But the Media Doesn't Want to be Free

It's odd how countries that have a 'free' press seem content to publish whatever is put in front of them. Coming up to the Vienna Aids Conference, UNAIDS puts out a press release about their new 'platform', called 'Treatment 2.0', with which they are going to conquer the virus that they have, so far, failed to influence in any way since the UN spawned this curious agency. And the world's press simply echoes what UNAIDS says. You can search for any of their expensively honed terminology and you'll find the same thing, repeated like a fart in a whispering gallery, until it's overtaken by their next performance. And the world's busy dung beetles do what their species does best, rolling out articles as indistinguishable as balls of shit. It's not (yet) as if the global media is entirely owned by the likes of that arch dung-heap master, Rupert Murdoch. But out they come, without thought, comment or criticism. Of course they roll, they're spherical!

Before the World Cup, which apparently involved football and sex, the busy creatures were set to work on UNAIDS' predictable offering. This involved making the connection between football supporters away from home drinking a lot and the possibility of their availing of some of the personal services said to be on offer in South Africa. Every news agency did the usual and warned people to avoid having sex with anyone and if they had to have sex, to make sure they used a condom.

Now that the World Cup is over, news agencies can still churn out articles with the popular mixture of football and sex in the form of warnings to those who may have indulged in any kind of unprotected sex while in South Africa, to go for a HIV test. If their pre-World Cup messages had any effect, many football fans probably used condoms and should be ok. For those who were not reading or heeding the articles, it is a good idea to get tested for HIV and all other sexually transmitted infections.

But one thing these guardians of our health and wellbeing never mentioned is that HIV is not only sexually transmitted. In fact, they have been trotting out the sex message for so long, people have probably heard it by now. UNAIDS and therefore the world's press, meanwhile, have kept what they know about non-sexually transmitted HIV to themselves. UNAIDS are quite explicit in the advice they give to their own employees who may be working in African countries: avoid using health facilities that are not approved or provided by the UN. If the risks are high for UN employees, they may be higher for football supporters and even higher still for Africans.

Football fans visiting South Africa probably had a far greater likelihood of contracting HIV, hepatitis B or C, when visiting a clinic, dentist or tattoo parlor. UNAIDS are well aware of this. But they do not tell Africans, who have no option but to use any facilities they can afford. And they didn't bother to tell football fans. And now, when the press are doing their duty by wallowing through the latest releases, they too are neglecting to mention this risk. People who had unsafe sex may go and get tested, but people who had medical or cosmetic treatment are far more likely to transmit HIV or anything else to their partner before discovering, probably some years from now, that they picked up something during the World Cup.

The BBC runs a typical article, mainly targeting men, despite the fact that women who had medical or cosmetic treatment in South Africa could be just as much at risk. The article is about a campaign being run in the UK, which trots out the half-truth about HIV being sexually transmitted, even though it has always been known that HIV can be transmitted in other ways. Although the article mentions holiday makers in general, many of whom may be visiting developing countries, there is still no acknowledgement of the risks people face in health and cosmetic facilities.

One commentator referred to the campaign as "amusing and engaging". It may well be, but what's the point in amusing people and engaging their attention when the message has been mangled, for whatever perverse reason? South Africa is not just the country with the highest number of HIV positive people in the world. In common with most other African countries, South Africa also has appalling health conditions and run down facilities which are barely accessible to most people. Holiday makers may not have to use the facilities that ordinary Africans have to use. But there is as much of a risk to holiday makers from unsafe medical and cosmetic practices as there is from unsafe sex, perhaps more. So why the failure to mention this?

The media seems to need a reminder that they are allowed, they are even encouraged, to analyse, criticize and comment on what they write about. They are even permitted to disagree. If UN agencies like UNAIDS spew out dung, there is no reason why the media should passively roll it up and pass it on to their readers. If every news agency carries the same story, word for word, as they do in the case of HIV and sexual transmission, without ever mentioning non-sexual transmission, there is only need for one news agency. Right now, it almost seems as if there is only one news agency, run entirely by dung beetles.

Big Media: Double Standards or Negligence?

I searched in vain for any mention of the risks of non-sexually transmitted HIV before the World Cup. But all the big news sources, CNN, BBC, Al Jazeera, along with lots of newspapers and news sites, covered sexual transmission of HIV, exclusively. They warned people about unprotected sex and using condoms, etc, but none of them warned people that in South Africa, medical and cosmetic treatment can carry huge risks from unsterilized equipment and unsafe procedures.

This is particularly odd because I would put money on it that these same organizations warn their own employees about non-sexual dangers. I could be wrong, perhaps they don't warn their own employees. But many big organizations do, such as the UN, WHO and CDC. Even an MSF Kenya employee I talked to recently said she and her colleagues wouldn't use local medical or dental facilities (though, inexplicably, she didn't seem to think medical transmission posed much of a risk to people who lived in the country). So big media are either guilty of the double standard of warning their own employees of a risk that everyone in African countries face without warning African people; or they are guilty of negligence in not warning their employees about this serious risk.

Of course, they may have been advised by UNAIDS or the like that medical treatment does not pose much of a risk. What they mean by this is that they are currently admitting that in excess of 5% of HIV is transmitted by medical treatment. These thousands of people infected are so insignificant that UNAIDS deems it better to keep talking about sexual transmission and completely ignoring medical transmission because otherwise, people might not have confidence in their medical service providers. So, is there a risk or is there not?

If the risk is so small, only a few tens or perhaps hundreds of thousands of new cases every year, why not warn people about it? Because if the risk is small, they shouldn't be unduly worried about their medical service providers. But then, if the risk is small, why do UN agencies warn their own employees away from using medical services in African countries that are not approved by the UN? And while in excess of 5% of cases may not seem so significant to UNAIDS, that's 8 or 9 times higher than the contribution of medical treatment to HIV prevalence claimed for Kenya, which the same UNAIDS put at about 0.6%.

What is so wrong with saying that people face risk from both sexually transmitted and non-sexually transmitted HIV? Is it so hard to admit that when millions of needles and other sharp objects are stuck into people every day, some diseases may be accidentally transmitted? Because, if UNAIDS had the balls (or do I mean teeth?) to admit this obvious possibility, people living in African countries would be in a position to do something to protect themselves, perhaps even to lobby their governments to change things so that they don't face these dangers.

I think UNAIDS are right, if people found out that they or their children face an appreciable risk of being infected with HIV, they would think twice before having routine medical treatment. But what would UNAIDS prefer? That tens of thousands of preventable HIV infections continue to occur because they think that number is insignificant compared to people suspecting that their medical service providers are not very safe?

Either the danger of medical transmission is insignificant, and then it shouldn't be beyond the capability of UNAIDS and their chums to manage the fallout from telling the truth: that there is some danger. Or medical transmission is anything but insignificant, in which case UNAIDS and all other relevant agencies should lose no more time in warning people of the risks and in mitigating those risks so that people can return to their medical service providers with greater confidence.

I don't accept that it is better to keep people in the dark and allow some of them to become infected with HIV when this is completely avoidable. I don't accept that it is better not to tell people how to protect themselves or to try to cover up the danger on the grounds that people not using medical services is a bigger evil. African people are being treated like idiots, who don't know how to evaluate risks and to take measures to avoid them.

It looks as if people visiting the World Cup are being treated the same way, being told to avoid sex or to use a condom. Some of the more self righteous in the HIV industry like to say that the only way to be 100% sure of not contracting HIV is to abstain from sex. But this is not true. Abstaining from sex has not protected the thousands who have been infected non-sexually and the thousands more who will continue to be infected because UNAIDS, in their great collective wisdom, don't wish to inform people that there are also non-sexual risks that abstaining from sex and wearing a condom won't protect you from.

What is so difficult about telling the whole story, that HIV can be transmitted sexually and non-sexually? And if UNAIDS can't be trusted to do so, why is it so difficult for news agencies to do so? Do they really all care that little about HIV continuing to spread, unnecessarily? Or are they just so obsessed with sexual behaviour that only sexual risks are considered worth reporting?

Abolishing UNAIDS is a Prerequisite to Fighting HIV Pandemic

I'm not just suggesting that UNAIDS have failed to reduce HIV transmission to the extent that the epidemic will be wiped out in the foreseeable future, although they have certainly failed to do this. I'm suggesting that they seem content to allow HIV to spread, especially in developing countries, as long as it is not transmitted sexually.

This is disingenuous because people who are not infected with HIV sexually, for example, if they are infected though medical treatment or cosmetic treatment, can still go on to infect others sexually. It is not possible to significantly reduce sexual HIV transmission without also reducing non-sexual transmission. It is also rather pointless to target sexual transmission and exclude non-sexual transmission completely.

The question is, why does UNAIDS see its mission as relating almost entirely to sex? In the early days of Aids, before the exciting prospect of a UN agency entirely devoted to one disease was even recognised, non-sexual transmission of HIV was still considered important. Warnings about HIV risk included risk of medical transmission and risk from other procedures that involved possible blood borne transmission.

As a result, Western hospitals changed the way they did things, especially relating to any procedures involving possible blood exposure. Blood transfusions represented one of the greatest threats and even developing countries now have policies relating to transfusions that are estimated to have cut this form of HIV transmission considerably, perhaps completely.

But developing countries have not had the resources or the training to improve their health facilities enough to convince the UN, and probably many others, that they are safe. And indeed, they are not safe. Westerners travelling to developing countries, especially in Africa, are often warned about medical and other treatment that could carry the risk of exposure to HIV and other blood borne diseases. But Africans are not warned.

An unusual exception to the practice of warning Westerners (and not bothering about people in developing countries) seems to be occurring at the moment. I don't think people visiting South Africa for the World Cup are being warned about non-sexual risks, although they are hearing plenty about the sexual risks. Some of them will probably feel they have had enough sex by the time they get to South Africa. Others may only feel their appetites whetted.

But South Africans are still, to a large extent, in the dark about non-sexual HIV transmission. A report from a few years ago estimated that the number of new infections per year among those aged between 2 and 14 was about 69,000. About 192,000 people between 15 and 24 were infected. But where are all these infections coming from? What makes a South African more or less likely to be infected?

69,000 children infected in one year! What are the possibilities? That their mothers are all HIV positive (the report authors say it is unlikely that these are linked to mother to child transmission)? But many (not all, unfortunately) HIV positive mothers receive treatment to prevent transmission to their infants. And even among those who don't, HIV transmission is not 100%. There are other possibilities, but certainty is needed. When a country has tens of thousands of HIV positive children, this needs to be investigated, so we can be sure what is going on. If you were the parent of one of those children, would you accept UNAIDS contention that most HIV is transmitted sexually?

Being black in South Africa means you are 9 times more likely to be infected than if you are from any other race. Being from Mpumalanga province means that you are 12 times more likely to be infected than if you are from Northern Cape. And if you are from an urban slum, you are over 5 times more likely to be infected than if you are from an urban non-slum area. If you are from a rural area, you are far less likely to be infected, regardless of whether you are from a slum or a non-slum.

Females between the ages of 20 and 29 are over 6 times more likely to be infected than males of the same age group. Just in case these figures suggest that the predominantly well off male and younger visitors to the World Cup could be at an advantage, they will be mainly in urban areas and if they happen to visit medical or cosmetic outlets, the contaminated blood they are exposed to could have come from a male or female of any age or race and from any location.

Also, rates of new infections among people who reported never having sex or who reported not having sex in the past 12 months stood at 1.5% and 2.4%, respectively. This could represent tens of thousands of people whose HIV infection probably came from a source other than sex. Where did their infection come from? From being African, according to the UNAIDS received view; they have simply underreported their sexual behaviour, in other words, they lied.

So, if you are visiting South Africa and you end up in bed with someone you meet there, you would be crazy not to wear a condom, just as it would be crazy in any other country in the world. You would be better off avoiding sex altogether, if that is your favoured way of reducing the risks you face for HIV, unplanned pregnancy and other sexually transmitted infections.

But you are not protecting yourself adequately if you think that having sex is the only way of becoming infected with HIV. You may well be safe enough if you take the right precautions, no matter who you sleep with. But you will be in far greater danger if you have to go to a hospital, a dental surgery, a tattoo parlour or a hairdresser.

If soccer fans visiting South Africa are lucky enough to be able to choose the health facilities and other service providers they visit, that's great. But South Africans will not be so lucky. As long as UNAIDS insists on playing the sexual card, people will remain in the dark about non-sexual risks. Providers of health and cosmetic services will continue to use unsafe procedures and people will continue to be infected with HIV.

Now that fifa and other commercial interests have their snouts firmly in the trough and journalists have been distracted by one of their favourite subjects, sex, UNAIDS is unlikely to take the only sensible route of warning people about both the sexual and non-sexual risks of HIV. As to why they have so far refused to accept that non-sexual transmission of HIV plays a significant part in the HIV pandemic in Africa, that is anyone's guess. But people are being infected, they are suffering and dying, unnecessarily. Why does UNAIDS receive public money to behave in this way?

HIV Risk From Lies and Half Truths

In the run up to the World Cup in South Africa, the excuse for talking exclusively about sexual behaviour and HIV risk and ignoring any other risks, such as the risks of medical transmission, seems to be that sexual transmission is the most common form of transmission in African countries.

The view that sexual transmission is so common that non-sexual transmission is almost negligible is debatable and the official figures are based on guesswork rather than proper research. But even if the figures were correct, it would be stupid to ignore non-sexual risks just because sexual transmission is more common.

Driver error may be a common cause of road traffic accidents but I wouldn't want to ignore the fact that my breaks are worn out just because it is a less frequent cause of accidents.

We know that the UN worries about medically transmitted HIV enough to warn its own employees about it:

"Use of improperly sterilized syringes and other medical equipment in health-care settings can also result in HIV transmission. 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."

So why not warn soccer fans and other visitors to South Africa and other African countries? More importantly, why not warn all Africans, most of whom have no option but to use their medical facilities, no matter how inadequate they are?

Sure, international health institutions want people to trust their health facilities enough to get medical treatment when they need it, to get tested for things like HIV and to take the advice of health professionals. But is that a reason to deceive the public?

The public might be afraid that official sources are lying to them or that they are keeping something back. But official sources are lying to them and keeping something back. All over Africa, there have been clear outbreaks of medically transmitted HIV. These have been covered up or just ignored and no investigations have been carried out.

Even if only a handful of HIV infections were caused by medical transmission, people should be made aware that the possibility exists. They should be in a position to protect themselves, to insist on sterilized equipment and other safe practices. If they don't even know that unsafe medical procedures occur, they will not know that they need to protect themselves.

But there is little question about whether medical transmission of HIV is common in African countries. Medical facilities have long been underfunded, understaffed and otherwise inadequate. It would be more surprising if very few transmissions of HIV occurred than if a sizeable number occurred. The only question is about how common medical transmission is compared to sexual transmission.

In the long run, people will have more confidence in public health information and in public health facilities if they are told the truth now. Those trusted to provide people with the information they need to stay healthy are not presently entitled to that trust. Maybe people will question the safety of health facilities once they realise that things have been kept from them. But as things stand, they are right to ask questions.

If it is risky for UN employees to trust medical facilities that are not approved by the UN, it is also risky for soccer fans. And if it's risky for visitors to Africa to mistrust medical facilities, it is also risky for Africans. No amount of abstinence, faithfulness to one partner or condom use will protect people from medically transmitted HIV. HIV can be, and often is, transmitted by medical and dental treatment and by cosmetic treatment such as tattooing, piercing and hairdressing, in African countries. It is not just transmitted by 'unsafe' sex.

Condoms Won't Protect Fans Against Non-Sexual HIV Risk

Since writing about HIV and the World Cup in the last few days, I have looked for news outlets and the like for coverage of non-sexual HIV risks that people visiting or living in South Africa face. I found nothing. A couple of sites mention needle sharing as a potential risk but the tone of the warning suggests that it is aimed at intravenous drug users. There is no mention of the risks of visiting a dentist, a doctor, a nurse, a surgeon, a tattoo artist, a hairdresser or any other non-sexual risks. Can journalists and others trying to squeeze all that they can out of the World Cup not find space for a brief mention of these issues?

The remarkable thing about medical transmission of HIV in African countries is not that it doesn't happen. It's that no investigations have been carried out when medical transmission has clearly occurred or where it may have occurred. Infants, children and even adults who have had no sexual exposure are HIV positive, yet there have been no calls by international health institutions, African governments or HIV donors for investigations. In most African countries, the number of women infected far exceeds the number of men infected. And though women's groups fall over themselves to get their issues heard, they don't seem to be outraged that women seem to comprise the largest number of victims of medically transmitted HIV.

Compare this to a story in Australia. There are fears that thousands of patients at a clinic may have been infected with HIV, hepatitis and other diseases after hygiene standards were found to be seriously deficient. The clinic has been closed while the investigations take place. I don't know of any similar investigation in an African country and I've rarely heard of a hospital or clinic closing merely because patients health and lives may be at risk.

Endoscope and biopsy equipment were found to have been insufficiently sterilized after nine patients became sick. There was also a contaminated anaesthetic involved. These are problems that African hospitals face all the time. They often don't have the equipment to sterilize everything properly, nor even enough trained staff to carry out the work. African hospitals also have the problem of old equipment, shortages of equipment and the need to reuse things that are designed to be disposable. Health workers are not going to do without gloves just because there is a shortage. How many options do they have?

In Australian hospitals, people are far less likely to be infected with HIV, hepatitis or other serious illness. But in African countries, where only the sickest go to hospital and many serious diseases are endemic, the risks are very high. But patients becoming ill after receiving medical treatment in African hospitals is so common that this is unlikely to trigger any kind of investigation, as happened in the Australian instance. And if people die, there are unlikely to be any questions asked. Many people die every day of all sorts of things. Health workers have little enough time to deal with sick people, let alone dead people.

In the UK, children who may have been jabbed with discarded hypodermic needles in a paddling pool are being monitored for HIV and other conditions. The have to wait three months to be sure they have not been infected with HIV, but at least they and their parents were alert to the fact that they may have been contaminated. I have passed through a couple of health facilities in East Africa and seen needles and other sharps in the grass where people walk in rubber sandals and where children play. I wonder if African children running around in bare feet would even notice a pinprick or scratch from a needle.

But I know that the parents of most children here would have no idea that needles and other hospital wastes carry a risk of infection with HIV and other diseases. Some people can tell you that sharing needles and the like carries a risk but most have not been fully warned about the risks associated with medical and cosmetic facilities. Indeed, the official line is that there is only a tiny risk from medical and cosmetic transmission of HIV. Those responsible for the official line, UNAIDS, WHO, CDC and the rest, must be well aware that non-sexual risks are far higher than they admit. But for some reason, they don't want Africans to know that these risks exist and, consequently, how to protect themselves.

And so, as the Western world worries about Westerners going to the World Cup being infected with HIV through some kind of sexual encounter, it's quite amazing that there are no warnings about non-sexual risks. Football supporters don't just like drinking and having sex after matches, they also like fighting, especially when their team loses. And drunk people can be prone to all sorts of accidents. People will end up in accident and emergency wards, dental surgeries and the like. People also may like to get that special football tattoo in South Africa, where it may be cheaper, but also more dangerous.

No doubt, there will be the usual slew of stories after the event about how various efforts and initiatives failed and how things should have been done differently. Journalists will never close the stable door if they can make a story about the bolted horse. So if the media, websites, officials and other sources of information will say nothing about non-sexually transmitted HIV, instead concentrating exclusively on sexual transmission, there will also be stories about how people are let down by health services and how unhygienic tattooists, hairdressers and ear piercers are. But only when it is too late for the victims.

If the Western press is really so worried about the health of Westerners, they should highlight the risks of non-sexually transmitted HIV and other health risks that people receiving medical and cosmetic treatment in South Africa face. They clearly are not worried about the risks that South Africans face and will continue to face after the World Cup has ceased to be front page news. But there is hope that South Africans themselves will one day question the official line, that they have so much sex that this explains why the country has more HIV positive people than any other. South Africans themselves may question the state of the health services that are available to them and ask why they have not been warned about non-sexual HIV risks or how to protect themselves. This is a very good time for them to raise these questions, before the Western press goes back to seeing Africa as a far away place populated by foreigners who have a lot of risky sex.

Unmixed Messages Could Scupper World Cup ‘Opportunity’

It's all about taking part, not winning, right? It’s certainly not about corporate domination, making money or anything so sordid. The World Cup probably means different things to those who care, can afford it or have something to gain from it. But there seems to be a worry that warnings about public safety could detract from people’s enjoyment of the football. According to the British Guardian, Fifa are blocking attempts to distribute condoms at venues. Fifa deny this and say no attempts have been made to set up condom distribution facilities. But even safe sex information has been banned, apparently.

I imagine people from Western countries travelling to South Africa will receive plenty of information about safe sex before they leave their own safe countries. Many will probably have their own supply of condoms or be able to buy them on arrival. They may even receive information on other HIV risks, such as from medical and cosmetic treatment.

They may be told that some health providers have a shortage of equipment and trained personnel, so they have to make sure that needles, syringes, suture needles and other equipment are properly sterilised if they haven’t taken a supply of medical equipment with them. It’s possible that visitors will also be warned to avoid getting tattoos, body or ear piercings or any cosmetic treatment that breaks the skin. (I’ve seen a warning about avoiding tattoos because they may be regretted later but none about the risk of HIV or any other disease.) Condoms are great for preventing sexual transmission, but I think people will need information about more than just basic safe sex.

Some Aids organizations are said to see the World Cup as a good opportunity to give out messages about HIV. But which messages are they trying to give out? That HIV is sexually transmitted? Report after report has shown that most people in African countries already know that. Whether people from Western countries know that or see that as relevant to them is another matter. But when will Aids organizations start to warn people about non-sexual risk of HIV? Non-sexual risks, especially from medical treatment, have been recognised since the early 1980s, almost since HIV was identified as the virus that caused Aids. But since early on in the epidemic, international health institutions have remained relatively silent about this important mode of infection. It is rarely discussed and every year these institutions publish figures purporting to show that medical transmission is very low and hardly worth worrying about.

Hospitals in South Africa are generally in poor condition, places you would not visit for treatment unless you really had to. Most South Africans really have to put up with these conditions, but rich South Africans (and rich visitors) don’t. They can opt for the expensive and hopefully safer hospitals, such as the ones that are looking for health tourists during the World Cup. Even those World Cup fans who need routine accident and emergency treatment will probably opt for something a bit better than the facilities available to poor South Africans. If Aids organisations see the World Cup as an opportunity to get a message across, that message should be relevant to everyone, regardless of their race, economic circumstances or any other criterion.

It is clear that HIV is transmitted by routes other than sexual behaviour. It is also clear than non-sexual transmission is far higher than UNAIDS and others will admit. Just how high non-sexual transmission goes in African countries is unclear because outbreaks of medically transmitted HIV have, so far, been entirely uninvestigated. UNAIDS is happy to warn UN employees to avoid medical treatment in African countries, except in UN approved hospitals. But they don’t seem to want Africans to know about the risks of medically (and cosmetically) transmitted HIV. This is the message that needs to be broadcast during the World Cup. Why the sudden worry that a few Westerners will become infected with HIV when Africans are being infected every day and much of this transmission could be avoided?

A brief article about preparations for medical emergencies during the World Cup mentions the ‘beleaguered health system’ and the huge HIV epidemic, but says nothing about the risk of medical transmission of HIV. The country is not suddenly going to acquire the capacity to provide adequate and safe medical treatment for everyone, no matter how important the World Cup is perceived to be. But that is part of the important message that Aids organizations should be concentrating on: that people should be aware of all the risks and how to protect themselves in order to avoid HIV and other diseases. The warnings should no longer be just about sexual risk but should include non-sexual risks too, especially risks of medical transmission.

The sort of racism that gives rise to UNAIDS and other institutions claiming that HIV is mostly transmitted by heterosexual sex in African countries results in an overemphasis on sexual risk and little or no emphasis on medical transmission. But another instance of racism seems to come out in the run up to the World Cup. There seems to be a lot more concern about non-Africans becoming infected with HIV than about Africans, who face risks, sexual and non-sexual, every day. They have faced these risks for decades and it looks as if they will continue to do so for decades. Apartheid may have ended, nominally. But every African, as well as every non-African, needs to be aware of how to avoid HIV infection and everyone needs access to information and facilities that will protect them. These are not yet available: that is why around 1,400 South Africans become infected with HIV ever day. HIV risk didn’t start with the World Cup and it won’t end with there. But it looks as if the usual Aids organisations will waste the opportunity by talking exclusively about sexual risk, yet again.

UNAIDS Set to Score Own Goal in South Africa

Many people who follow the HIV pandemic will be looking with interest at the soccer in South Africa or rather, reports about possible HIV transmission there. There are claims that tens of thousands of women from around the world are flocking to South Africa to work in the sex industry and that a lot of soccer fans will be availing of these services. Whether these claims are true or not is anyone's guess, I've seen no evidence to back them up.

It seems likely that even if people visiting South Africa don't know how to protect themselves, those working in the sex industry will. One hopes so, after decades of warnings about the dangers of sex and HIV. If these warnings haven't worked by now, perhaps those spending public money on them should rethink their HIV strategy.

But what about the dangers of non-sexual infection with HIV? Neither those in the West coming over to South Africa nor those living in South Africa are likely to have had so many warnings. Tourists may well be aware of non-sexual risks, such as tattoo parlours, cosmetic outlets like barber shops and, perhaps most importantly, medical facilities. Go into a travel shop in many European countries and you will find medical equipment that you can bring with you on your trip, such as needles, syringes and sutures. Some of the well known guide books warn against some of the non-sexual dangers of HIV infection in addition to sexual behaviour.

Africans are not granted the benefits of access to affordable medical equipment or even of information about non-sexual HIV risk and how to protect themselves. It seems they are just not as important as tourists and others visiting the continent.

Perhaps Westerners visiting South Africa have some chance of protecting themselves against these risks, although the media coverage of the issue is (as usual) concentrating on sexual risk. In a typical article covering the soccer, we can read about sporting stars and what they have to say about HIV and sexual violence, especially against women and girls. I assume they are saying what they are told to say, perhaps what they are paid to say, but none of them appear to be talking abut non-sexual transmission of HIV. Or perhaps the press just doesn't bother covering that issue.

My guess is that people's heads, wherever they come from, have been so filled with information about condoms, casual sex, multiple partners and the rest, non-sexual risks will have little impact. And conflating gender based violence with HIV risk is not very helpful either. Gender based violence, whoever the victims, is wrong, it's not just wrong because victims may be infected with HIV. In fact, the majority of victims are not infected with HIV, but gender based violence is none the less abhorrent.

In a similar vein, an article about the singer Annie Lennox becoming a Goodwill Ambassador for UNAIDS also conflates the need to reduce HIV transmission with the need to fight against gender based violence. I admire Annie Lennox and I hope she gets through to people in a way that UNAIDS has completely failed to do. But being supported by UNAIDS would tend to suggest otherwise. Still, Lennox is an intelligent and sincere woman. We may see her shaking off the shackles of UNAIDS patronage and speaking the truth about HIV.

The truth is that the mainstream HIV industry has concentrated on sexual transmission of HIV to the exclusion of medical or cosmetic transmission. This was not so much the case in the early days, before the interference of massive levels of funding, commercial, political and religious interests. But now, the industry is all but silent on anything but sexual HIV transmission.

This is not because UNAIDS, the UN, WHO, CDC and other big players don't know about non-sexual HIV transmission. They have just chosen to ignore it. It's not quite clear why and I'd really like to hear their explanation. However, they simply spew out their guesswork figures, which already presuppose that heterosexual transmission accounts for most HIV transmission in African countries. They assume sexual transmission to be so high that there is not much scope for estimating anything more than a few percent for non-sexual transmission, unless the number of transmissions is higher than 100%, which wouldn't be beyond those clever UNAIDS epidemiologists. They can do anything with figures, it appears, except tell the truth.

Even campaigns about sexual transmission of HIV have been unconvincing, to date. But they are better than the complete silence that non-sexual transmission receives. People just don't realize the number of risks they face in their day to day lives. And people in African countries face more of those risks than those in Western countries. For a start, HIV prevalence is already very high in many Sub-Saharan countries. But medical facilities are often understaffed, underfunded, underequipped and oversubscribed. This is a disasterous combination if you consider how efficient medical transmission of HIV is, compared to sexual transmission.

Whatever happens during the World Cup, there will be little point in investigating what went wrong with the campaigns afterwards. The World Cup itself is irrelevant to the fact that millions of Africans face etremely high risk of contracting HIV every day and this has little or nothing to do with their sexual behaviour. The evidence for that is available now. It's time international health institutions stopped ignoring it.