Increase Testing, Find Out What is Really Driving HIV Epidemic in South Africa

There is a debate in South Africa about whether schoolchildren from 13 up should be tested for HIV. Some are opposed to testing, apparently claiming that children "may not be psychologically prepared to deal with a positive result or the stigma likely to follow". But the point of pre- and post-test counselling is to psychologically prepare people for getting the test and finding out the result.

This may be more difficult in the case of younger children. But that doesn't make it any less necessary. The alternative is to wait until symptoms appear, by which time treatment will be more difficult and the risk of serious illness and even death are increased. If found to be HIV positive, people can be monitored and treated as and when treatment is required.

South African health services may not have the capacity to treat all those who are in need of treatment. But they need to test as many people as possible to assess what exactly their needs are. Even if they can't give everyone the level of treatment they require, those who are not tested won't get any treatment at all.

The fact that, as one teachers' union representative points out, even parents are afraid to be tested, is not a reason for not trying to increase the numbers of people being tested. People have been filled with notions about HIV in Africa being transmitted almost exclusively by promiscuous behavior, which means that HIV is still highly stigmatized, even after thirty years of research showing that it is not solely spread sexually and it is not primarily a matter of individual responsibility.

But teachers, teachers' unions and others should be aiming to reduce stigma, not accepting it as inevitable. They may be correct in claiming that the government is trying to make up the numbers for their exaggerated claims about how many people they were going to test in a short space of time. Certainly, testing large numbers of children, who may be seen as easy targets, is a very cynical way of achieving projected figures.

However, countries with high HIV prevalence need to test more people, especially younger people. There are three reasons, the first being that people have better health outcomes if the disease is caught early.

The second is that testing early should help to work out how people are being infected. For example, some will have been infected by their mother, some will be sexually active and some will not fall into either of these groups. People who are neither sexually active nor infected since birth will need to be investigated carefully to find out exactly how they are being infected.

Nosocomial infection is very likely to be responsible in many instances. Failing to identify such sources of new infection and failing to do anything about them will result in continuing high rates of HIV transmission in South Africa and other countries where similar failures occur.

The third reason for testing as many people as possible is that HIV prevalence among young people is a useful proxy for HIV incidence, the yearly rate of new infections. Incidence is very hard to measure but without such measurements, it is difficult to predict how the epidemic is going, whether it is increasing or reducing.

Being able to treat infected people is only one good reason to test as many as possible. Finding out what is driving the epidemic is, arguably, even more important. Far more people are at risk of becoming infected than are already infected. One of the aims of HIV policy in South Africa needs to be to prevent new HIV infections, not just to passively identify those already infected so they can be treated accordingly.

Young people, especially young girls, are those most at risk of being infected with HIV. That harsh reality is a lot better than the reality of being HIV positive. If people are still afraid to be tested then the South African Government needs to challenge global HIV policy, which denies that a significant amount of HIV transmission could be non-sexual. If South Africa, with the largest HIV positive population in the world, is not prepared to stand up to this erroneous claim, who will be?

Unfortunately, a lot of young people will be identified as HIV positive even though they have never had sex. And they will not all have been infected by their mother, who may not herself be infected. Not all HIV positive young South Africans are being infected sexually so it needs to be made clear how they are being infected. Only then can the South African epidemic be successfully tackled. The less involvement from UNAIDS and the HIV industry, the better.

Sexual Behavior: Myth Supports the Assumption, Evidence Does Not

IRIN has a recent article entitled "Fidelity campaigns could take years to see results". This is not news. Campaigns advocating abstinence, limiting sex to one partner and using condoms have been around for years and it is well known that they take years to show any results. It is also well known that they don't have very much effect on HIV prevalence.

Despite this, much of the money spent on HIV prevention, a very small amount compared to that spent on treatment and care, is used for fidelity campaigns of one kind or another. They usually result people in being able to trot out the right answers to questions, which keeps the market researchers happy. And, in the end, these campaigns are a good way of spending lots of money.

Various institutions that have bought into these empty campaigns are very well funded and can afford good marketing. They are hardly going to produce reports showing that their campaigns were pretty pointless. Rather, they will put a gloss on everything so that they can continue to receive funding. That's often what the funders want, too.

Institutions such as PSI, that were set up to interfere in the sexual and reproductive health of people in developing countries, can be expected to spend their enormous budgets on their traditional interests of population control (or 'eugenics', as it used to be called). But they really don't need to react with such surprise when their campaigns continue to fail to make much impression on HIV transmission rates.

Whatever the claims of PSI and similar institutions, fidelity and other behavior change approaches to HIV prevention are constantly referred to as 'evidence-based', as if that vouched for their effectiveness. But the notion that "over 90% of adult HIV infections in sub-Saharan Africa are acquired through sexual contact" is an article of faith in the HIV industry, even though the dubious claim dates back almost 20 years.

An article published in BioMed Central, by Marshall Munjoma, et al, simply assumes the truth of this 'behavioral paradigm', assumes that Africans lead incredibly active sex lives, care little about their health, the health of their children or the health of their partners, and takes things from there. And yet, the article strongly suggests that not all HIV is transmitted sexually.

These researchers start by pointing out that HIV incidence, the yearly rate of new infections, peaked in the late 1980s and declined thereafter. They don't explain the initial spread of HIV, the peak in incidence, nor its subsequent decline. And they certainly don't relate these phenomena to sexual behavior.

Yet, if the sexual behavior theory of HIV transmission is true, the major changes in behavior must have begun in the 1980s. By the end of the 1990s, most people who were infected in the 80s would have died and those infected in the 90s would have continuted to die into the 2000s. Once incidence peaked and declined, little further behavior change is required to explain what happened since the late 1990s.

Not only do the researchers fail to explain the sexual behavior changes that must have begun in the 80s and continued through the 90s but they attribute the rapid declines in prevalence in the late 1990s and early 2000s to changes in sexual behavior! The decline in prevalence is due to high death rates. High death rates continue to reduce prevalence in Zimbabwe and new infections also continue, just at far lower rates than in the 1980s.

The researchers note that new infections among women attending ante-natal clinics women are very high over a 6 year period in the 2000s. But many of these infections probably occurred during the women's third trimester or not long after giving birth. Why is it assumed that they must have been infected sexually? Some of these women were probably not having sex very much at these times. Were their partners tested?

The study also found that half those infected were 20 years or younger and nearly 100% of married women reported having sex with their spouses only. The researchers seem content to ignore the possibility of non-sexual transmission in at least some of the people they spent so long tracking. What is the point of research that ignores such vital clues as to how HIV may be transmitted?

To tie in with the IRIN article and the blind faith in behavior change interventions, the authors conclude that the decline in prevalence is due to behavior change, even though 90% of the study participants, both those who seroconverted and those who didn't, do not believe that abstinence protects against HIV. If people don't believe abstinence will protect them, why would they abstain?

Why is HIV Prevalence So Low in Cuba? (Hint: Health Services)

Last October Esther Murugi, Kenyan minister for special programs, called for greater acceptance of gay people in society. Her call was met with predictable righteous indignation from most politicians and church leaders. And her call stirred up a bit of debate, a small amount of which may have been constructive.

In the last few days, Murugi called for isolation of HIV positive people as a means of eradicating the disease. Does she mean Kenya should isolate all 1.5 million HIV positive people for up to ten years and longer? Isolate them where? There are not enough schools for all the country's children nor hospitals for the country's sick people.

I'm inclined to give Murugi the benefit of the doubt. After all, she is willing to stand up for one of the most reviled groups in East Africa, gay people. And I don't think she can be held responsible for believing rubbish about HIV, given that global HIV policy is governed by a bunch of racist, sexist quacks.

Ok, she thinks that Cuba has one of the best controlled HIV epidemics in the world because they isolated HIV positive people. What she is probably not aware of is that Cuba has the highest number of doctors per head of population in the world. HIV positive people were actually treated, counseled and supported in Cuba, long before they were in most other countries.

Cuba, like many other countries (the US only recently dropped its travel ban on HIV positive people), panicked a bit at first. But they had one thing that most Western countries have and most African countries do not: good health services. And they took action to make sure that HIV transmission was reduced, both sexual and non-sexual transmission.

Murugi may also be confused because at one time Cuba didn't have access to antiretroviral drugs. That was because of US trade sanctions, not because those cruel Cuban leaders didn't care about HIV positive people. In fact, Cuba is probably one of the few countries in the world that acted decisively, quickly and effectively to limit the damage that HIV caused in most other countries, rich and poor.

Indeed, Cuba still manages to keep HIV transmission low, which is more than can be said for several Western, Eastern European, Asian, African and other countries. Cuba is fortunate in enjoying relative autonomy from UNAIDS and other institutions that seem to exert such a negative influence on HIV prevention and treatment policies around the world.

The minister is seriously misinformed, but misinformation about HIV is not uncommon, rather, it's the norm. And if any Kenyans happen to agree with Murugi, the answer is no, it's not going to happen. The country hasn't even tested the majority of HIV positive people yet or got the majority of people who need antiretroviral drugs on treatment. The country's health services do not have the capacity to even account for all HIV positive people, let alone isolate them, in any sense of the word.

If the minister wishes to make herself useful, she could raise the issue of gays again and perhaps take other measures to reduce HIV related stigma, rather than increase it. For instance, she could point to the evidence from WHO that a significant percentage of HIV comes from unsterile injections (and probably from other unsafe medical procedures).

The extremely low levels of HIV transmission in Cuba, from before HIV was identified, through the earliest days of the pandemic, right up to the present, probably have a lot more to do with the quality of their health services than with the amount of sex Cubans have or the types sexual practices most commonly found there. Levels of transmission in every country probably relates to quality of and access to health services and certainly doesn't relate to sexual behavior. But only Cuba seems to have noticed that.

And if Minister Murugi wants more Kenyan people to be tested, more HIV positive people to receive treatment and more HIV negative people to be protected, she needs to ensure than health services are cleaned up first. The last thing Kenya needs is for everyone to rush to their collapsing health services in the state they are in right now. That's only likely to increase transmission.

African Heterosexual Females Branded By Global HIV Policy

The murdered Ugandan gay activist, David Kato, was one of the victims of a piece of persecution by a tabloid newspaper, Rolling Stone. Rolling Stone published the names and photographs of people they believed to be gay. By the time a judge got around stopping publication the damage had been done.

I can't prove that David Kato was murdered because he had been exposed, I can't even prove he was murdered. But his death illustrates the sort of thing that can happen in a country where persecution of certain people is not considered important enough by the state to give them the protection they need.

The sort of hate and prejudice that lies behind the murder of David Kato exists everywhere, but some countries have laws to protect people from its worst excesses. Most gays can probably remain anomalous, or hope to. But they will all live in fear of discovery. If discovered, they could become victims of police violence, mob violence, persecution, extortion and the like.

But gays are just one group that suffers the consequences of hatred and prejudice. In some African countries, women are equally stigmatized. They can also be victims of violence and suffer injury, persecution and even death because they are a member of a stigmatized group.

Not all women are stigmatized to the same extent. But most victims of sexual and non-sexual violence are women. And the law in many countries gives them little protection, especially if the perpetrator of the violence is their husband or another family member.

In most countries, women are more likely to be poorer than men, live in worse conditions, play the biggest part in raising children, have lower levels of education, have less access to health and other social services and the list goes on. This is a result of prejudice, but of course, this is not the same kind of prejudice experienced by gays.

Women start to experience the kind of prejudice experienced by gays when high HIV prevalence is added into the picture. Fingers are pointed at sex workers and other groups. But in countries where HIV prevalence is highest among ordinary married women who only have one sexual partner, Uganda being a case in point, all women are branded as promiscuous.

Men are also branded as promiscuous, but HIV rates are far lower among men. Even people who just read what appears in the mainstream press suspect they are being lied to when they are told that it's men who go around spreading HIV and yet far more women are infected.

I often ask people for their opinion on how HIV is spread and if they think it's odd that in some places, HIV positive women can outnumber HIV positive men by 5 to one. They sometimes come up with the ludicrous suggestion that there is a small number of men who are responsible for infecting huge numbers of women. They must be very busy and such a group has never been identified.

Not for want of trying. Fingers have been pointed at 'mobile' people, either internal or external migrants, long distance drivers, armies and many other groups. But in the end, the majority of people being infected with HIV are ordinary people with ordinary sex lives. What UNAIDS refers to as 'low-risk' sex is, in fact, very high risk. I think of this as the UNAIDS paradox.

There is no paradox if you bear in mind that not all HIV is transmitted sexually, that some, perhaps a lot, is transmitted through unsafe healthcare and cosmetic practices. Most people are aware of these phenomena but there is a great reluctance to investigate. People prefer to say 'well, you're right, but I still think it's mostly sexually transmitted', or worse.

So I am not arguing that people who are HIV positive, whether they are gay, involved in sex work, injecting illegal drugs or anything else, shouldn't be stigmatized because stigmatizing people is wrong. It is wrong. But HIV positive people shouldn't be stigmatized because we don't know how they became infected. And even if they were infected sexually, that doesn't mean they have done anything wrong.

Anti-gay and other prejudices are not new and they are proving hard to reduce. But Africa suffers from an anti-African prejudice, based on the UNAIDS lie that 90% or more HIV in African countries is transmitted sexually. Effectively, heterosexuals and those who engage in heterosexual sex are the victims of prejudice and stigma.

If anti-gay stigma reduces the number of gay people who take precautions against infection with HIV, anti-African, anti-woman and anti-heterosexual stigma does the same. Few people want to be tested for HIV unless they have to because merely raising the possibility that you are infected invites suspicion, finger-pointing, ostracization, persecution and physical violence.

Like HIV itself, stigma doesn't just arise from 'somewhere else', from foreigners, migrants, Africans, women, right wingers, Muslims, or whatever. Stigma, HIV related stigma in particular, arises from the way society as a whole has come to view sex, all sex. The 'proof' that sex is bad is the existence of a HIV pandemic. But the evidence that the pandemic was driven by sex? Alas, there is none. That's why it's called prejudice.

Concurrency: the Favorite Plaything of the Sex-Obsessed HIV Industry

For a relatively short time, the notion of concurrency became the favorite plaything of the sex-obsessed HIV industry. They hypothesized, not just Africans with rampant and uncontrollable sexual urges, but Africans with sexual partnerships that overlapped with each other.

If serial monogamy refers to the practice of finishing one relationship before going on to another, concurrency increases the chances of infecting more than one person. Given normal probability of transmission through penile-vaginal sex, those subscribing to the purely sexual theory of HIV transmission need all the help they can get.

But some have speculated about another aspect of rapid transmission, which has been well demonstrated, but never clearly tied to concurrency. The probability of transmitting HIV is highest during the first three months of infection and during the last 9 months or one year. During the latent phase, which can last 8 years or so, probability of transmission is especially low.

So, if someone acquires HIV, they are highly infectious during the first few months. Sex-only HIV transmission theorists need that person to infect several people during that short period to explain exceptionally high prevalence found in some countries. Concurrency may help explain high prevalence, but it doesn't completely explain it.

More embarrassing for these adherents of the 'behavioral paradigm', the belief that sexual behavior accounts for the bulk of infections, is that concurrency doesn't appear to be very common in many countries, even countries with high HIV prevalence.

People like Jeffrey Eaton, Timothy Hallett and Geoffrey Garnett have gone to great lengths to push concurrency, and the behavioral paradigm in general, but they have even discovered that it just can't be pushed that far. They try to model the effects of relatively low levels of concurrency that also take into account the stage of HIV infection. They even use ridiculously high estimates of transmission rates.

But they are forced to conclude that "this model produces HIV epidemics that grow more slowly than those observed in southern Africa, suggesting that factors not included here—in particular, small groups with greater number of sexual partners and cofactors that increase HIV transmission—also contribute to accelerating the spread of HIV".

This is a completely deflating argument, showing that some level of concurrency has some influence on rates of transmission, possibly. The level of influence, like rates of concurrency, is not estimated. Perhaps it's not even possible to estimate it.

Another study suggests that many people in high prevalence countries don't have very many partners (Table 2). The percentage of people who had more than one partner in the last year before the study ranged from 6% in Malawi to 25% in Lesotho. Fair enough, Lesotho is a high HIV prevalence country, but so is Swaziland, where only 10% had more than one partner.

And having more than one partner is not the same as concurrency. Eaton et al find that "increasing from 10 to 11% of individuals having concurrent partnerships increased the mean endemic HIV prevalence from 3 to 7%." We can't assume concurrency is higher in high prevalence countries without arguing in a circle (though mathematical modeling is probably no stranger to circular arguments). What the researchers say may be true, but we don't know what truth it expresses.

Even if concurrency plays a role and that role can be quantified, how do we then explain the rise, peak and decline in HIV rates in most sub-Saharan African countries before most prevention programs started and long before the notion of concurrency became the popular plaything it is today?

Eaton et al conclude that "primary infection in the context of concurrent sexual partnerships may be the factor that has enabled HIV to spread through general populations to such high levels." They are entitled to conclude that it may be a factor, not the factor. And that doesn't really get us much further.

But there isn't much further to go when your only contribution to HIV transmission theory is that it is a sexually transmitted infection. It is, but to what extent? It is also transmitted from mother to child, by injecting drug use, through unsterile health care practices and even unsafe cosmetic practices.

If Eaton et al want a model that grows like some of the epidemics found in some sub-Saharan African countries, they need to factor in non-sexual transmission. Otherwise they will continue to be in the dark and to leave everyone else in the dark. And the useless HIV prevention strategies that have dominated the field for so many years will continue to fail.

The UNAIDS Paradox: Low Risk Sex Appears to be Risky in Africa

Aidsmap.com has an article about a study carried out in Uganda which shows that there is little evidence of an increase in risky sex since the widespread rollout of antiretroviral drugs (ARV). Many people have been worried that the (relatively) easy availability of such drugs could give rise to both HIV positive and negative people disregarding principles of 'safe' sex.

It is not just in Uganda and other African countries where there are worries that such increases in risky behavior could follow ARV rollout. Wealthy countries have shown that increases in risky behavior are a reality and that this could easily wipe out some of the gains that have been made over the years. People are just not as frightened of HIV as they used to be.

But in the case of Uganda, the study gives the impression that risky sexual behavior is not such a big thing there. More surprisingly, it sounds as if it never was. After starting treatment, some people engaged in higher levels of risky behavior but later this trend reduced. In the end, they reverted to pre-treatment levels.

Well, if pre-treatment levels of risky behavior are not worrying in HIV positive people, they must be even less worrying in HIV negative people. There have been other studies like this one, also giving the impression that levels of unsafe sexual behavior are fairly low. Not that anyone has produced data showing what could count as normal and what could count as high when it comes to sexual behavior.

Not only that, even those who talk about high levels of unsafe sex don't really show that levels really are higher than elsewhere. Nor do they appear to have any reliable data to show that higl levels of unsafe sex occur more in African countries, nor in countries and regions where HIV prevalence is high.

It can be odd listening to people talking about HIV because they appear to consider the issue important, but also, in a sense, unreal. For a start, they always talk about sex, especially illicit and unsafe sex. It's as if some sex, most sex, if they are to be believed, falls into that category, while a small amount does not.

But as to what constitutes a lot of sex, no one I have asked can really say. It has been suggested that people who are HIV positive have at least one different partner a week, perhaps more, but these are just assumptions. As to why it is even assumed that some people have so many partners, and I'm not doubting that some people do, it often seems to relate to the perceived number of people who go to bars and drink alcohol.

But the Ugandan study does confirm one thing; levels of unsafe sexual behavior are not, in general, high. They probably never were. There has never been evidence of a glorious time before the HIV epidemic, when hardly anyone engaged in unsafe sex. Nor for a time when levels of unsafe sex rocketed, allowing HIV to spread rapidly. Nor for a time when all this subsided and HIV transmission rates began to decline to present levels.

Other research leads to similar conclusions. The five yearly Demographic and Health Surveys show that those who engage in risky sex are often less likely to be infected with HIV than those who don't. Trials such as the CAPRISA microbicide trial showed that the majority of people had a few sexual experiences a month and most of them only had one partner.

The Uganda study also found that use of condoms among HIV positive people increased after they started treatment. This may well be, as claimed, due to 'incraesed counselling intensity'. But condom use wasn't very high to start off with. As a minimum, you would expect people being counselled and on treatment to take some extra precautions.

However, a substantial proportion of those most likely to transmit the virus still don't wear condoms. It's hard to know if the 'intensive counselling' really has all that much effect. And when you look at sexual behavior among HIV negative people, the many years of HIV prevention interventions look even less impressive.

But the article is 100% about sex. There is never a hint that transmission may occur through any other route. Non-sexual routes to HIV infection may well have been talked about earlier on in the epidemic and, in the case of Uganda, steps may have been taken to reduce their impact. But now sex has completely taken over.

The fact that the HIV industry is attributing declines in transmission to HIV prevention programs that only started a long time after the declines suggests that they don't know why transmission declined. They don't seem to know how to reduce transmission and they don't even seem too bothered by that.

If we still don't know why HIV spread and subsequently declined, after thirty years of research, then nor do we know what to do if transmission rates begin to increase again. Don't people find that frightening? UNAIDS' claim that Uganda's epidemic is driven by low risk sex is not credible.

Global HIV Policy Too Prejudiced to End Pandemic in Africa

In an article in AlterNet, Jessi Fischer asks "Why Do We Vilify Male Sexuality"? But it's not just male sexuality that is vilified, it's sexuality in general. As a result of people's apparent desire to vilify sex, they seem anxious to seek out targets, people whose sexuality is perceived as most deserving of vilification, as opposed to their own sexuality, which is not.

When HIV was identified and thought to be exclusive to homosexual populations, many were happy to vilify men who have sex with men. Doing so was nothing new, after all. And when it was recognised that HIV also infected heterosexuals, sex workers, injecting drug users and 'promiscuous people' were vilified. They still are.

Sex was considered so important in the transmission of HIV that almost all large-scale HIV 'prevention' campaigns since the 1980s have concentrated on sex. In countries where it was possible to remove the threat of medical and other transmission of HIV, this was done, with a high level of success in rich countries. Less wealthy countries have had varying levels of success, some failing altogether.

As for poor countries, they didn't have a hope. Health services in the poorest countries were bad enough in the 60s and 70s but those countries who fell for the World Bank and IMF's 'structural adjustment' policies of the 80s, 90s and 2000s reduced health and other public services till most of their population hardly ever see a nurse, let alone a doctor or any kind of specialist.

Under international 'development' policies, health services, social services, education, infrastructure and anything else that could allow developing countries to develop were reduced, often to zero. Independently of HIV, although overlapping substantially with the pandemic, levels of health, education and overall development had already started to decline from the 1980s onwards.

It was very convenient to blame HIV for this, but the damage had already done. By the time HIV transmission rates had peaked and slowed down in the 90s and 2000s, structural adjustment and other policies, policies that continue to punish the poorest people in the world, had already destroyed whole populations.

Early on in the pandemic, it became obvious that HIV was not easily spread through sexual intercourse alone, especially not penile-vaginal sex. But those who had jumped on various political, religious and commercial bandwaggons weren't prepared to let go. The association of HIV with sex, especially promiscuous sex, was like a gift from the heavens.

HIV was, in a sense, just what development theorists had been looking for. They had been messing around with population control for decades, billions had been spent on persuading people in developing countries to use contraception, have fewer children, plan their families, etc. None of these attempts had been particularly productive, but the suggestion that they could hawk condoms as a means of protecting people from HIV, not just from unplanned pregnancies, was more than they could resist.

Billions more was spent on the same organizations which had done such a mediocre job for several decades, FHI, PSI, TFGI, and others (I assume there were some non-American institutions involved?). Unsurprisingly, they had even less effect on sexual behavior, maternal health and family planning than they had had in the past. But then, these weren't really the issues, were they?

The whole global HIV prevention effort was sidetracked by sex and has still to find its way back. This is not for lack of scientific evidence. The evidence has always pointed to the impossibility that serious HIV epidemics could be driven by sex alone. Serious levels of transmission only occur when the transmission route is highly efficient, such as through blood transfusions, mass vaccination campaigns, injecting drug use, etc.

But the international community was so enthralled by the apparent vindication of their view of Africans as animalistic, as not quite human, their policies are still completely skewed by such prejudices. African males are sexually incontinent and females are primarily victims, but also they have an insatiatable appetite for being pregnant, regardless of any danger to their own health or the health of their children. That's the story, anyhow.

And so the pinnacle of scientific endevour in HIV prevention is that we know how to prevent it; we just don't want to let go of our prejudices. Our prejudices are far more important than academic progress and, as for the lives, health and livelihood of generations of Africans, that has never been our major concern. And it probably never will be.

When Will UNAIDS Be Abolished?

When people find used hypodermic needles in areas where children play in Western countries, they are upset. Quite rightly so. They don't like the thought that their children are being exposed to injury and diseases, possibly even serious or deadly diseases.

But even many Westerners seem to believe that HIV 'dies' within seconds, minutes or some fairly short period, outside of the body. This is not what the US Center for Disease Control (CDC) says on the subject, although it may have said that at one time. Their current answer to the question 'How well does HIV survive outside the body?' is difficult to interpret.

But no matter how you interpret the risk, no one wants a possibly contaminated needle piercing their skin or that of their children. As well as the physical injury, there is also a risk that the needle is contaminated with hepatitis and it is almost certainly contaminated with bacteria.

So the CDC's comment about 'incorrect interpretations' of risk causing 'unnecessary alarm' seems injudicious. I know the question is about HIV but the answer really needs to address risk as a whole. Potentially, HIV can survive for days and even weeks, under the right conditions. Contact with contaminated needles and other instruments should be avoided and where this is not possible, medical advice is required.

However, the idea that the HIV does not live outside the body is widely held, by professionals and lay people. And in countries like Kenya, Tanzania and Uganda, it is far more dangerous to be unaware of the risks. The chances of medical or cosmetic equipment being contaminated in countries with high prevalence of HIV, hepatitis and other diseases can be very high.

You might think that there would be a lot of awareness of these risks and how to avoid them but I have rarely spoken to anyone who has considered the risks they face from contaminated instruments in health or cosmetic facilities.

UNAIDS dismisses the importance of any form of non-sexual HIV transmission, let alone transmission in health facilities. They grudgingly accept that a few percentage points of HIV transmission in East African countries may come from such routes. But they hardly mention cosmetic instruments, razors, tattooing equipment and the like, at all.

As a result, such transmission may be occurring at high rates and people are doing nothing about it. When they take their child to the hairdresser, or go themselves, they could be picking up scabies, hepatitis, HIV or some kind of bacterial infection. To help people avoid these risks, the best thing to do would be to inform them.

Risks in health facilities are more difficult to handle. Doctors, nurses and other health personnel can be pressed for time and it is not easy for patients, or those accompanying patients, to intervene. At best, personnel will be annoyed, at worst, they will refuse to treat the patient, give them poorer quality treatment or make them wait a long time.

The WHO has published data showing that as much as 14% of injections in developing countries are contaminated with HIV and they have unpublished data showing that this figure can be a lot higher. A large proportion of hepatitis B and C is transmitted through contaminted needles. And an estimated 70% of all injections are not even necessary.

When there is even the hint that someone in a Western country may have come into contact with contaminated equipment, there is an investigation to establish how procedures could have resulted in such a risk. And anyone who may have been affected, even going back years, and through thousands of records, is contacted and screened.

Not only does this sort of investigation and screening of possible use of contaminated equipment not take place in developing countries but UNAIDS and others seem keen to deny that such things, which happen in the best resourced health systems in the world, could possibly happen in the worst resourced health systems in the world.

HIV Policy Needs to Follow Health Policy, Not Vice Versa

Following my last post, I received a comment raising the issue of the role of sexually transmitted infections (STI) in HIV transmission. This is a vital issue so I gave a brief response but promised to answer more fully in a blog post.

Firstly, health is not just a matter of absence of disease, so health policies should aim to prevent diseases where possible, as well as treat them.

This has clearly not been done with STIs. Preventable and treatable STIs are endemic in many developing countries and, regardless of whether they play a role in HIV transmission, sexual health is in urgent need of prioritization.

Very high levels of STIs, and of all easily preventable or curable diseases, are a symptom of poor health services, services that have been declining for decades. Concentration on HIV has often meant that STIs and other diseases have been ignored, so this has added to the serious STI epidemics that have developed.

However, the role of STIs in HIV epidemics has not been clearly demonstrated and there have been conflicting reports, especially where tests with treating STIs as a HIV prevention intervention have been carried out.

There is an interesting article on this subject called "Confound it: latent lessons from the Mwanza trial of STD treatment to reduce HIV transmission", by David Gisselquist and John Potterat. This is about the STI treatment trial in Mwanza, Tanzania which, according to the researchers involved, showed that reducing STIs could reduce HIV transmission.

The researchers' claim is odd because STIs were not reduced much during the trial, yet HIV transmission did seem to be reduced. Also, similar trials were carried out in two other locations and neither of them demonstrated any benefits for STI treatment.

Gisselquist and Potterat have two suggestions as to why the trial results in Mwanza differed so much from the two in Uganda. For a start, those taking part in the Mwanza trial appear to have received safe health care, which is something most East Africans don't receive. And there happened to be an injection safety initiative taking place at the same time as the STI trial.

The authors warn that continuing to target STIs without also improving health services by making it far safer, especially in relation to injection practices, there is a risk that transmission of HIV and other blood borne viruses will increase.

In the mid 1980s in Nairobi, HIV rates were found to be over 80% among sex workers at a time when they were extremely low among males in the city. The hypothesis, still the dominant hypothesis about HIV transmission in African countries, was that these women were infected through sexual intercourse with HIV positive men.

But if few men were infected, that seems unlikely. To explain such high transmission rates among women, even though they were engaging in high risk sex on a regular basis, the possibility that they were infected through health services must be investigated.

After all, there was an STI reduction program in Nairobi targetting sex workers in the early 1980s. As far as I know, this program did not target sex worker clients, which may well explain why HIV prevalence among men, in Nairobi and most other parts of Kenya, has never been as high as it has been among women.

Not only is it possible for HIV to be transmitted rapidly through unsafe health care, it is far more likely than transmission through unsafe sex. The transmission probability for many health practices is many times higher than the transmission probability for penile-vaginal sex.

Blood transfusions, for which the transmission probability is extremely high, may well have been made safer very early on in the epidemic. But most people don't have transfusions, whereas many people do receive injections and other invasive procedures. And the safety of these procedures has never been adequately assurred.

If these comments are even partly correct, not only is current UNAIDS policy allowing many people to become infected with HIV and other diseases; but it is also ensuring that many people become infected who might remain healthy if they ignore the health advice they are likely to receive. That's if they even have the option to ignore the advice.

Targeting STIs is a good thing in itself and may even reduce sexual transmission of HIV. But there is little point in reducing sexual transmission while at the same time increasing non-sexual transmission, especially that through unsafe injections and other procedures. HIV policy needs to follow health policy, not the other way around.

What Do UNAIDS Call a HIV Positive African? Promiscuous

To continue yesterday's theme about the difference between HIV in Western countries and HIV in high prevalence countries, most of which are in sub-Saharan Africa (SSA):

Treatment with antiretrovirals (ART) is widely touted as a type of HIV prevention because if people are responding to ART their viral load should be low and they should be far less likely to transmit the virus.

In Switzerland, in particular, HIV positive people on ART have been told that they could have unprotected sex and that the risk of transmission would be very low.

However, in SSA countries, people are not given the same advice. But also, it has been suggested that people who are on ART could experience 'disinhibition'. They could engage in higher risk sex because they think their treatment means they are less likely to transmit the virus.

Conditions in SSA are very different from those in Switzerland. For a start, perhaps a majority of people, certainly a lot of people, don't know their HIV status. When it comes to preventing sexually transmitted HIV, the more precautions people take, the better.

Even those who promote the rather unconvincing 'treatment is prevention' strategy admit that if treatment results in significant disinhibition, the modeled reductions in transmission will not occur.

So far, so good. It could be argued that conditions are so different in SSA and in Switzerland that the advice given to HIV positive people on ART should also differ.

But many articles have come out about how disinhibition doesn't occur in SSA countries. And at the same time, articles have also come out about how it does occur in Switzerland.

It would be very convenient if levels of disinhibition in SSA were not high enough to cancel out gains, but it also sounds a lot like wishful thinking. Especially if, in practice, disinhibition does occur in Switzerland.

The orthodox line about HIV, a virus that is difficult to transmit sexually, is that over 80, perhaps over 90% of it is transmitted through heterosexual sex in African countries.

In wealthy countries, the virus is usually transmitted through anal sex or through intravenous drug use. It is not much transmitted through heterosexual sex.

We are supposed to believe that, despite the difficulty of transmitting HIV through heterosexual sex, Africans do so because they have such exraordinary sex lives. But if they have these extraordinary sex lives, why is disinhibition so unlikely?

As I say, probably wishful thinking. Which is not really a good basis for a HIV treatment strategy, and even less so for a prevention strategy.

In countries where hundreds of thousands or even millions of people are infected with HIV, so many will not know their status and so many will not be on treatment even if they need it, treatment and prevention need to continue to be driven by separate initiatives.

There is little point in putting more and more people on treatment and hoping that they will adhere to the drug regime as they need to, supposing their supply of drugs even keeps up with their needs, unless efforts are also made to reduce the incidence of new infections. Drugupplies are often too unreliable to ensure that viral load will always be kept low.

But many people, also, are not being infected sexually. This means that they will not know what risks they are facing when they visit health facilities or anywhere else they may be exposed to contaminated blood or bodily fluids.

It is popular to talk about the need to test as many people as possible and to test people as often as possible. Despite this, most people have never been tested and the ones that have been, have only been tested once.

Testing on its own is not enough. It also needs to be established, for each person who becomes infected, how they are infected. The fact that they are sexually active does not mean they were infected sexually. Many people are sexually active and some of them become infected with HIV, but their partner is not positive. This means they were probably not infected sexualy.

It may take a bit of work to establish how people were infected, especially as most people will blame their own sexual behavior because they have the heterosexual theory of African HIV transmission drummed into them. But it is vital to take appropriate steps to reduce HIV transmission. Assuming that most transmission is sexual does not lead to appropriate steps.

In addition to testing and retesting, there needs to be an honest and creadible assessment of the risks people face and of all the likely routes to transmission. Those who are positive need to be assessed for treatment and those who are negative need to be made aware of all the HIV transmission risks they face, sexual and non-sexual.

HIV transmission rates are still very high in many countries. Transmission needs to be reduced. Treatment of those infected alone is not likely to reduce transmission enough. We have to keep our eye on non-sexual transmission as well as sexual transmission. Concentrating on sexual transmission alone, for example, by targeting discordant couples, is not going to protect them from non-sexual transmission.

All that remains now for HIV epidemics to be turned around is for UNAIDS and their HIV industry friends to lose their highly prejudiced views of African people and to treat Africans as they do their own employees and Westerners, who seem to be considered far more important than Africans.

Apparently, the Truth About HIV is Relative to Nationality and Wealth

A typical article about HIV reads "Cheating spouses have always caused problems for their marriages." That may be so, but it does not mean that 'cheating' drives HIV epidemics in high prevalence African countries. Data about sexual behavior and HIV prevalence show that many people engaging in 'safe' sex become infected with HIV and many engaging in 'unsafe' sex remain uninfected.

It has long been recognised that the majority of HIV infections in several countries, Uganda, Kenya and others, come from people in long term relationships who only have one partner, many of whom take adequate precautions against sexually transmitted HIV.

Of course, you could engage in unsafe sex and become infected non-sexually. You are unlikely to ever find out because if you live in a resource poor country, especially an African country, it will be concluded that you were infected sexually.

Whether you are infected sexually or otherwise, it's good to take precautions against infection of any kind. But it would be pretty stupid to protect yourself against sexually transmitted HIV, for example, and turn a blind eye to the fact that your children are all receiving invasive medical treatment with unsterilized equipment.

Who would be stupid enough to do that? Perhaps people who have been bashed over the head for years about their sexual deviance. Indeed, their sexual deviance is considered so bad that the possibility of their being infected non-sexually by a virus that is difficult to transmit sexually is rarely mentioned.

The article in question, as they usually do, rants on about a discordant couple, where one partner is infected and the other is not. There is no mention of how the one partner became infected nor of how the other is in danger of being infected non-sexually as well as sexually.

Well, UNAIDS and the AIDS orthodoxy are not going to change their tune in a hurry. But they haven't even managed to persuade very many people to use condoms to protect themselves from infection or to get careful advice when they wish to become pregnant. They are even failing in their favorite field, sex.

So underinformed are the majority of people that they know as little about the dual role condoms play in reducing transmission of sexually transmitted infections and preventing unplanned pregnancy as they knew many years ago, before most people had heard about HIV.

The entire process of HIV prevention seems to consist of misinforming people. And the article even refers to a 'myth' about HIV negative people being protected when their partner is on antiretroviral drugs (ARV).

But this is not a myth, even according to the HIV orthodoxy. Big pharma and HIV Incorporated are trying to sell the idea that treatment is prevention; that because those on treatment have a low viral load, they are less likely to infect their partner.

Well, like the myth in the first paragraph, it's more of a half truth. The HIV/AIDS industry has been trying to sell the idea of taking ARVs instead of bothering to carry out any real prevention programs that they might not be able to make huge sums of money out of.

In some Western countries, discordant couples are advised that they can have safe unprotected sex as long as the infected partner has a low viral load as a result of successful ARV adherence. But this is not the advice given in African countries.

And it would be very stupid advice. If we haven't established how most people are becoming infected with HIV, we cannot advise them about what is and what is not safe behavior, about what they can do and what they must avoid.

And that underlines the biggest risk regarding HIV: being African. If you are African, you will not be  told that you face serious risks in health facilities and cosmetic facilities, not just through your sexual partner.

If you are African, you are almost condemned to being infected without anyone noticing until it is too late, especially if you are a woman who is foolish enough to get pregnant.

And when you are found to be HIV positive, because you are African, it will be assumed that you were infected sexually, regardless of how well you may have protected yourself, whether you have had sex or not or anything else. To be African, in the eyes of the orthodoxy, is to be promiscuous.

The most illogical thing is, just because people are promiscuous, and some are, everywhere, that doesn't mean you will be infected sexually. Therefore, the fact that you are infected does not mean you are promiscuous. UNAIDS and the rest of the industry may be obsessed with your sexual behavior, but they don't actually know anything about it, their frequent pronouncements notwithstanding.

An interesting feature of HIV myths is the fact that both those who are in danger of being infected with HIV or of infecting others, and those who are supposed to be responsible for reducing transmission, all have their own myths. And what is a myth in poor countries may be the orthodoxy in rich countries, and vice versa.

Giving Up Sex Will Not Protect You From HIV in Africa

All the HIV/AIDS industry has to do is put out a press release and the global media reproduces it over and over again, without question or analysis. It's hard to believe that such slavish repetition is what counts as journalism.

Even Alternet.org, with their pretentions of offering something different, just pick up whatever is thrown at them. A recent article, typical end of year stuff, rehashes all the hypes of the year about HIV, how it is all going to be sorted out in the end by technology.

The main worry about this sort of article is not that technology will never develop to the extent that it can treat, prevent and even cure HIV one day. The worry is that we don't have to wait till that happens before we do anything to prevent a lot, perhaps the majority of HIV infections in high prevalence countries. Yet, we are still waiting.

UNAIDS and their pharmaceutical industry chums have been putting about the idea that if only people would have less sex, everything would be ok. But some people don't have sex, or they are very careful when they do, and they still end up HIV positive. Others have lots of sex, even unsafe sex, and they generally do not end up HIV positive.

We even know who is likely to be infected. If they are female and living in a handful of mainly African countries, between one third and half of them will be HIV positive or dead before they are 40. Doesn't that strike people as a bit odd?

If they are not from one of those countries in question, they can have as much sex as they like, as long as it is penile-vaginal sex. Outside of high and medium prevalence countries, where epidemics are 'generalized', that is, not confined to high-risk groups, HIV is transmitted by intravenous drug use and anal sex, generally.

Unless you subscribe to the racist and sexist 'oversexed African' view of HIV transmission, and you're in the esteemed company of the entire HIV/AIDS industry if you do, you have to conclude that there is something we are not being told about HIV.

How can it be an almost exclusively sexually transmitted infection in a handful of countries and almost exclusively transmitted by anal sex and intravenous drug use in all other countries?

Even the HIV/AIDS industry knows that HIV is not exclusively, perhaps is not even mainly, sexually transmitted. They don't like to admit it, but sexual transmission of HIV is not very efficient.

However, non-sexual transmission modes, such as unsafe healthcare, are higly efficient. UNAIDS and the UN as a whole are well aware of this and they warn their own employees to avoid medical facilities in high HIV prevalence countries.

For some reason, they don't think it necessary to warn people living in high prevalence countries. Every tourist coming to African countries can read warnings about using health facilities in these countries. It's just people living in them who are not warned.

Worse still, UNAIDS denies that unsafe healthcare plays a significant role in transmitting HIV. They estimate that it may account for 2-5%, but that is certainly not enough for them to consider warning people who have to use health facilities that lack trained personnel, basic equipment and even soap and water.

Testing is of little value to populations as a whole if no attempt is made to find out how people are being infected. And no attempt is being made to find out. If someone is African, it is assumed they were infected sexually, even if they don't have sex, don't have unsafe sex or have a partner who is not infected.

Never mind the technologies that so many billions of aid money is going into, or the technologies that may one be developed. People are being infected, suffering, infecting other people and dying because they are being told half truths and outright lies.

HIV is tranmitted non-sexually, especially through unsafe healthcare. We need to tell people that so they can protect themselves and protect their partners and families. People will not be fully protected if they have 'safe' sex, take various drugs, use condoms or take any other precautions against sexual transmission. They also need access to safe healthcare.

HIV Stigma Doesn't Come from Ignorance, it Comes from Lies

UNAIDS' and the Aids industry's stigmatizing of HIV positive people has many consequences. If you resolutely claim that HIV is almost always transmitted sexually in African countries, people in African countries who are HIV positive will continue to be stigmatized. Telling everyone that HIV is driven by promiscuity means that everyone who is infected is considered to be promiscuous.

Some of the most vulnerable victims of the industry's stigmatization are sex workers or those assumed to be sex workers. Of course, according to UNAIDS, a huge precentage of African women are sex workers, even if they don't know it themselves.

Many women, whether sex workers or not, are aware of sexually transmitted HIV. Most women attend antenatal clinics when they are pregnant, if they can reach one. Those who do engage in transactional sex visit clinics if they can. In fact, the majority of women probably follow the strictures of the HIV industry, especially where they think they might be at risk.

Most women are not, however, aware of non-sexual HIV risks. Those visiting antenatal clinics or giving birth in health facilities are unaware that the majority of injections given in developing countries (70%) are unneccessary. A huge amount of HIV and hepatitis is probably transmitted in such facilities due to reuse of injecting or other equipment.

In some countries, HIV prevalence among sex workers has been found to be as high as 70 or 80%. How can this be? Especially when prevalence among men in the same areas is 5% or less. It is not possible for three quarters of heterosexual women to be infected when such a small percentage of men are infected.

Prevalence among young women of child-bearing age in some countries is 30 or 40%. It is nowhere near this level among men of any age. Who is infecting these women? The Aids industry doesn't even bother checking the status of partners of all these HIV positive women, let alone find out how they became infected.

Even if African women are as promiscuous as UNAIDS and the rest of the industry tell us, we don't know how they are becoming infected sexually, unless a sizeable percentage of men are also infected. There simply is no small group of HIV positive men who sleep with almost all the sexually active women in a particular population.

Sex workers face risks, there's no doubt about that. They have been stigmatized by UNAIDS and the industry to the extent that many of them are afraid to visit health facilities, though they know they have to. And they may be right to be afraid. Perhaps the massive rates of HIV prevalence found among sex workers and others attending sexually transmitted infection (STI) clinics face more serious risks in the clinics than they do from their clients.

But sex workers also face stigmatization and persecution from their clients, who often refuse to pay or demand more abusive or dangerous types of sex. They face stigmatization from police and security people and often have to pay bribes, in cash or by sexual favors. And they are stigmatized by the public, who have been told by UNAIDS and the industry that sex workers spread HIV.

Nauseating articles about how sex workers are so badly treated, when the same articles simply spread the industry stigma, do little to help. Sex workers need to know the truth: that HIV is not spread by sex alone. Indeed, everyone needs to know the truth. Sex may well spread HIV but so does unsafe medical treatment, cosmetic treatment, tattooing, traditional medicine and any other practices that may involve contaminated blood or other bodily fluids.

One of the biggest threats to reducing HIV transmission seems to be the very HIV researchers who don't bother investigating non-sexual HIV transmission, especially in health facilities for sex workers and for pregnant women. They seem utterly oblivious to the possibility that sex is not always transmitted sexually, even when it happens right under under their noses.

It's time to investigate the massive levels of HIV among sex workers whose clients are almost all HIV negative, the mothers whose husbands are HIV negative, the babies and children whose mothers are HIV negative.

Of course sex workers are treated badly and that needs to stop. But articles that simply repeat the half truths about HIV almost always being sexually transmitted is simply adding to the neglect of their health and welfare. The very stigma the Aids industry claims to abhor comes from the industry itself.

Of course the poverty that so many people have to suffer is terrible. But it is not poverty or lack of education, terrible things in themselves, that are driving the epidemic. HIV is a virus that is sometimes transmitted sexually, but not always, probably not even often. We can't continue to refuse to investigate the relatively simple question of the extent to which HIV is transmitted non-sexually.

It's not just sex worker clients, police and others who abuse sex workers and non-sex workers alike: it's researchers and academics who claim to be helping but who don't seem to be able to see Africans as ordinary human beings. Perhaps if they take that first step, the rest will be easy.

UNAIDS Happily Stoke Up HIV Epidemic Using Public Money

Someone recently raised the question in a Kenyan newspaper of whether a negative HIV test result in one partner implied that the other partner is also negative. The answer is a resounding 'No', but the person replying was not quite clear enough on the matter: "There are instances where one partner is HIV-negative and the other is HIV-positive".

In many African countries, half of the couples infected with HIV are discordant, meaning that only one partner is infected. And about half of those in such discordant relationships are female. People in discordant relationships can and do have unprotected sex, often for years, without transmitting the virus. And in couples where both partners are infected, it has often been found that they were both infected by a different source.

More worryingly, you can not imply the HIV status of a woman from the HIV status of her children. Not only can HIV positive women have HIV negative children but HIV negative women often seem to end up with HIV positive children. UNAIDS and others deny that this phenomenon is significant and very little research has been carried out to find out if they are right.

Indeed, the very mention of terms like 'nosocomial', 'iatrogenic', 'hospital acquired' (all meaning roughly the same thing) is something of a taboo. In the same way that people all over the world see talk about sex as taboo, the highly paid and overqualified people who make up the AIDS industry see talk about non-sexual HIV transmission as taboo. Perhaps it's a cultural trait or some kind of institutional tradition, who knows.

Things in Mozambique may be different. Most of the relevant publications are in Portuguese, but Dr David Gisselquist recently sent me some figures for HIV positive children with HIV negative mothers. It was kindly translated by a researcher who knows Portuguese. I just wonder how much other vital data is available but only in a language I don't know. I suspect there's a lot.

Anyhow, the proportion of HIV positive children with HIV negative mothers is around 30%. This is an alarming figure, suggesting that infants and children, as well as mothers (and the population as a whole), face serious risks of HIV transmission from unsafe healthcare.

The AIDS industry has always tried to diminish the likelihood of any form of non-sexual HIV transmission and a similarly embarrassing revelation a few years ago, that time in Swaziland, was dismissed as being a result of babies being raised by someone other than their birth mother. This unconvincing argument is quite telling, too; the industry is not interested and will not investigate.

Cock-ups in health services are not confined to dirt-poor countries with disasterous infrastructures and extreme shortages of skilled personnel and equipment. They also occur in countries that have very high quality, accessible healthcare systems. There have been numerous scares about healthcare transmission of HIV, hepatitis and other conditions. And recently there was a scare about a mother in the UK who was given the wrong (expressed) breastmilk for her infant, several times.

The figures for Mozambique are unlikely to reveal the full picture. Women with HIV positive children who are HIV positive themselves may not have infected their children. And it is also possible that some children may have infected their mother. Or they may both have been infected through different routes. Many women are found to seroconvert late in their pregnancy or just after giving birth. The AIDS industry assumes that this is because they continue to have unprotected sex, probably often with strangers, during their pregnancy.

This is an appalling attitude towards African people and, as it is not the received view of non-Africans, it must also be considered racist, institutionally racist. The picture that is painted of women is similarly bigoted and entirely sexist. In Western countries, if a HIV negative woman is found to have a HIV positive child, there is an investigation, not an outpouring of racist bilge.

To misrepresent HIV as a purely sexually transmitted virus (in African countries, alone) is to condemn people to a lifelong, debilitating disease that will likely reduce the sufferer's lifespan. It also condemns many people to a life of stigma, persecution, isolation and violence.

To stand by and watch people being needlessly infected with HIV is bad enough but to brand them as stupid, careless, ignorant, and even as evil, is beyond belief. The HIV industry, especially UNAIDS, need to be recognised as being more than just ineffective; they are also playing a significant part in fuelling the HIV epidemic.

For the New Year; Less Talk About Sex, More About Unsafe Healthcare

Doug Kirby is only one in a long list of people to speculate about Uganda's 'success' in reducing HIV transmission from relatively high rates in the 80s and 90s to relatively low but steady rates in the 2000s.

As he and others wonder what happened, some sceptics have doubted if Uganda did anything in particular and have even suggested that the epidemic may have arrived, spread and declined, almost entirely independently of anything that was done to prevent it.

A lot is made of the so called ABC program (Abstinence, Be faithful, use a Condom), as if all HIV is transmitted sexually. It isn't, it never was and at one time, even in Uganda, this important fact was acknowledged.

Anyhow, no one working in Uganda in the 1980s and 1990s remembers the term ABC, it appears to have been invented later, and not even in Uganda. Also, no one seems to remember the sheer idiocy of an 'abstinence only' program, either in name or in nature. But let's indulge in Kirby's apparent sincerity as he speaks for the majority of HIV researchers.

The notion of abstinence is inherently vague; is it to abstain from sex for ever, to abstain until marriage (one of the senses used by Demographic and Health Surveys), to abstain for a period (such as during the day during the course of Ramadam), to abstain from certain kinds of sex, to abstain from sex with one's main partner, to abstain from sex with those other than one's main partner, to not have had sex for the past week/month/year, etc.

Knowledge of ABC as a whole is also deceptive because it clearly doesn't lead to the expected behaviors and HIV rates are often higher among those who appear to have higher levels of knowledge about 'safe' sex. In Tanzania, for example, knowledge is higher among wealthier, better educated, urban dwelling, 20-39 year olds, but so are HIV rates.

Indeed it has never been shown that people with the 'requisite' knowledge are less likely to be infected. In fact, those with the requisite knowledge appear to be more likely to be infected. This is not to suggest that knowing what they are taught about HIV puts people at higher risk. I am suggesting that this 'knowledge' is just not particularly relevant and it leaves out things people really need to know, such as details of non-sexual risks and how to avoid them.

None of these 'methods' of reducing the chances of being infected with HIV really amount to much. So they couldn't explain how Uganda's epidemic declined. They might have contributed a little but it's impossible to say how much. They are not really testable. They are simply based on the incorrect assumption that almost all HIV is tranmsitted sexually in African countries, so if people don't have sex, they won't be infected.

Education is a right that need have no connection with HIV or any other disease. As it happens, better educated people usually enjoy better health. But there is no useful list of causal connections between education and health. Sex, sexuality and reproduction education are also rights, but a reasonable level of general education is a prerequisite in order for people to be well educated about these issues.

Lack of knowledge about sex, sexuality and reproduction is likely to cause many problems. People growing up in ignorance of such issues face many risks, such as sexually transmitted infections, unwanted pregnancies and possibly emotional and psychological problems.

But when it comes to HIV, this area of education is not enough. People also need to know about non-sexual risks, faced in cosmetic and hairdressing facilities, tattoo and body piercing parlors, traditional healing and related contexts and, most importantly, in health and medical facilities.

If people don't know about non-sexual risks, they will not know how to take steps to avoid them. They will not know enough to check if the hairdresser sterilizes their equipment adequately, that some processes are better avoided if their safety is unknown and that in underfunded, understaffed, undersupplied health facilities, you have to check that the equipment being used is sterile, whether that equipment is new and unused or reused but properly sterilized.

If none of these measures are taken regarding non-sexual HIV transmission, no number of condoms delivered, sexual experiences foregone or anything else will guarantee protection against HIV (and other viruses, such as hepatitis B and C).

Uganda may have taken some of these precautions against non-sexual HIV transmission in the early days of the epidemic. Doug Kirby doesn't mention them much, but that doesn't mean they didn't occur. But the health access situation in Uganda is quite similar to those in Tanzania and Kenya. Most people don't have access to health services and when they do, the quality is low. But as health services spread, or as people move to access health services, HIV also spreads.

In contrast, in Southern African countries, far more people can access health services. Unfortunately, those health services are also of very low quality. So the chances of being infected in health facilities is even higher in Southern African countries. Therefore, it is unlikely to be a coincidence that Southern African countries have the highest HIV rates in the world.

Of course, I could be completely wrong, Perhaps UNAIDS are right that only 2-5% of HIV transmission comes from unsafe healthcare. Or WHO may be right that only 15-20% of transmission comes from unsafe healthcare. What I would like to see is proper investigation of health care facilities and a credible estimation of what proportion of HIV is being transmitted non-sexually (not just in health care facilities, but also as a result of traditional practices, cosmetic practices and anything else that may be involved).

We have been very unsuccessful in influencing sexual behavior and this lack of success may continue. But providing people with affordable and safe healthcare would not be nearly so elusive. And people have the right to know what the major non-sexual HIV risks are and how to avoid them. Up to now, Africans have been treated with utter contempt and, as a result, millions have been infected with HIV. Many have died and many more will die, despite all the money being churned into antiretroviral drugs.

No Leap of Faith Required to Question HIV Orthodoxy, Just Honesty

Many millions of words have been dedicated to what was said to have happened in Uganda in the 1980s and 1990s that resulted in a serious HIV epidemic peaking and declining dramatically.

Well, for a start, all the high figures cited for HIV prevalence in Uganda in the early days of the epidemic are for specific groups, such as pregnant women. Prevalence for the whole sexually active population at that time is rarely given and is probably not clear, even now.

Once more detailed prevalence figures were established for later periods in the epidemic, it became clear that there had long been more women infected than men. This should have resulted in questions about who infected all these women.

But HIV professionals don't ask such questions because they don't fit the 'behavioral paradigm', the view that HIV is almost always transmitted sexually in African countries (but not in non-African countries, go figure). They are content to talk about how low the prevalence figures are now, though they are nothing to boast about.

So the 'dramatic' drops in HIV prevalence, from double figures to single figures in a few years, never occurred. What drops in prevalence did occur would mostly have been down to very high death rates.

All the talk about behavior change was mostly just that, talk. Some behavior change may have occurred, probably as a result of people witnessing massive levels of sickness and death, but this would have been after incidence rates had already peaked and declined.

Why incidence rose so rapidly in the 1980s and perhaps before, and why they peaked and declined, is not clear. At least, it's not clear if you accept the behavioral paradigm. There is no evidence that 'unsafe' sexual behavior inexplicably increased in the late 1970s and early 1980s and then declined again before the end of the 1980s.

Unless there was some identifiable change in levels of sexual behavior that led to barely credible feats of promiscuity in Uganda some years before the HIV epidemic peaked, it remains a mystery why the epidemic ever infected so many people.

And it's not just in Uganda that there remains this mystery. The massive rise in promiscuity that occurred there must have taken place a few years earlier in Western Equatorial countries, where HIV had been a less serious epidemic for even longer. Sometimes it becomes more of a mystery to explain why some places in Africa never experienced this strange phenomenon.

Anyhow, this totally unrecorded rise in promiscuity must have taken place in Tanzania a bit later than it did in Uganda. In Kenya it must have taken place a few years later still, because incidence there increased and peaked a few years later.

Then Southern African countries experienced this same unrecorded and mysterious increase in promiscuity that barely affected Western and Northern African countries at all.

Outside of African countries, no wave of promiscuity was needed to explain serious HIV epidemics because this virus which is said to be spread predominantly through sexual behavior in African countries is accepted as a virus that spreads most efficiently through unsafe injections among intravenous drug users and among men who have sex with men.

That's the way the behavioral paradigm goes, anyhow. It claims that Africans have inordinate amounts of unsafe sex and that different African countries at different times experienced enormous increases in unsafe sexual behavior that 'explain' the resulting difference between low HIV prevalence countries such as Senegal, medium prevalence countries such as Uganda and high prevalence countries such as Swaziland.

The original question about what 'happened' in Uganda, prevention interventions and the like, was if the same thing could occur in other countries. Well, the same thing didn't occur in other countries, according to the official story. Outside of Uganda, most governments denied the existence of HIV or ignored the epidemic. Very few leaders were in any way open about HIV in their own country.

Despite this, most medium and high prevalence countries have followed a similar epidemic pattern to that found in Uganda: HIV arrived and spread rapidly, peaked and declined. Since the initial decline, infection rates have continued at a relatively low rate, as have death rates.

But all this appears to have occurred independently of anything the respective governments did or didn't do. Whether governments reacted to the epidemic or ignored it, roughly the same pattern resulted.

So, the two things the behavioral paradigm encourages us to believe are different but not wholly compatible: firstly, the paradigm paints Africans as grossly promiscuous and unconcerned about their own health or the health of their children.

And secondly, when called upon to explain the original increase, peak and deline in HIV infections, the orthodoxy makes up a story of a promiscuous people (because all Africans are the same under this paradigm) becoming even more promiscuous, because of urbanization or some other factor that may have little or no explanatory power.

We are then left with the problem that the Senegalese and people from various other low prevalence countries have never really been particularly promiscuous. And even some tribes in a country like Kenya have less sex than others. The Luo, with high HIV prevalence, according to the paradigm, must have a lot more 'unsafe' sex than the Somalis, who have low HIV prevalence (despite having the highest fertility rates in the country).

If we accept a sexual explanation and follow the argument through, we still have to tie ourselves in knots. What gave rise to an epidemic of promiscuity that eventually resulted in a serious HIV epidemic in only some parts of some countries?

It's way past the time for HIV 'experts' to accept the fact that HIV is spread both sexually and non-sexually and that when it can't be adequately explained by normal sexual behavior, found in every country in the world, that something other than sexual behavior must be involved.

No leap of faith is required to question the HIV orthodoxy; all that is required is a bit of honesty and integrity. I don't think that's too much to ask but, we're still waiting.

Academics Can Not Be Trusted to Tell the Truth About HIV

Until HIV academics lose their obsession with sex, HIV epidemic patterns will continue to be misrepresented, giving instead a seriously biased picture. This bias does not just have consequences for academic papers; it translates into biased policy, biased intervention programs and biased reporting. As a result, HIV continues to infect and kill millions of people, unchecked by those who are supposed be best placed to control the epidemic.

Doug Kirby had an article a couple of years ago entitled 'Changes in sexual behaviour leading to the decline in the prevalence of HIV in Uganda: confirmation from multiple sources of evidence'. The 'conclusion' that sexual behavior was behind all African epidemics is not really the issue here; that is something of a reflex.

The issue is about 'confirmation' from 'multiple' sources of evidence. In a nutshell, the paper does not lend confirmation to the behavioral paradigm, the belief that HIV is almost always transmitted sexually in African countries. Nor are the 'multiple' sources of evidence wholly independent of each other.

The fact that adherents of the behavioral paradigm have persuaded most of those working in the field to sing from the same hymn sheet does not have the effect of strengthening the evidence.

The reason all this talk about sexual behavior in Uganda does not confirm the behavioral paradigm, during the 1980s or any during other period,  is that it simply ignores non-sexual HIV transmission. People are rarely asked questions about anything but their sexual behavior, knowledge and attitudes. And yet it is thereby concluded that only sexual behavior, knowledge and attitudes are relevant.

Kirby's article even mentions that people were "more careful in general, avoided people with AIDS, were careful with blood, were careful with injections, etc." This glosses over what may be useful evidence about non-sexual HIV transmission.

But this was in 1989, when it was still acceptable to mention non-sexual HIV transmission. Not long after that it ceased to be acceptable. People were rarely asked about anything but their sexual behavior, knowledge and attitudes. Therefore, there is little data available. And this article, like so many others, skates over anything that is not about sex.

In fact, Kirby's point seems to contradict his thesis: the majority of people had made no change in their behavior or merely intended to make changes. Only a small minority had actually made changes. Not only is there little evidence that sexual behavior change was likely to have any impact on the epidemic, that relevant behavior change actually occurred and had any impact on the epidemic, or that it will ever have a substantial impact on the epidemic anywhere, but the whole paper assumes the truth of its conclusions, despite the paucity of evidence.

As for the 'multiple' sources of evidence, newspaper articles published whatever the going story was at the time. This would have been influenced by a mixture of half-baked policies, misinformed pronouncements and a handful of 'academic' papers that happened to suit the current buzz around AIDS.

The focus groups and other qualitative data is likely to have been heavily influenced by the same media buzz. In other words, most people would have been remembering what they heard, read and talked about as much as by what was happening, which was and continues to be largely misunderstood.

'Models' of what was happening, especially when the figures came from ante-natal clinics and STI (sexually transmitted infection) clinics tend to be somewhat circular. These facilities would have had very high figures for HIV infection because they were established to deal with the epidemic. In addition to the fact that figures from these facilities could not be generalized (although they were and sometimes continue to be), it is likely that many people were infected in health facilities through unsafe medical procedures.

It is not much talked about now and when it is, it is usually talked about as if it doesn't happen any more. But in the eighties especially, and sometimes in the 1990s, HIV was not just seen as an STI. It was also seen as a virus that was spread through various medical procedures. Blood transfusions were one of the most prominent medical procedures because the probability of transmission through contaminated blood was extremely high.

But most people don't receive blood transfusions. What most people do receive are injections and various other procedures which carry a high risk of transmission if equipment is contaminated. The risk is nowhere near as high as it is with transfusions but it is orders of magnitude higher than it is for sexual transmission, the probability of which is quite low per sex act.

Articles like Kirby's simply leave non-sexual transmission out of the picture. What proportion of various country epidemics are down to non-sexual transmission is unknown. What is known about sexual transmission is impossible to evaluate because we have little idea what proportion of overall transmission it accounts for.

Indeed, it is no secret that sexual behavior can not really explain why some countries and parts of countries have inordinately high HIV prevalence. But those who take the behavioral paradigm as their starting point still make up the majority among HIV academics.

Exactly why academics have continued to present this biased view of HIV epidemics is really not clear. Surely the desire to appear to be right, now that thay have been painting themselves into this corner for so long, cannot explain why so many millions of people are being condemned to avoidable sickness and death? But that doesn't really solve the problem of how to change this situation.

It appears that academics can not be trusted to tell the truth. They are not content to research, analyze and report unless their writings conform to what amounts to a dangerously biased orthodoxy. Will they continue to lie until their consequent irrelevance becomes widely recognised? Or will we simply let them get on with not doing their job while innocent people, women, men and children, suffer the consequences?

Kirby claims to have no competing interests but some of the funding was supplied by UNAIDS, that great bastion of the behavioral paradigm and attacker of anyone who suggests that HIV is not all about sex. Kirby also mentions help from Daniel Halperin, which would also have ensured that the conclusion wouldn't shock or offend anyone in the orthodox camp by reducing bias or acknowledging any of the more serious limitations of the study.

HIV Programs That Never Happened

A steaming pile with hundreds of flies buzzing around it surely means a fresh press release has been issued. And putting '2.0' after the word 'treatment' has ensured that every big news agency repeats the press release so that if repetition makes something true, there really is a new approach to HIV treatment. And treatment is prevention, that's been repeated a lot too. And young people are leading the prevention revolution, because a press release saying so has been passed in advance of the Vienna Aids Conference, which involves those in the HIV industry meeting up and patting each other on the back. Predictably, the 'free' press has picked up that one as well.

Meanwhile in South Africa, a piece of research gives an idea of what people really think about condoms, which are an important aspect of preventing HIV transmission through sexual contact. In many African countries condoms are used by young people, but only by some young people and only some of the time. A point that has been entirely missed by UNAIDS is that male condoms need to be worn on penises, preferably erect ones, before and during sexual intercourse. They can be removed afterwards. But waving them around conference halls, writing policy papers about them, filling up storage space with them, putting lots of pretty pictures of them on your website and issuing press releases about them has little impact on sexually transmitted HIV.

This paper finds that most women and girls are not in a position of power in a relationship and do not usually get to decide or even discuss whether to use a condom. Also, some people have negative beliefs about condoms, such as that they decrease sexual pleasure. Others feel that if condoms are discussed, there must be a lack of trust in the relationship, although that lack of trust may be quite justified. A lot of people just don't talk about condoms, HIV or risks like pregnancy or infection with a sexually transmitted infection (STI).

But what is probably one of the biggest obstacles to reducing HIV transmission is the association of HIV with sexual promiscuity and casual sex. Many people, under such circumstances, would think twice before buying condoms in a pharmacy where there are lots of other people or even being seen with condoms, even by their most intimate friends. Young people are unlikely to be sold condoms by pharmacists or given them by health workers because of the stigma that HIV has been surrounded with. Given that HIV transmission is not just a matter of sexual behaviour, why all the stigma?

Well, the HIV industry itself plays a big part in fuelling the stigma that surrounds HIV transmission. The big players in the industry (and they are big) maintain that HIV in developing countries is almost always transmitted through heterosexual sex. They deny that there is any significant risk from unsafe healthcare or cosmetic practices, despite many questions about this claim. The fact that there are young children and infants with HIV whose mothers' are HIV negative should set off alarms and give rise to investigations. But in African countries, no such investigations have been carried out. Many women are infected, often after they become pregnant, even though they have only had sex with their HIV negative husband. Again, no investigations.

Colluding with the HIV industry are the many political interests, African and non-African, commercial interests, generally non-African, and the hoards of religious groups, who can't open their mouths without spreading stigma. And the above research uncovers some of the lies that church leaders spread about HIV, about condoms and about sex education. It's not as if church leaders are above reproach themselves and I'm not just talking about the Catholic Church.

You can accept the plethora of 'good news' HIV press releases or not but it would be very surprising if young people were 'leading the way' in HIV reduction when they are surrounded by a complete absence of accurate information about HIV and a whole lot of lies, often contradictory lies. While UNAIDS tells them that 'safe sex' will protect them from HIV, the churches tell them that condoms are not safe. Many young people are told little or nothing by their parents or teachers, who probably know little more than their children do. If HIV transmission among young people is falling, this is unlikely to have much to do with HIV prevention programs.

Political and Religious Leaders Overseeing the Spread of HIV

There's an interesting article on Aidsmap.com about how Ugandans who think they may be HIV positive are less likely to refer other family members for HIV testing. In a survey, people were asked before testing if they thought they were likely to be HIV positive. A majority said they thought they were likely to be. Of course, only some of them were. But most of those who are HIV positive in the country do not know their status. This doesn't bode well for a country that is said to have been so successful and progressive in its fight against the disease.

The very people who are most likely to be HIV positive are least likely to go for testing. So you would think that the Ugandan government would aim to target these people, make it easier for them to get tested, increase access to HIV facilities, reduce discrimination and stigma. Instead, the government is going in the opposite direction, trying to whip up anti gay feelings and making such strong threats against people even suspected of being gay that most people will be less willing to find out their HIV status, whatever their circumstances.

The Bahati Bill will make a lot of people avoid even discussing HIV or sexuality because if someone is found to be gay, HIV positive and sexually active, they will face the death sentence. In order to cover up their sexuality, many gay people are said to have heterosexual relationships, even to marry a heterosexual partner. Their partner will even face a lengthy prison sentence for not reporting that they were married to a gay person. Currently, only an estimated one quarter of HIV positive people know their status. If this bill becomes law, that figure should go down even further.

Some leading American Christians are said to be behind Bahati's bill. But the Catholic church is equally adamant that condoms shouldn't be used to prevent unplanned pregnancy, HIV or other sexually transmitted infections. They even lie about the effectiveness of condoms, which would seem to be in breach of the ninth commandment. But as far as they are concerned, it is 'artificial contraception', and therefore immoral. The use of condoms is currently being debated in The Philippines, where HIV prevalence is low, but rising.

You would think that political and church leaders would aim to reduce transmission of HIV and to stamp out stigma and discrimination. But, on the contrary, they seem to be against any measures that target some of the most significant channels to HIV infection. We must look beyond political and religious leadership if we are to have any hope of making progress in the fight against HIV.

It's OK, Apparently Journalists Are Supposed to Lie

In an article about the Polish journalist and writer, Ryszard Kapuscinski, Neal Ascherson claims that "there is no floodlit wire frontier between literature and reporting". This is interesting because he feels that being a "great story teller" does not make someone a liar. Which is true, except when they are supposed to be writing an article that people assume is 'reportage'.

I don't know about Kapuscinski but if there is no frontier between literature and reporting then why would anyone bother to read the daily tripe? Journalists churn out a lot of rubbish concerning things they know precious little about, but people read papers and listen to radios and TVs every day to find out what is happening in the world. When they read some jumped up hack going on about how there couldn't be global warming because it's very cold today, they think that the whole issue about climate change has been trumped up.

So when it comes to genetically modified organisms (GMO), consumers of journalistic bullshit (the majority of mainstream reporting) think of Frankenstein foods, or whatever crap the 'profession' has dreamed up to ensure that the last thing people do is think or become informed in any way. Neal Ascherson may write for The Guardian, a 'moderate' paper, but lying and reporting are not the same thing and if a journalist lies, he or she is a liar.

What I'm saying about GMOs will probably be of no interest to journalists because I am not opposed to them just because they may be dangerous to humans, animals, plants, water supplies, in general, the whole global ecosystem. Although, I admit it, the fact that no one knows exactly what effect long term consumption of GMOs has on those who consume them (because no credible research has been done), does seem like a glaring omission. I am opposed to the fact that a few multinationals want to control the whole of humanity's ability to provide enough food for itself. Not only do they want this but they already control a massive proportion of global food production. To cap it all, many of the most powerful idiots in the world are in favour of this, with the support of...big media owners.

Ok, I've skipped past the journalists because they are just doing a job and they are paid for by some revolting Murdoch-like character who is trying to do for global media what Monsanto is trying to do for food production. But Ascherson makes a good point, don't bother reading what journalists have to say, unless you like a good read. As for science reporting in the mainstream media, forget it.

Domination of global food production by a few multinationals should be bad enough but approval of GM potatoes or any other GMO in Europe (or anywhere else) will also be a disaster because such crops will contaminate other crops around them. We know that they will because the evidence is clear from every field trial of GMOs. We know that there are other dangerous drawbacks to GM crops and also that none of the promised advantages of these crops have materialised. So what they hell are we growing them for?

I wouldn't wish to blame lying journalists for doing any more than following orders, or whatever it is they do, but if they want to brown-nose the bosses of companies like Monsanto, the least they could do is declare their interest. Because every time they throw in a straw man argument like 'Frankenstein foods', they are scoring a goal for the GMO industry. Monsanto can just claim to be using the crops for animal feed or biofuels. But then the problem doesn't go away. Once GMOs are used, the damage is done.

There are enough arguments against the use of GMOs, aside from the dangers to human health. But these arguments are much more difficult to answer. So rather than get the biotech industry to answer them, they are presented with arguments that they have a ready prepared response to. A response that has been well sold by journalists. And have you noticed the way articles often point out how widespread GMO contamination already is, as if to say it's only a matter of time before there is no longer any point in protesting? That's how they got GM cotton into India. Thanks journalists.