Wednesday, August 31, 2011

New Resource: Don't Get Stuck With HIV Website and Blog

Given that this blog covers the issue of non-sexually transmitted HIV so much, I'm very happy to be involved in the creation and maintenance of a brand new website and blog called 'Don't Get Stuck With HIV'. The two main areas of non-sexually transmitted HIV are health care procedures and cosmetic services.

Some health care risks are fairly obvious. For example, if skin piercing equipment is not sterilized properly it can result in infection with HIV, hepatitis or various bacterial infections, effectively, whatever the last patient had. Whether the treatment is received at a health facility or a dental clinic, in the back of an ambulance or in an emergency scenario, the more you know the about the risks, the more you can do to avoid them.

Even getting a blood test, donating blood and certain kinds of traditional medicine, especially those that break the skin, such as male circumcision, can carry risks. And it's not just blood that can be contaminated: pus, urine, vaginal fluid, anal mucus and others can also pose a risk.

Some cosmetic risks may not be so obvious. Many would guess that getting a tattoo is risky if the studio is not following strict guidelines on safety and sterilization. But even some hairdressing processes can be risky: razors and other sharp instruments can be used (and reused!) and some hair products can irritate the skin and cause small lesions, which could facilitate infection.

The advice on the site is mainly aimed at people in developing countries, especially in African countries where HIV prevalence is high. If there are many HIV positive people in a population, this increases the chances of health and cosmetic services being involved in the spread of HIV, hepatitis and other diseases, such as scabies. But even people in wealthier countries need to be aware of such risks.

There have been numerous health care related outbreaks of blood borne diseases in wealthy countries and they still happen, despite the efforts of health care and cosmetic professionals to avoid them. But in poorer countries there is little or no research on the subject; UNAIDS and much of the HIV industry have little interest in commissioning research. Far from it, they vociferously deny that non-sexual transmission plays any part in high prevalence HIV epidemics, all of which are in sub-Saharan Africa.

A good way of keeping up to date with non-sexually transmitted HIV and hepatitis, especially health care related outbreaks, is to join the Safe Injection Global Network, which also has a brand new site. Their weekly email newsletter includes both research and media articles on the subject and you can subscribe by emailing the editor with 'subscribe' in your subject line.

The Don't Get Stuck With HIV website also has a blog, which will discuss some of the relevant issues arising. People are invited to comment, discuss, make suggestions or take part in any way that would promote recognition and understanding of this vital area of HIV transmission. There is also a Facebook page available and a Twitter account, so you can spread the news about Don't Get Stuck With HIV and follow the cause.


Tuesday, August 30, 2011

Without Addressing Determinants of Health, Technical Fixes May be Useless

There is an interesting conflict between the findings of two different pieces of malaria research. One piece from Tanzania claims that mosquito numbers have decreased over a number of years to such an extent that fewer and fewer people are being infected.

Whereas scientists in Kenya agree, but claim that malaria infections are lower because of public health measures, such as "well-managed control programmes which involved distribution of nets, effective medicines and vector suppression".

It looks as if there will have to be a meta-study to resolve the issue: has malaria declined because of successful public health measures, because malaria spreading mosquitos are in decline (for one or more reasons), or is malaria prevalence merely cyclical, as has been found with some other diseases?

The Tanzanian-Danish study is adamant that the decline in malaria is not attributable to human interventions, apparently. This conclusion is unlikely to be popular among public health donors, who tend to attribute success to their efforts and failures to something that can remain quite mysterious.

Rumors about the possible influence of climate change have arisen, predictably, but that's a pretty amorphous determinant, at best. But, as scientists, they have to say something.

Despite the claims about distribution of nets in countries such as Kenya and Tanzania, I have talked to many who do not have nets, do not have enough nets, can't afford insecticide treated nets, or don't live in conditions that make nets useful, for example, they don't sleep in a bed or share the bed with so many people the net is useless.

Other articles have mentioned the fact that nets are often used for things far removed from their intended purposes. And so called 'free' nets are often sold, sometimes at too high a cost for the most needy.

And when it comes to drugs, there have been many articles lately, bemoaning the fact that 'fake' drugs (a term that fails to distinguish between generic versions of drugs, counterfeits and placebos) are responsible for sickness, death and resistant strains of malaria. Clearly, the drug industry wants public money to be used to ensure that they extract as much as they can from those living in the greatest poverty.

So all these scientists and experts really do have themselves in a tangle. Declines in numbers of mosquitoes have been equally sharp in villages without mosquito nets, though some articles would make you think there was no such thing as a village that didn't have nets.

Interestingly, a long way from East Africa, insecticide resistance has been linked to an increase in malaria in Senegal. Apparently, mosquitoes have become resistant to the insecticide used on bednets and malaria incidence is now higher than it was before the reduction campaign.

In addition to resistance in the mosquitoes, older children and adults are becoming more susceptible to the disease, which is an entirely separate matter. People's immune response is increased by frequent exposure to malaria, but it then drops once exposure is reduced. This research also acknowledges that the increase in the disease had been forseen for some time.

Sometimes these 'vertical' public health programs, ones that aim to address only one disease, seem a bit futile. For example, attempts to eradicate polio by using an improved vaccination without improving people's living conditions, especially their access to clean water and good sanitation, seem like a bit of a loser.

Similarly with malaria, many people who are most at risk from malaria live in areas with a lot of stagnant water and little control over waste disposal. The same people risk numerous water borne, hygiene related and other diseases, not just the economically viable ones. Perhaps the obsession with technical fixes, yet again, is getting in the way of providing people with what is vital for their survival and their health: decent living conditions.


Monday, August 29, 2011

We May Never Agree on the Science of HIV, But Let's Treat HIV Positive People Like Humans

To return to a theme that has cropped up several times on this blog, it can be difficult to understand why HIV positive people are the victims of so much hostility, stigma and persecution.

But when you reflect on how they are portrayed by the HIV industry, it is not so difficult. What then becomes difficult is how the HIV industry can be the instigator of some of the very phenomena it claims to abhor.

It's a bit of a cheap point, but HIV stands for HUMAN immunodeficiency virus. So where is the humanity? Worse still, why the systematic dehumanization of Africans by the HIV industry?

HIV positive people, and even those who are thought to be at risk of being infected, are depicted as promiscuous beyond what is credible, even possible, in humans.

Women are often portrayed as victims, even passive victims. Yet they are also portrayed as so desperate and so dependent that they will do absolutely anything relating to sex for some money, food or other goods. They are sometimes even so portrayed by those who elsewhere portray them as victims.

Men are portrayed as the main drivers of HIV epidemics, even in populations where there is a far smaller proportion of HIV positive men than women. If children and infants are found to be HIV positive when the mother is not infected, it is implied, even stated, that pedophilia must have been involved.

The mainstream media writes pretty much what it likes about people in high prevalence countries, which are all in sub-Saharan Africa. The most ludicrous claims remain unapposed, even when they are echoed throughout the entire media industry.

As well as portraying men as animals and women as either sex or money mad, or both, several recent articles claimed that some HIV positive Swazi people have taken to eating cow dung mixed with water because they lack food and can not take their antiretrovirals on an empty stomach.

As for HIV researchers, many of them don't seem to see Africans as human subjects. Numerous research projects have involved highly questionable practices, probably even unethical practices. HIV positive people have been allowed to infect other people and HIV negative people have been allowed to continue having unprotected sex with a partner that researchers knew was HIV positive.

Where is the humanity in what is supposed to be a humanitarian initiative? HIV is a virus, a sickness, a disease. It is also preventable in many instances. Because, in addition to being transmitted through various kinds of sex act, it is also transmitted through various medical and cosmetic procedures.

Why do so many people in powerful and influential positions, and so many institutions, use their knowledge and resources to beat people, to humiliate them, to stigmatize and dehumanize them? We may never agree on the science, but let's behave like human beings when addressing other humans who are HIV positive or are at risk of being infected.


Saturday, August 27, 2011

Why Do HIV Scientists Think They Are Veterinarians When In Africa?

In a letter to The Lancet, Dr David Gisselquist raises a number of perfectly valid questions. There are millions of HIV positive women in Africa who have a HIV negative partner. How did these women become infected? The vast majority of these women have not had sex with anyone but their partner; and a substantial number of them have not had sex with anyone.

The issue Gisselquist is raising is not an entirely scientific one. The data available is clearly not sufficient to show how the women are becoming infected. So you have to make a choice between accepting that women who say they have only had one, or even zero partners, are telling the truth, or assuming that they are lying. If you choose the former, the question is pertinent.

But if you choose the latter, the women could have had any number of partners and any amounts of just about any style of sex imaginable, 'safe' and 'unsafe'. And this is exactly the way the HIV industry looks at HIV in non-Western countries, especially African countries.

This is the typical, highly racist view that most Africans, especially African women, are liars. In addition, they are unbelievably promiscuous and will sleep with just about anyone for money, gifts, status or whatever else happens to be rumoured at a given time. There is nothing scientific about assuming the women are lying or about making up a story to fit the data.

Gisselquist urges us to consider the possibility that Africans are not all dishonest, promiscuous, feckless, without a care for their own health, that or their partner or that of their children and other dependents.

When a HIV positive women has to reveal her status to her HIV negative partner and the entire HIV industry is telling him and everyone else that 80-90% of HIV is transmitted through heterosexual sex in African countries, what are her chances of being believed when she says she has not been having sex with someone else?

But the pointy-hatted brigade have published a 'reply' to Gisselquist's letter, signed by Edward J Mills and Nathan Ford. They start off by accusing those who say we have given far too little attention to non-sexual HIV transmission of having "an insufficient understanding of basic epidemiological principles".

But this is not about epidemiology when it comes down to it. Mills and Ford simply deny the possibility of non-sexual transmission playing a role, or even a partial role, in the massive HIV epidemics found in some African countries. And they make the astounding claim that "several epidemiological models have shown that an unfeasibly high number of unsafe injections would be needed to account for the HIV epidemic".

So instead of an unfeasibly high number of unsafe injections (and various other non-sexual risks that Mills and Ford completely ignore), they posit an unfeasibly high number of sexual exposures. The transmission probability for most kinds of non-sexual exposure is many times higher than that for most kinds of sexual exposure.

You don't need evidence to demonstrate that Africans do not engage in unfeasibly high levels of unsafe sex; the levels posited by various mathematical models and vague theories are just that: unfeasible.

And it's important to note that Gisselquist is not claiming that "men acquire HIV/AIDS through sex but women do not", as Mills and Ford state. He accepts that men and women acquire HIV through sex, sometimes. But far too little investigation has been carried out in high prevalence countries to rule out high levels of non-sexual transmission, probably through very common health procedures, such as hormonal birth control injections.

Far more women are infected with HIV than men in high prevalence African countries. And women often face far more non-sexual risks than men. This should trigger some careful investigations. Instead, it triggers a lot of frothing at the mouth about "diverting of attention" from what Mills, Ford and the rest of the HIV industry consider to be obvious: that Africans are just different, not entirely human, very stupid, selfish and careless.

HIV Scientists' main stumbling block seems to be in seeing themselves as veterinarians when they deal with Africans. If they ask people questions, they need to have the integrity to believe the answers they get. And if they wish to base their HIV prevention strategies on racist assumptions rather than on their own evidence, they should learn to distinguish between science and prejudice. These are not fine distinctions, by any means, but they are vital.


Thursday, August 18, 2011

Treatment for All People, Not Just for the Profitable Ones

It's interesting to compare the hype surrounding strategies such as 'treatment as prevention', pre-exposure prophylaxis, vaginal microbicide and the like with the relative silence surrounding pediatric HIV. Marc Lallemant calls it a 'neglected disease'.

Pediatric HIV has been almost eliminated in rich countries. Hundreds of thousands of infants are infected every year and hundreds of thousands more die of AIDS. Only one third of infants who need antiretroviral treatment are receiving it. Without treatment, a third will die before they are one year old and even more will die in the following year or two.

Versions of antiretroviral drugs suitable for children are not seen as a tempting proposition for pharmaceutical companies, it appears. Not only do they want vast profits, they want easy profits and pediatric formulations are just not easy enough.

So it could be asked why anyone would consider a strategy such as 'treatment as prevention', which involves testing everyone for HIV regularly, perhaps once a year, and treating anyone found HIV positive immediately. Currently, people need to reach a specific stage in HIV progression to receive treatment.

Yet in developing countries, many pregnant women don't have access to antenatal care, about three quarters are not tested for HIV, many don't have access to the drugs needed for prevention of mother to child transmission. Even accurate information and adequate support for preventing transmission after delivery is not available to most women.

Developing countries just don't have the equipment, personnel, facilities or even the training to prevent the majority of pediatric HIV transmissions. They don't even have the capacity to diagnose HIV in most infants until it is too late for them to benefit from treatment. It's too expensive. And the all the noise we hear about 'treatment as prevention' is absent when it comes to infants, or even mothers with HIV.

One of the shocking features of diseases that are referred to as 'neglected' is that most of them are easily prevented and treated; most of them are not even expensive to address.

As with pregnant mothers, it would be far better to find out how people are being infected and develop a strategy to prevent infection, insofar as it's possible. But failing that, there is no justification for providing treatment for adults and denying it to infants, just because the former makes the pharmaceutical industry vast and easy profits and the latter does not.

Treat everyone who is infected with HIV, regardless of their demographic. But do not mistake that for prevention. We have failed to prevent millions of HIV infections over many years because we have refused to establish how people are becoming infected. We will continue to fail as long as we fool ourselves into thinking that 'treatment is prevention'. It is not, and it never will be. Nor is it a substitute for prevention.


Wednesday, August 17, 2011

Nice Work: UNAIDS Paid to Continuously Clean up its Own Mess

Whatever about the non-HIV/AIDS portion of Tanzania's health sector, and it's likely to be a very small portion indeed, the HIV/AIDS portion is pretty much funded and controlled by a powerful cabal of international institutions, such as UNAIDS, the World Bank, the IMF, a few elite academic institutions, Big Pharma and some private foundations such as the Gates Foundation.

And yet communications about the HIV pandemic, which affects sub-Saharan Africa more than any other area in the world, always seem to talk about what 'we' (the cabal in question) have resolved to do. It's as if the circumstances surrounding the pandemic simply materialized out of nothing, as if they (the cabal) are just some disinterested but magnanamous outsiders, trying to put things right.

For instance, members of the UN General Assembly High Level Meeting on HIV/AIDS are said to be committed to “intensify national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV”.

But stigma, discrimination and violence relating to HIV are a direct result of the way the virus has been characterized by the HIV industry itself. When HIV was identified, stigma was first directed at gay men, then at various other groups, sex workers, intravenous drug users and others. But in Africa, the stigma was directed at all Africans.

And it still is. The HIV industry insists that HIV is almost always transmitted through heterosexual sex in high prevalence African countries. They don't know what proportion of HIV is transmitted through heterosexual sex, therefore they don't know what proportion is transmitted non-sexually, such as through unsafe healthcare or cosmetic practices. But nor are they in the least bit interested in finding out.

Because it's much easier to blame individuals and their promiscuity. You only need to rely on people's pre-existing prejudice about African sexuality to swallow this story. When it turns out that women are far more likely to be infected than men, you have to keep rewriting the story, but you can still depend on existing prejudices.

The prejudice is so pervasive that even many Africans seem to believe it. I have been told many times that Africans really do have lots of sex. But there remains quite a disagreement about who 'spreads' HIV. Some say it's men, some say it's women, some say it's foreigners, perhaps tourists, migrants or internal migrants, some even go with the HIV industry favorite, truckers.

But firstly, there is no evidence that Africans have inordinate amounts of sex, safe or unsafe. Secondly, there is no evidence that people in high prevalence countries have more sex, safe or unsafe, than people in low prevalence countries. And it is well known that HIV is difficult to transmit sexually.

Even in countries with relatively high HIV prevalence, the virus is not spread evenly. There are high prevalence areas, such as Iringa in Tanzania, at about 15%; and there are low prevalence areas, such Kigoma, where prevalence is less than 2%. Would anyone be stupid enough to claim that people in Iringa have more sex, or even more 'unsafe' sex, than people in Kigoma?

In Kenya, the province with the highest birth rates and the lowest rates of condom use has the lowest HIV prevalence. The North Eastern province also has the lowest figures for access to health, education and other social services. It is the poorest province in the country by a long shot, according to almost every indicator, except for HIV prevalence.

There are low prevalence areas in Kenya and Tanzania where many people have not heard of HIV, and it does not affect them greatly. Most of them do not know someone who has died of AIDS. HIV tends to infect people living in or close to cities or highly developed and densely populated areas. Like health and other social services, HIV also needs an infrastructure.

And stigma, too, needs an infrastructure. Africans do not have an interest in naming a disease, describing its modes of transmission and labelling those said to transmit it. That's a job for a cabal, like the one described above.

If the HIV cabal is interested in confronting "the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV", they could start by questioning their own prejudices and asking where Africans got the idea that HIV is 'spread' by promiscuity and other 'bad' things. It's a virus, not a magic spell.

It has taken a lot of money and work to stigmatize whole populations in high HIV prevalence countries and that money has been controlled by the HIV industry itself. Wringing their hands and wailing will not reverse the damage they have done. HIV transmission will only be significantly reduced when we establish exactly how the virus is being transmitted. And we know where to start: HIV is not only transmitted sexually.


Saturday, August 13, 2011

UNAIDS Want Equal Numbers of Male and Female HIV Infections?

Despite the fact that it clearly doesn't work, UNAIDS and the HIV industry are persisting with their incitement to racial hatred approach to HIV prevention. Following the UN/IRIN 'Swazis eating cow dung' article, which was echoed throughout the social and media networks without analysis or criticism, they are back to their 'African women are prostitutes' theme.

This time, the prostitution theme (or 'transactional sex', which could be interpreted to describe all sex) is set in the Swazi garment industry, where HIV prevalence stands at 50%. The industry mostly employs women and they receive very low wages for long hours, despite the value of their output to the US, whose 'African Growth and Opportunities Act' (AGOA) facilitates such sweatshop industries.

The trouble is, the two stories don't really go together very well. The one about HIV positive people eating cow dung because they are too poor to afford any other food suggests that HIV infects poorer people. But HIV prevalence tends to be lower among poorer people and higher among wealthier people.

And the story about sweatshops suggests that even those working in the formal economy are so poor, they need to supplement their income by having high risk sex for money. Those in the garment industry are poor and exploited, that's what instruments like AGOA are designed for, but they are by no means the poorest in the country.

The probability of transmitting HIV, even under the most risky circumstances, is far lower than one. So if 50% of women are infected, up to 100% of them have been exposed. Yet, not everyone in a population has sex, let alone 'unsafe' sex. Most of the women working in the garment industry are young. Low probability of an event occurring (HIV infection) means that the women must take a lot of risks, and this takes time.

Sex work has its risks, but sexually transmitted infections (STI) are not even the biggest worry for a lot of women. In many countries, HIV transmission is uncommon among sex workers unless they are also intravenous drug users. In other words, sex is not as big a risk for HIV as we have been led to believe. So why should sex appear to be such a risk in Swaziland, especially in the sweatshops?

The simple answer is, there is no evidence that women in high HIV prevalence populations have more sex, or more risky sex, than women in other populations where HIV is rare. It's easy for a journalist to pick up a few anecdotes about a woman who gets money for having sex in her spare time to supplement her sweatshop wages, just as it's easy to find someone to supply anecdotes about people eating cow dung (which they probably picked up from IRIN or one of the many media outlets that ran the story).

But this is just gossip and unless it sheds light on how women are being infected with a difficult to transmit disease in such shocking numbers, it is not going to reduce HIV transmission. There is something going on in Swaziland that is facilitating the spread of HIV and it is not just sex, which goes on everywhere.

What could it be? Well firstly, health services need to be investigated. Because they are clearly weak when it comes to simple functions, like guaranteeing a constant supply of drugs for HIV positive people whose lives depend on them. This is another thing the UN's IRIN covers frequently, weak health services. Health services don't even have enough staff, equipment, training or supplies to guarantee the minimum standards; how can they guarantee that they are not also inadvertently spreading HIV?

We know African health facilities are such dangerous places that the UN won't allow its employees to use the ones that ordinary Africans have to use. But do these sweatshops also have health services, such as routine immunizations, health checks and, even worse, STI testing and treatment? Assuming that the main risks people face are sexual could be bringing about the very scenario such procedures are supposed to prevent.

The chances that careless, underfunded, mandatory STI testing and treatment programs are spreading diseases, including HIV, are huge. It is highly suspicious that groups thought to be at risk of HIV are infected in unbelievable numbers when those who are said to be infecting them, men, are infected in far lower numbers, and much later in life.

It's quite possible that many women are being infected nosocomially, especially through unsterile injections relating to STI vaccination and/or treatment, and going on to infect their partners. This is in serious need of investigation, because an epidemic that infects half of all women in a demographic sector, even though it's a difficult disease to spread sexually, is not driven by sex.

If HIV being transmitted through unsafe healthcare is the explanation for the otherwise mysteriously high prevalence among young African women, the last thing Swaziland or any other African country needs is a mass male circumcision campaign. Yet that's what UNAIDS are demanding for high prevalence countries. Are they trying to do to African males what they have succeeded in doing to females?


Thursday, August 11, 2011

Public Health, Private Interests, HIV and Circumcision

If you don't have time to read the articles below, or even this blog post, take a look at this BBC video. An effervescent medical device industry executive positively drools over their latest offering: an elastic band that fits over a plastic ring, used to circumcise men without the need for surgery, or even anesthetic.

The same executive might not feel so comfortable about a similar device for circumcising women. Of course, circumcising women is a revolting practice with no medical benefit. But rates of HIV tend to be very low among African tribal groups which practice female circumcision. And reducing HIV transmission is, ostensibly, the main reason for circumcising large numbers of men.

Even circumcision enthusiasts don't know why male circumcision appears to reduce female to male HIV transmission during heterosexual penile-vaginal intercourse (although it may increase male to female transmission, which is generally far more common in African countries). They are as much in the dark about any protective mechanism as they are about the value of female circumcision in reducing HIV transmission.

But their enthusiasm for carrying out the operation on millions of men, as people continue to die of diseases that can be prevented for a fraction of the cost of a circumcision, remains intact. Thankfully, Malawi has decided that the evidence for mass male circumcision is not convincing, but many African countries have bought into it.

Apparently in South Africa, where HIV transmission rates among circumcised men are still alarmingly high, 'sexual behavior has not changed', despite those having the operation receiving rigorous counseling and other 'prevention' training. Up until recently we were told how sexual behavior needed to change because men were so brutal and women were so vulnerable.

So the behavioral norms that were considered so horrifying at one time and were considered to 'drive' HIV epidemics are no longer horrifying?

Even the WHO suggests that about 16 people may need to be circumcised to prevent one HIV transmission over a period of ten years. That's a hell of a lot of circumcisions required to make a small dent in Southern and East Africa's high and medium prevalence epidemics. And that's if it actually has any positive impact at all in the long run.

But one of the most worrying aspects of the whole circumcision charade is the fact that it all seems to be stoked up by people who are not themselves at any risk of being infected by the virus or even of being corrupted by the behavior that is said to spread the virus. And their evident zeal is only sometimes stoked up by a desire to make lots of money, though I'm sure that helps.

It has been pointed out that in the case of another 'prevention' strategy, pre-exposure prophylaxis (PrEP), an estimated 45 people need to be taking antiretroviral drugs in highly profitable (for the pharmaceutical industry) quantities to prevent a single infection. Are mass male circumcision campaigns and PrEP really aiming at public health, or is there something else behind them?

While there is a lot written about HIV positive people engaging in 'criminal' behavior and the various legal instruments being discussed to curb such behavior, there has been less talk about crimes being committed against people in the name of reducing HIV transmission, or even various other diseases. In Kenya, quite a few people were put in prison for refusing to take their TB drugs in the last couple of years.

In Nigeria, people have been threatened with prison for refusing to immunize their children against polio. It's not always clear why some people resist polio vaccinations so strongly, but there is a hint that people want more than just a routine injection, for example, clean water and sanitation, a decent level of nutrition, even treatment and prevention for far more common ailments.

This is the country where Pfizer has had to pay out tens of millions of dollars in compensation for causing widespread deaths and disability during a drug trial that went wrong (Trovan). No one in their right mind has any reason to trust pharmaceutical companies, least of all Africans, who are often not even the beneficiaries of the drugs that are tested in African countries.

People have legitimate fears about public health interventions. It's very sad to see people dying unnecessarily, but they should have the right to question what they are being told, the right to be educated, not just compelled. And they should have the right to be told the truth about the diseases in question, as well as the intervention that is being imposed.

So far, people are not being told the truth about HIV or about mass male circumcision. HIV is not always spread sexually and mass male circumcision campaigns can have serious consequences, such as infections with other diseases and even the failure of the campaign to achieve a meaningful reduction in HIV transmission.

We don't know if those HIV positive people who refuse antiretrovirals in a test and treat program might one day be criminalized. Many who refuse are already stigmatized and persecuted. Similarly, if PrEP was available for everyone considered to be at risk of HIV infection, would those who refused to take it be criminalized (or just publicly shamed)?

Supposing UNAIDS did decide that mass female circumcision of some kind was the best way to reduce HIV transmission, or that such a campaign would complement other reduction programs? Would everyone accept the various opinions, data, cajoling and railroading, as many are doing with male circumcision, PrEP and various other public health campaigns? So why do we accept some interventions and not others that may be equally well supported by 'evidence'?


Tuesday, August 9, 2011

The Consequences of a False and Insulting Portrayal of Africans

Presenting a false and insulting portrayal of tribal people is, as Stephen Corry argues in the New Internationalist blog, inherently unethical. And the consequences can indeed be far-reaching. Corry lists "murders, dispossessions and long-term abuses of tribal peoples" which are "underpinned by racist thinking". Corry is attacking a TV program which portrayed an Amazonian tribe as "sex-obsessed, mean and savage".

So I hope followers of Corry will agree that presenting a false and insulting portrayal of the people of an entire continent is similarly unethical, though on a far larger scale. And it certainly has far reaching consequences. The HIV industry's portrayal of Africans as sex-obsessed, mean and savage, and their perpetuation of demeaning and stereotypical views, is the grounding for global HIV policy and HIV spending in African countries.

In fact, the theft of African land and resources by governments and corporations on a massive scale is just one of the consequences of the HIV industry's fabrications, just as it is for the kind of tribal groups that Corry writes about.

Because African men are effectively depicted as rapists and child molesters and African women as defenceless (but money-mad) victims, the view that HIV is almost always heterosexually transmitted in African countries, and hardly ever anywhere else, is now the mainstream view.

Take for example almost every HIV 'prevention' program that has ever been considered for Africa: Abstinence, Being faithful and using Condoms (ABC), mass male circumcision, sexually transmitted infection (STI) reduction, pre-exposure prophylaxis (PrEP), microbicides, treatment as prevention (sometimes called 'TraP', apparently), conditional cash transfers, and I'm sure there are others.

Almost all these prevention programs target people thought to be (and sometimes actually) highly sexually active, even though HIV is relatively difficult to transmit through penile-vaginal sex. These programs even target people who are not at all sexually active because African sexuality is thought to be so pervasive, no one escapes, not even the very young and the very old.

And at the same time, non-sexual transmission routes, such as through contaminated blood transfusions, reused syringes and needles or various other medical precedures, which are both common and extremely efficient at transmitting HIV, receive next to no attention or funding.

This is not to say there are no social problems in African countries. A recent article finds that there are problems with use of porn videos, illegal alcohol, unprotected sex, coercive sex, rape and various other things involving teenagers in a part of Kenya where HIV prevalence is highest.

But there is little evidence that these problems, which are very serious and do need to be addressed, are particularly closely related to the HIV epidemic there.

HIV is sometimes transmitted sexually and some types of sexual behavior are more risky than others. All of these problems need to be addressed, whether HIV transmission is involved or not. But this is not a reason to ignore non-sexual transmission, which could be taking place in the very STI clinics and health facilities that people end up being sent to. Vulnerable people need protection, but not just from sexual risks or even from the risk of HIV, alone.

It's always worrying when the World Bank tries to reassure the public of anything. So their article entitled "Cash Payments Can Reduce HIV/Sexually Transmitted Infections in Africa―New" should set off alarms.

Improving education, health, infrastructure, economic circumstances and the like is clearly desirable. But when the 'solution' comes from the institution that has spent decades giving out loans to struggling economies on condition that they reduce public spending on all those same goods, why should we accept their findings about such 'conditional cash transfers'?

The bank feels that women and girls especially are having unsafe sex in return for money because they are poor (and uneducated and suffer various other kinds of social deprivation), so they wish to address this problem by paying them to have safe sex, or even to have no sex.

But how about ensuring that people with preventable and treatable STIs get the education and treatment they need to avoid these diseases and prevent them from becoming endemic, as they currently are in many countries, not just in AFrica? How about improving people's economic circumstances, or simply ceasing to compromise people's economic circumstances so that they no longer live in highly risky environments?

The World Bank paying girls to attend schools in an education system that has been ransaked under the bank's auspicies and health facilities that have been rendered extremely risky precisely because of the bank's own strictures about spending, investment, recruitment and training, is utterly revolting, as well as highly insulting to the African victims of this travesty.

For Africans, especially in high HIV prevalence countries, the consequences of their false and insulting protrayal as sex-obsessed, mean and savage could not be more extreme: HIV positive people are reviled and patronized, while they suffer and die from a preventable virus; and HIV negative people continue to face avoidable risks merely because addressing the risks would draw attention to the pernicious lies that underpin global HIV policy.


Sunday, August 7, 2011

AVAC, Big Pharma Front Group, Anticipates Healthy Returns from HIV has an article subtitled: 'how [Uganda] lost the global lead in combating HIV'. And it is a question well worth asking. Uganda, probably more than any other African country, said and did all the 'right' things, everything they were told to say and were well funded for by what became the multi-billion dollar AIDS industry.

The article, naturally, makes it sound as if it has only recently been realized that efforts in Uganda are not really having much impact on the epidemic. But even in the early 2000s it was clear that Uganda hadn't really had any success since the first few years of the epidemic, before the HIV industry had evolved.

In the early days, and not just in Uganda, those involved in healthcare recognised that HIV was spread in a number of ways, one of the most important of which was through contaminated blood, especially in the healthcare context. After all, it was in the 1980s that haemophiliacs in wealthy countries were infected in tens of thousands.

There were other massive outbreaks of HIV in healthcare settings, such as the one in Romania, where thousands of teenagers are now coming of age having lived with HIV all their lives. Thousands more have died of AIDS. Few will forget Libya's notorious outbreak, but there were still more outbreaks that received less press attention.

In addition to the current tens of thousands of Chinese people who were infected with HIV through contaminated blood, blood products and other healthcare procedures, there are the uncounted hundreds of thousands, perhaps millions of Africans, who continue to be infected because the AIDS industry ceased talking about and funding efforts to reduce non-sexual HIV transmission.

In the 1980s, the Ugandan government was rightly praised for raising the alarm about HIV and doing everything in their power to reduce transmission, however it occurred. But in the 1990s HIV was hijacked by political, religious and commercial interests in a scenario where if sex wasn't involved, it wasn't worth talking about. HIV prevalence decreased rapidly in Uganda in the 90s because death rates rocketed. But since the mid to late 1990s up to the present, HIV incidence and prevalence have remained fairly steady.

This means that the money pouring into the country, and pouring into other medium and high prevalence countries, is having little or no impact. No country has succeeded in controlling its HIV epidemic by ranting about, or even by throwing buckets of money at, sexual behavior; no African countries, no Asian countries, not even Western countries, and certainly not the US, which spends the most on such ranting but has the highest HIV rates in the Western world.

If only Uganda hadn't attracted the attention of the hoardes of politicians, business people, bureaucrats, religious leaders and assorted cranks, has beens and what not; the country might have continued to monitor conditions in health facilities and improve medical procedures that potentially involved exposure to blood or other bodily fluids contaminated with HIV.

Uganda is not the only medium prevalence country where HIV prevalence has stagnated for quite a few years. Kenya and Tanzania are in a similar position. In fact, prevalence in all three countries has barely changed in the last 10 years if you take into account the fact that death rates were only peaking in the early 2000s there, whereas rates peaked in Uganda in the 1990s. Reducing HIV prevalence through high death rates is hardly something to boast about.

But the article bemoaning how Uganda is 'falling behind' comes out with the same HIV industry rubbish about HIV being almost always sexually transmitted, claiming that this accounts for 76% of all infections and another 22% is accounted for by mother to child transmission. This leaves 2% for a combination of healthcare related transmission (such as blood transfusions, reused syringes, etc), men having sex with men, heterosexual anal sex and intravenous drug use.

The 76% figure is in serious need of investigation. This is the sort of figure that has been blowing any efforts to reduce HIV transmission off course for over twenty years. The article itself puts a finger on the problem, but without realizing it. It is because Uganda has been doing everything the AIDS industry expects of it that they have been failing. Just how many more years do they have to continue proving how wrong their strategy is?

Report after report shows that the people becoming infected in largest numbers are people who do not engage in 'unsafe' sex, that those who are infected are often those with one, or even no partners, they are often the ones who use condoms and know just about everything they have been told about how the HIV industry says HIV is transmitted.

Uganda is one of the countries where a lot of the early HIV research took place, where people were followed around, without necessarily being told they were HIV positive, to see how long it took them to infect their partner. Yet this Tuskegee style experiment appears to have left researchers in the dark as to how HIV is actually transmitted, rather than clarified the matter.

The article closes with a remark from Mitchell Warren, director of AVAC, the pharmaceutical industry front group which purports to advocate for prevention: “new prevention options – medical male circumcision, PrEP, microbicides and eventually vaccines – will play a critical role in reducing the cycle of new infections. As we look toward the next 30 years of AIDS, investment in prevention research has never been more important. Going forward we need funding structures that are flexible, agile, and generous enough to adapt rapidly to new opportunities.”

Roughly translated, this means that 'the pharmaceutical industry is very happy that HIV is not being eradicated and they expect to sell a hell of a lot of drugs and make even more billions than they have made so far, especially as they have persuaded those with the money that giving out endless rounds of drugs is all that is needed to solve the problem'. It won't reduct transmission, of course, but why would the pharmaceutical industry want to do that?


Wednesday, August 3, 2011

UN Publicity Machine Devours its own Entrails

With a breathtaking lack of self awareness, IRIN, part of the UN, has an article entitled 'Africa: The crazy things they say: politicians and HIV'. If this article is not an argument for the abolition of UNAIDS I don't know what is.

Yes, there are some political leaders in Africa who think strange things about HIV. And there are political leaders everywhere who think strange things about HIV. This is despite billions of dollars being spent around the world on the disease, some of which was aimed at informing people about it.

Established 17 years ago, a more spectacular failure among international instutions than UNAIDS would be hard to find, though there is plenty of competition.

Not only are some of the leaders and populations of the highest prevalence countries in the world systematically misinformed about HIV, meaning that little can be done to reduce transmission, but the institution continues to point the finger at Africans themselves for a disease that it was their sole mandate to address.

I have tried to articulate why I thought lying about how HIV is transmitted in African countries is a form of extremism. But the IRIN article does it far better. From a Swazi MP who said HIV positive people should be branded on the buttocks, to a South African president who severely curtailed treatment for hundreds of thousands of HIV positive people, the article just about sums up what UNAIDS has achieved.

The press is as bad as those leaders, spreading just about any rumor they think will sell their content, with the BBC recently leading the pack of racists with a 'story' about Swazis eating cow dung because they were too poor to afford food and needed something in their stomachs to reduce the side effects of antiretrivoral treatment.

One of the African leaders who started off pressing for effective measures to reduce HIV transmission was Museveni of Uganda. Under his leadership in the 1980s many things changed in health facilities, government departments, schools, universities and elsewhere, so that people were informed about HIV and enabled to avoid it.

But the 1990s saw the health issue of HIV being hijacked by the media, the pharmaceutical industry, politicians, religious leaders and others. HIV prevention messages were exclusively replaced by patronizing rubbish about what people should and shouldn't do in bed. Making HIV into a moral issue and one about promiscuity and illicit sex ensured that stigma, which was already a problem, became institutionalized and it has remained so ever since.

UNAIDS have rarely been heard to refer to any kind of non-sexually transmitted HIV except to deny that it exists. And they have to spend their time thinking up ad hoc explanations of why a virus that is difficult to transmit sexually is almost always transmitted sexually in (some) African countries and hardly ever in non-African countries.

If IRIN want a real story, they could look at why some people who should know better have strange ideas about HIV. But IRIN itself has always been part of the problem, being a mere mouthpiece for the UN aristocracy. The article modestly declares that it "does not necessarily reflect the views of the United Nations". True, not necessarily.

It's easy to point the finger at African leaders and sneer at their misunderstandings about HIV, and finger pointing is a specialty for UNAIDS. But it's worth asking why these leaders are so misinformed by an institution that has had little else to do with its billions but inform them. But kudos to IRIN for highlighting part of the problem, however inadvertently.


Tuesday, August 2, 2011

Role of Unsafe Injections in HIV Transmission Acknowledged

Not long ago UNAIDS launched one of those glossy publications of the sort that the UN as a whole is justly famous for. The launch was accompanied by the sort of publicity that few but the UN can afford. And the publication claimed that the 25% reduction in HIV infections among young peoplein high prevalence countries is due to sexual behavior change.

Well, they would do, because according to UNAIDS, HIV is almost always transmitted through heterosexual sex in high prevalence countries. But it would be a neat trick if non-sexually transmitted HIV were also reduced through sexual behavior change. And, given that even UNAIDS admits that some HIV is not transmitted through heterosexual sex, how do they account for reductions in non-sexually transmitted HIV?

They don't mention it much. Perhaps they hope no one will notice, or that no one will be impolite enough to mention if they do notice. But there are some who have very good reason to draw attention to the fact that a lot of HIV and other viruses are transmitted through unsafe healthcare, especially unsterile injections, disposable injection equipment that is being reused, often without any attempt made to sterilize it.

The SafePoint Trust disseminates information about unsafe healthcare, to those giving and those receiving the healthcare. They promote the use of non-reusable syringes, also called 'auto-disable' syringes, because they break after a single use. The statistics they have gathered together about syringe reuse are really shocking.

None of the information disseminated by SafePoint will be new to UNAIDS. They have access to and use the same publications as SafePoint. But UNAIDS deny that non-sexually transmitted HIV plays a significant role in serious HIV epidemics. Regardless of the weight of evidence to the contrary, they insist that 80%, even 90% of HIV is heterosexually transmitted in African countries and that much of the other 10 or 20% is transmitted from mother to child.

Among the many cited facts from SafePoint's leaflet, we are told that 20 million medical injections contaminated with blood from a patient with HIV are administered every year. From this, UNAIDS concludes that about 1-1.5% of HIV infections might come from unsterile injections. This is despite massive outbreaks of healthcare acquired HIV in non-African countries in the 1980s. And the WHO used to recommend the reuse of needles and syringes up to 200 times in vaccination programs, right up to the late 1990s.

Thankfully, many hospitals in Tanzania now use auto-disable syringes for some types of injection. But their use is by no means universal and you can still buy disposable syringes in pharmacies and shops. Also, injections are not always administered in sterile conditions, or by people who have been trained in medical safety.

The way UNAIDS and other luminaries of the HIV industry resolutely refuse to acknowledge non-sexual HIV transmission, and to persist with their highly stigmatizing ranting about African promiscuity and unsafe sex, is inexplicable. Even the mainstream MedPageToday has an article on unsafe practices in US hospitals, which are light years ahead of African countries in terms of conditions.

UNICEF has carried out a study of an initiative to improve injection safety, especially in relation to reuse of syringes for vaccination programs. Perhaps they can get in touch with UNAIDS and inform them that their intransigence is responsible for much of the continued non-sexual HIV transmission of the last 10 or more years? Perhaps also, the initiative will be extended to non-vaccine related injections, which make up the bulk of use of injecting equipment.

The Safe Injection Practices Coalition (SIPC) has launched a free online course for healthcare providers on unsafe injections, which should help inform professionals about the risks and how to eliminate them. This may take some time to get around in countries like Tanzania, where power and connectivity are not reliable. But it's a very good start. However, the course is likely to be aimed at a US or Western audience.

UNAIDS have not increased in relevance over the years and these initiatives certainly don't improve their credibility. But the institution might be entitled to a few brownie points by ensuring that some of the billions spent on HIV is now spent on non-sexually transmitted HIV. Then they might even have something to boast about. But the institution should still be abolished, for the good of those already infected and for those who will certainly be infected if global HIV policy continues to obsess about sexual behavior and ignore some of the most easily avoidable risks.


Monday, August 1, 2011

Why Lying About HIV Transmission in Africa is a Form of Extremism

The simple answer: because it is dehumanizing. It dehumanizes Africans to say that HIV is endemic in some countries 'because of the people's sexual behavior'. And dehumanizing people is an advanced step in many kinds of excess, such as discrimination, persecution, racial, sexual and gender based hatred, impoverishment, violence, terrorism, and many others.

As a result of the dehumanization of Africans over the thirty years of recognized HIV transmission, many extremist suggestions have been made about 'containing' the epidemic: mass forced sterilization, castration and isolation, to name a few. Some suggestions have been put into practice: mass testing, 'pledges' to avoid sex, 'payments' to avoid sex, use of Africans as research guinea-pigs, unethical research on humans, mass forced treatment, stigmatization of sufferers and mass circumcision.

As a result of the dehumanization of Africans, there is talk of putting even more people on drugs, whether they are HIV positive or not, even whether they choose to accept treatment or not. These strategies include pre-exposure prophylaxis (PrEP, for more of which, see my other blog), treatment as prevention, microbicides and even vaccines, if such vaccines are ever developed.

African people are not treated like non-Africans: if someone here is diagnosed as being HIV positive, they are told they were infected by 'unsafe' sex. This is not generally how people diagnosed with HIV in non-African countries are treated. Especially if the patient denies having any kind of 'unsafe' sex.

When infants are found to be HIV positive in non-African countries, the mother is tested. It is not assumed that the mother is positive. If the mother is found to be negative, the issue of how the infant was infected is investigated in non-African countries. In African countries, it is implied, even stated, that infant rape can not be ruled out.

When you diagnose a disease in animals, you put them on treatment. You observe their behavior and make conclusions about what steps need to be taken to ensure that such behavior does not continue. But you don't need to take this approach when you are dealing with humans. So why is that they way Africans are treated by the HIV industry, WHO, UNAIDS and various 'academic' institutions?

We have gone a long way down the road of dehumanizing Africans when a mainstream media outlet can publish a story about Swazis 'eating cow dung' because they are starving and need food to take along with their antiretroviral drugs. We have gone a long way down the road when hundreds and thousands of others link to and spread that story throughout the World Wide Web, much like a virus, you could say.

I thought carefully about mentioning Nazis in relation to the story about Swazis. But Nazis really did attribute such things as eating feces to Jews, it was just one instance of the many stigmatizing things they would attribute to those they hated. Hitler really did believe that propaganda need not consist of true things about its target, that a mixture was quite sufficient.

If we are not yet aware that while HIV CAN be transmitted sexually, it CAN ALSO be transmitted non-sexually, we have been deceived by those who purport to be educating us about the virus. We should know that HIV is difficult to transmit through heterosexual sex among healthy people, but that it is much more easily transmitted through anal sex, through intravenous drug use and even through heterosexual sex among people who are suffering from serious health problems, including certain sexually transmitted infections.

Those living in non-African countries should be aware that most of the people who have HIV in their countries were not infected through heterosexual intercourse. This is a reflection of the sort of virus HIV is. It doesn't mean that HIV infects 'bad' people, despite the tone of much media content on the subject.

But if HIV is almost always spread through means other than heterosexual intercourse in non-African countries, why would 80% (or even 90%) of HIV be spread through heterosexual intercourse in African countries, as claimed by the HIV orthodoxy? The fact that a HIV positive person has had sex, even 'unsafe' sex, does not mean they were infected sexually.

We know, we have known since the 1980s, that HIV can be spread through unsafe healthcare such as blood transfusions and unsterilized equipment, especially  injecting equipment. And we have known there are other risks, such as cosmetic treatment with unsterilized equipment, tattooing, especially in prisons, traditional medical and other skin piercing practices, home deliveries, etc.

In addition, we know that healthcare facility conditions are appalling in many developing countries, especially high HIV prevalence African countries. Even UNAIDS advises UN employees to avoid health facilities in Africa. We know that many blood transfusions are administered without adequate precautions taken to avoid infecting the patient with HIV, hepatitis and other diseases, that skin piercing equipment is frequently reused without sterilization.

As long as we continue to point the finger at HIV positive Africans, implying, or even stating that they were infected sexually, we are allowing the virus to be spread. As long as we continue to pretend that we know how people are becoming infected with a virus that should never have reached endemic levels, we are allowing people to become infected. We have not yet investigated non-sexual risks in African countries. Why do UNAIDS studiously avoid doing this?

We dehumanize Africans by assuming things about their sexual behavior when no adequate investigations have been made about other, non-sexual HIV risks and this is just a part of an extreme racist phenomenon of allowing an epidemic that should never have occurred to continue to infect people, kill people and destroy their families and communities. The orthodox account of how HIV is transmitted in African countries is inherently racist. It is also a lie, the propagation of which has profound consequences.