39% of injections given globally in 2000 involved the reuse of unsterilized equipment. That's globally, not just in African countries, where health care conditions are dire.

But the Foundation's claims are less impressive when you look at UNAIDS' estimate of the contribution of unsafe medical practices to HIV prevalence in high and medium prevalence countries. They estimate that all unsafe medical practices, from blood transfusions to reuse of injecting equipment, make a maximum contribution of 2.5%, possibly a lot lower.

It's not unusual for different UN agencies to flatly contradict each other, even for communications from the same agencies to do so. But almost all of UNAIDS' publications about HIV in high prevalence countries have emphasized the role of sexual behavior, claiming that 80%, even 90% of all transmissions are a result of unsafe heterosexual sex. Most of the remaining 10 or 20% is said to come from mother to child transmission.

This leaves only a small fraction to be accounted for by the biggest causes of transmission in non-African countries, men who have sex with men and intravenous drug users. But also, non-sexual transmission through unsafe medical and cosmetic procedures, which occurs everywhere outside of Africa, is not considered to be a risk at all in high HIV prevalence countries.

Of course, HIV prevalence should be low among children receiving measles injections, so the risk of transmission through unsafe injections should be lower than among adult populations, where HIV prevalence is often very high. And prevalence is particularly high among young, sexually active females. So it is to be wondered how much HIV could be transmitted among pregnant women, sex workers and even people regularly attending STI clinics and any other type of health facility.

Another contradictory aspect of the significant declines in HIV prevalence, which date back to the 90s and continue right up to the present, is that UNAIDS has been attributing them to changes in sexual behavior. That's OK, declines could result from a combination of sexual behavior change and improved injection safety. It's just that UNAIDS doesn't normally mention injection safety.

In fact, UNAIDS often go to great lengths to deny the role of unsafe health care in HIV epidemics in African countries. They effectively undermine the entire article by the United Nations Foundation. And the few people who have tried to raise the issue of non-sexual HIV transmission over the past 10 to 15 years have either been slapped down or ignored.

Sensible people know that HIV is transmitted in a number of ways and that sexual transmission only accounts for some of it. But global HIV policy is not written by sensible people. It's written by people who think that mentioning the possibility of non-sexual transmission will result in people not taking precautions against sexual transmission and perhaps even avoiding medical facilities.

However, if people face the risk of being infected with HIV and other diseases in health facilities, they should take precautions against this risk. So they need to be informed about all the risks they face and about how to avoid them. Why is it so important that Africans avoid sexual risks but not non-sexual risks? This does not make sense and it probably results in hundreds of thousands of avoidable infections every year.


Saturday, July 2, 2011

Buying Blood on the Black Market in Tanzania: Tempted?

UNAIDS continue to insist that HIV is almost always transmitted sexually in African countries and they still discount the contribution made by non-sexual transmission routes, such as blood transfusion, unsterile injecting and other skin piercing equipment and lack of sterile procedures.

But those working in, visiting and being treated in health facilities here in East Africa have other stories. Anecdotal though they may be, you hear of women about to give birth being ignored until the last minute and then being assisted by someone who has made no preparations or has come straight from another delivery.

Others say they are not allowed to ask about or criticize procedures in health facilities without fear of being sent to the back of the queue, refused treatment or being loudly humiliated in front of others. So even those who know they may face risks in health facilities are in no position to do anything to protect themselves or their families.

When it comes to blood transfusions, blood that has already been tested when it was received by the blood bank turns out to be contaminated with HIV, hepatitis, bacteria, etc. Shortages mean that a lot of blood comes directly from donors, rather than from the blood bank. And this is especially the case for infants, pregnant women and road traffic accidents.

So I was not surprised to read an article in The Citizen (Tanzania) about 'informal payments' being demanded for blood. There is an extreme shortage of blood but no shortage of people only too willing to donate theirs in return for what could be the equivalent of a couple of week's pay.

How UNAIDS has the arrogance to insist that Tanzanians do not face any danger in health facilities, they insist that only 1 or 2% of HIV is transmitted through unsafe practices, including transfusions, is something I have never understood. Especially when they go to so much trouble to ensure that UN employees know that their safety can not be assured in facilities that are not approved by UNAIDS!

It's hardly surprising that crumbling health services and a highly impoverished population results in people taking risks. The risks involved in collecting blood in return for payment was recognised in the 1980s, shortly after HIV was identified. Once it was clear that intravenous drug users, sex workers and others who may need a bit of easy cash would be tempted to donate, regularly, the practice of soliciting blood donations in return for cash was stopped in many countries, including Tanzania.

But where there is such an urgent need for blood for patients and an urgent need for money for donors, how likely is it that a mere policy change will succeed in preventing such practices? The article describes people who identify customers and donors and attempt to fill in one of the many huge gaps that exists in the country's health services.

UNAIDS seem interested enough in women who sell sex for money because it's their only way of making enough to survive. It remains to be seen whether they will now provide training courses, counselling, various products, services and even ready cash available to prevent HIV transmission through contaminated blood. The practice is even said to occur in Iringa, which has the highest HIV prevalence in the country.

Similar practices have been reported in Nigeria. HIV prevalence there is a lot lower than in Tanzania but the population is more than three times higher. The number of HIV positive people in Nigeria, therefore, is probably the second highest in the world, after South Africa.

I make no apology for repeating myself: if UNAIDS can not guarantee the safety of UN employees in health facilities in countries like Tanzania, then they can not guarantee the safety of Tanzanians either. Therefore, health facility transmission of HIV needs to be investigated so that the risks can be reduced and people can be informed about how to protect themselves and their families. Tanzanians are as entitled to health, safety and life as UN employees.


Friday, July 1, 2011

Global HIV/AIDS Policy is Not All Lies; that's what Makes it so Dangerous

Using this blog, which takes my MA dissertation as its starting point, I have fought against certain prevailing ideas relating to HIV. For example, the idea that HIV should be exceptionalized. Exceptionalizing HIV distorts health funding and diverts resources that should be balanced out according to the relative needs of different health problems.

Another idea I have fought against is that of the sexually incontinent African, whose animalistic sexual and social behavior needs to be kept in constant check by the restrained and wise but also exceedingly generous Westerner. And the list goes on.

Often, I use papers and articles that don't aim to make any of the points I wish to make, yet they may throw some light on important issues, sometimes ones that contradict the author's intended point. These papers, interestingly, are usually by clinicians, scientists, epidemiologists and the like.

But sometimes I am able to cite authors who agree that Africans are people too, that HIV is not all about sex, that it is not possible for extremely high rates of transmission to be explained by any existing data about human sexual behavior and that other forms of transmission, which are common in low prevalence countries, are probably also common in high prevalence countries. These papers are usually not by the abovementioned sorts of academic.

So this article by Michael Grimm and Deena Class, both economists, is very welcome because it gets straight to the point: the amount of money still being spent on HIV exceeds that available for other health issues, many of which are responsible for far more morbidity and mortality than AIDS. They also point out that figures relating to HIV have been systematically exaggerated, including those about how much developing country economies suffer as a result of high rates of HIV transmission.

But most importantly, the authors argue that the relative contribution of sexual transmission in high prevalence countries claimed by UNAIDS leads to vast sums of money being spent on sexual behavior change programs, which have had little or no impact on HIV transmission.

The authors suggest that blood exposures in health facilities, along with less formal settings where people can also receive medical treatment, may account for a far higher percentage of HIV transmission than the risible 2% or less estimated by UNAIDS.

They don't mention other settings where blood exposures are also a possibility, such as tattoo parlors, beauty salons, hairdressers, roadside manicure and pedicure services, etc. But it's the non-sexual bit that counts!

This should all be good news for UNAIDS, or whoever takes over after everyone finally admits that they have screwed up, bigtime. Influencing sexual behavior is difficult, as the HIV industry's failure to come up with a viable strategy demonstrates all too well. But influencing health care procedures should be a lot easier.

In fact, most countries which have seen significant declines in HIV transmission since the epidemic peaked, and that includes most high and medium prevalence countries, have already probably started reducing non-sexual transmission. Blood donations may not be as carefully screened as the UNAIDS blurb would have us believe, but a lot of work has been done in this area.

Injection practices have changed a lot in many countries. There are autodisable syringes, which break after use so they can't be washed and reused. There are pre-filled syringes, one syringe per dose. Many people have been trained in recognising the potential for blood borne infection and some have even been supplied with the means to reduce infection.

Indeed, some would argue that the sudden and unexplained increase in sexual behavior that would be required to explain why HIV ever reached such high levels in a few countries, never occurred. Rather, the virus only took off once it got into health facilities, unrecognized and therefore uncontrolled.

The equally sudden and unexplained decrease in sexual behavior required to explain why prevalence subsequently peaked and dropped, before the useless sexual behavior programs even started, also never occurred. Much of the effort required to reduce HIV transmission took place in health facilities in the 1980s and 1990s. And the efforts even continued after UNAIDS was established, only to derail the whole process by obsessing about sex.

But these matters are all in serious need of investigation. Many hospitals in African countries don't have the supplies and equipment they need to ensure that people are not infected though unsafe healthcare. Many lack the training and supervision required. There is still a lot of work to do, as attested by UNAIDS' own warning to UN employees to avoid African hospitals.

As Grimm and Class point out: "it is telling that an HIV outbreak investigation (genetic sequencing of HIV genetic material to match specific viruses from different infected persons) has never been conducted in any high-prevalence African setting."  This is despite compelling evidence in Mozambique, Swaziland and other countries that nosocomial infection (infection through medical procedures) continues to be vastly underestimated.

UNAIDS used to claim that everyone is at risk of HIV infection, even long after it was obvious that this is not the case. But in African countries, where an unknown and probably significant percentage of transmission is non-sexual, everyone who uses health and cosmetic services is at risk of HIV infection. Will UNAIDS break their long tradition of ignoring evidence that their policies are useless?