If someone at the Vienna Aids Conference put out a press release saying tests have shown that regular use of bouncy castles cures HIV, would the world's media repeat it, just as they have done with every other improbable press release that has come out over the past few days? Have these journalists ever heard of criticism, originality, judgment, analysis or even writing? They did the same during the World Cup, regurgitating every scrap of rubbish they could find. Was everything washed down with free beer (Fifa approved, of course)? If so, no doubt they are washing things down with good wine in Vienna.
Even Reuters' AlertNet follows the flock with their triumphalist 'MTV drama brings cool to HIV prevention'. Apparently this drama, 'Shuga', was aired some time last year, but where? Perhaps it was aired in Nairobi or in private schools but I don't know anyone who has seen it or even heard of it. "In Kenya, the drama was watched by an astonishing 60 percent of young people – those are amazing figures for any programme," Bill Roedy, CEO of MTV, told IRIN/PlusNews. They're not just amazing, they are not credible. Where's the evidence, Roedy?
Over 80% of Kenyans live in rural areas and about 70% of those who live in urban areas live in slums. Official figures claim that only about 30% of Kenyans do not have access to electricity and that only about 25% don't have regular access to the media (print, radio and TV). But how many people have TVs or regular access to TVs? Most people in the areas I've been working in don't. But in the euphoria at Vienna, with the desperation to churn out feel-good stories, the press will repeat anything they are fed. Haven't they ever heard of evidence?
As for the 'evaluation' of what people learned and think and what that might show, what does that mean? Most people visit the bathroom after watching a few TV shows, does that mean they are good laxatives? Of course young people will be able to repeat what they have heard, especially when treated to a TV show about sex (though I'm still wondering how many have really seen it). Children here, and adults, have been blasted with rubbish about HIV and sex for so long now they know exactly what to say when asked. The problem is, even people who work with HIV have no idea that HIV can be and is transmitted non-sexually, nor any idea how to protect themselves from non-sexual HIV transmission.
This is an extremely dangerous situation. I've sat with people and discussed conditions in hospitals, their experiences with doctors, nurses, dentists and others who might pose a risk of blood-borne infection of some kind. But when the conversation turns to HIV risk reduction, they always talk about sexually transmitted HIV. Of course, Shuga is about sexually transmitted HIV, from what I can glean. What else is there, if you're part of the mainstream media, which MTV most certainly is.
Contradictions are not considered important in the HIV industry but one of the feel-good stories that's been churned around before and during the conference has been about young people 'leading' the drop in the spread of HIV. Yet now, the AlertNet article says "Worldwide, 40 percent of new HIV infections occur among young people between the ages of 15 and 24. Behaviour change campaigns have shown some success...". Behaviour change campaigns have resulted in people being able to answer questions about things they have been taught but they have not resulted in significant levels of behaviour change. And they have had no impact whatsoever on HIV transmission rates.
The 'evaluation' was carried out by the Johns Hopkins Centre for Communication Programs. Johns Hopkins, like the HIV industry, is vehemently opposed to the idea that HIV is commonly transmitted non-sexually in African countries. But just because the HIV industry is completely biased against anything that could threaten their massive levels of funding, that doesn't mean the media should behave as the lapdog of industry, academia and anyone else handing out free booze (or whatever they get out of it).
There's no polite way to say this and politeness would be misplaced anyway: the Vienna Aids Conference is an (expensive) exercise in arse sniffing, a specialty of the press. One can only wonder what they all do to while away the time during those long presentations and seminars. When I tell people in rural areas about things like the HIV industry and conferences, they ask reasonable questions, such as 'what is HIV prevalence like in Vienna?', 'why are they there?', 'how expensive are these conferences?' and 'if the industry gets so much money, why does none of it end up here?' Any chance of a woof, a yelp or even a whimper from the pampered, or they too well bred?
Showing posts with label vienna aids conference. Show all posts
Showing posts with label vienna aids conference. Show all posts
Thursday, July 22, 2010
Tuesday, July 20, 2010
Whose Rights, Which Rights and Where?
The punchline for the Vienna Aids Conference that's taking place at the moment is 'Rights Here, Right Now'. But it is only recently that the HIV industry has been making it clear whose rights they are demanding. They are demanding that HIV positive people, all of them, receive treatment. HIV positive people have a right to treatment but the conference rally cry seems to ignore the right that HIV negative people have to stay negative, indeed, the same right that HIV positive people have already been denied. Of course sick people have a right to treatment. But what the industry is claiming is that treatment for HIV positive people will ensure that HIV negative people stay that way; not healthy (not by a long shot), just HIV negative.
Well, in an ideal world, HIV positive people on successful antiretroviral treatment (ART) are less likely to transmit the virus to other people. We actually live in a world where most HIV positive people are not on ART, for a variety of reasons, and that will probably remain the case for the foreseeable future. But UNAIDS and the rest of the HIV industry don't live in this world. They live in a better carpeted world, better paid, where a disaster is having to drink a coffee with full fat milk when they ordered skinny. They themselves have a right to health. Others have a right to (HIV) treatment, and let's be clear, we are talking about people in developing countries here.
The Alma-Ata Declaration defines health as follows:
There are several manifestations of the industry's desire to see treatment as prevention. In some places, where circumcision rates are low, there are plans to circumcise millions of men. This may or may not protect those circumcised, the evidence is slim. But it is unlikely to protect those with whom they have sex. The difference here is that millions of people, most of whom are not sick, are being told to have an operation that will keep them healthy. It is further implied that their being healthy will ensure the health of others. And this is in countries that have few health facilities, doctors or nurses and chronic shortages of equipment and medication.
Another manifestation is called pre-exposure prophylaxis or PrEP. This involves people who are HIV negative taking ART drugs on the grounds that they will be less likely to become infected. So treatment is not only being offered to those who are HIV positive, it is also being offered to those who 'may' become infected, in the opinion of a bunch of 'experts' who think that HIV treatment is a substitute for health. HIV industry spokespeople like to talk about 'science' and 'evidence', but what about rights, logic and common sense? Is a healthy person just a potential customer to them?
The industry has long insisted (it's a bit tenuous to call it a belief) that HIV is almost always transmitted through heterosexual sex in developing countries. There are two problems with this 'behavioral paradigm': firstly, given that those in developing countries don't engage in more sex, safe or unsafe, than those in rich countries, why do some developing countries have unbelievably high rates of HIV transmission, far beyond what could be reasonably explained by sexual behavior? Secondly, it is clear that a lot of HIV transmission must occur through non-sexual routes, but what exactly are these routes and how much transmission do they account for?
The first problem is vexing because there has never been any evidence for the rampant levels of unsafe sex that would be required for 20 or 30% of any population to become infected with a virus that is difficult to transmit through sexual intercourse. The industry has reacted by insisting that some people really do have the time, the opportunity and the inclination to lead a life that, previously, only existed in porn films. The second problem, the industry simply ignores. Almost everything about the industry assumes the truth of the behavioral paradigm. You could say that they view everybody (in developing countries, of course) as already sick and that they see the treatment as being preemptive (without being preventive).
Until we know why people in developing countries are becoming infected with HIV in such large numbers, it is senseless to keep droning on about sexual behavior. If there is something about sexual behavior in developing countries that results in a difficult to transmit virus being transmitted with ease, we don't know what it is yet. But we do know that there is a lot more non-sexual HIV transmission than the HIV industry are prepared to admit. HIV treatment is for HIV positive people, and I hope everybody who needs it receives it, regardless of their race, religion, sexual status or anything else. But everyone has a right to health; everyone has a right to live free of HIV. Avoidable HIV transmission needs to be prevented.
There is still a need for genuine HIV prevention and if UNAIDS can't come up with anything better than slogans, the agency should be abolished. They have shown a complete unwillingness to drop the behavioral paradigm despite there being no evidence for it and a lot against it. Their calls for rights are just humbug and they seem to be more interested in self-preservation than anything else. As more and more people become infected unnecessarily and many die every day, UNAIDS and the rest of the industry do little but spread stigma and lies about HIV. Those who are HIV positive, many as a result of the industry's failures, have a right to treatment. Others have a right to health, the same right that so many HIV positive people have been denied by this industry.
The Vienna Aids Conference is being used as a platform to make desperate pleas for yet more donor money to be ploughed into an industry that has failed to reduce HIV transmission and will continue to fail, given their present trajectory. They do not have any new ideas; they have just dressed up their old prejudices in new terminology. People have a right to health. Those who are sick have a right to treatment, a right to live lives that are as close to healthy as possible. But enough money has been wasted on political and commercial interests. We know enough about HIV to do things much better.
(For further discussion of PrEP, see my other blog, pre-exposureprophylaxis.blogspot.com)
Well, in an ideal world, HIV positive people on successful antiretroviral treatment (ART) are less likely to transmit the virus to other people. We actually live in a world where most HIV positive people are not on ART, for a variety of reasons, and that will probably remain the case for the foreseeable future. But UNAIDS and the rest of the HIV industry don't live in this world. They live in a better carpeted world, better paid, where a disaster is having to drink a coffee with full fat milk when they ordered skinny. They themselves have a right to health. Others have a right to (HIV) treatment, and let's be clear, we are talking about people in developing countries here.
The Alma-Ata Declaration defines health as follows:
health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and [...] the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.Notice, it is not about treatment, which is for sick people. Telling healthy people who are hoping to stay healthy that treating the sick will also be good for them is not promoting their health. Treatment is not prevention, it is just treatment. But putting as many people as possible on treatment will not have the effect of eradicating HIV. Mass treatment may slow transmission down a bit, but refusing to do anything to reduce transmission aside from treating those known to be HIV positive and willing to be treated with ART, is denying the majority of people their right to health.
There are several manifestations of the industry's desire to see treatment as prevention. In some places, where circumcision rates are low, there are plans to circumcise millions of men. This may or may not protect those circumcised, the evidence is slim. But it is unlikely to protect those with whom they have sex. The difference here is that millions of people, most of whom are not sick, are being told to have an operation that will keep them healthy. It is further implied that their being healthy will ensure the health of others. And this is in countries that have few health facilities, doctors or nurses and chronic shortages of equipment and medication.
Another manifestation is called pre-exposure prophylaxis or PrEP. This involves people who are HIV negative taking ART drugs on the grounds that they will be less likely to become infected. So treatment is not only being offered to those who are HIV positive, it is also being offered to those who 'may' become infected, in the opinion of a bunch of 'experts' who think that HIV treatment is a substitute for health. HIV industry spokespeople like to talk about 'science' and 'evidence', but what about rights, logic and common sense? Is a healthy person just a potential customer to them?
The industry has long insisted (it's a bit tenuous to call it a belief) that HIV is almost always transmitted through heterosexual sex in developing countries. There are two problems with this 'behavioral paradigm': firstly, given that those in developing countries don't engage in more sex, safe or unsafe, than those in rich countries, why do some developing countries have unbelievably high rates of HIV transmission, far beyond what could be reasonably explained by sexual behavior? Secondly, it is clear that a lot of HIV transmission must occur through non-sexual routes, but what exactly are these routes and how much transmission do they account for?
The first problem is vexing because there has never been any evidence for the rampant levels of unsafe sex that would be required for 20 or 30% of any population to become infected with a virus that is difficult to transmit through sexual intercourse. The industry has reacted by insisting that some people really do have the time, the opportunity and the inclination to lead a life that, previously, only existed in porn films. The second problem, the industry simply ignores. Almost everything about the industry assumes the truth of the behavioral paradigm. You could say that they view everybody (in developing countries, of course) as already sick and that they see the treatment as being preemptive (without being preventive).
Until we know why people in developing countries are becoming infected with HIV in such large numbers, it is senseless to keep droning on about sexual behavior. If there is something about sexual behavior in developing countries that results in a difficult to transmit virus being transmitted with ease, we don't know what it is yet. But we do know that there is a lot more non-sexual HIV transmission than the HIV industry are prepared to admit. HIV treatment is for HIV positive people, and I hope everybody who needs it receives it, regardless of their race, religion, sexual status or anything else. But everyone has a right to health; everyone has a right to live free of HIV. Avoidable HIV transmission needs to be prevented.
There is still a need for genuine HIV prevention and if UNAIDS can't come up with anything better than slogans, the agency should be abolished. They have shown a complete unwillingness to drop the behavioral paradigm despite there being no evidence for it and a lot against it. Their calls for rights are just humbug and they seem to be more interested in self-preservation than anything else. As more and more people become infected unnecessarily and many die every day, UNAIDS and the rest of the industry do little but spread stigma and lies about HIV. Those who are HIV positive, many as a result of the industry's failures, have a right to treatment. Others have a right to health, the same right that so many HIV positive people have been denied by this industry.
The Vienna Aids Conference is being used as a platform to make desperate pleas for yet more donor money to be ploughed into an industry that has failed to reduce HIV transmission and will continue to fail, given their present trajectory. They do not have any new ideas; they have just dressed up their old prejudices in new terminology. People have a right to health. Those who are sick have a right to treatment, a right to live lives that are as close to healthy as possible. But enough money has been wasted on political and commercial interests. We know enough about HIV to do things much better.
(For further discussion of PrEP, see my other blog, pre-exposureprophylaxis.blogspot.com)
Monday, July 19, 2010
Difficult Questions That Won't Be Asked in Vienna
Press releases say that about 20,000 people are expected to attend the Vienna Aids Conference this year. I don't know if they will all attend for the whole six days but if they do, it is likely that someone or some institution will be paying an average of $200 per day per person. They conference may not cost $24,000,000, perhaps it will only cost $10,000,000. But even so, that could supply 50,000 people in developing countries with antiretroviral treatment (ART), the drugs and other aspects of treatment, for a year. That's assuming that an average of $200 is being spent per person.
I wouldn't want to suggest that the Vienna Aids Conference is a useless waste of money, it may well have its value. But that much money and that many people in that city? Much of the discussions will be matters that have been both published and well publicized over the last year or two. In fact, a lot of money has already been spent on disseminating the data, reports, presentations, findings, opinions, maunderings, crackpot ideas and things swept up after previous conferences and stuck together with cello tape.
We know already from pre-conference releases that many of those attending buy into the 'behavioral paradigm', the view that HIV is primarily transmitted by heterosexual sex (in African countries) and that in order to reduce transmission, people need to change their sexual behavior. The behavioral paradigm is divisive, racist and sexist and even its closest adherents know that it is entirely without foundation. Yet, there are unlikely to be many people presenting at this conference, or any other Aids conference, willing to admit that their whole theory of HIV transmission is based on a falsehood.
We can only speculate about why the HIV industry seems hell bent on allowing HIV to be transmitted through non-sexual means, such as unsafe health care or cosmetic practices. And it is also hard to understand why they will probably continue to allow HIV to be transmitted sexually by failing to implement any effective prevention strategies. Perhaps the industry is concentrating on 'solutions' that make enough money to be attractive to those who hawk those solutions. They do seem to favor technical solutions, ones that involve expensive commodities. But alas, this is only speculation.
It is unusual to see articles in the mainstream media that even mention non-sexual HIV transmission, especially transmission through unsafe health care. But there was one in Media Global yesterday. This article mentions the WHO's estimate that between 5 and 10% of all HIV infections in Africa occur as a result of unsafe blood transfusions. It also mentions that a WHO researcher estimates that 17% of HIV infection in African countries is due to unsafe injections. Worse still, a substantial proportion of transfusions and the majority of infections are entirely unnecessary!
Putting these together, over 20% of infections could be coming from unsafe health care, perhaps almost 30%. To put that in perspective, only around 10% of new HIV infections in Uganda are estimated to come from commercial sex workers, their clients and their clients' partners added together. If 20-30% of infections are coming from unsafe health care, the percentage attributable to sexual transmission must be considerably lower than previously thought. Unsafe health care could even be the main route to transmission.
The HIV industry knows how to make a lot of noise. After all, it's a very well funded industry. It receives billions of dollars of public money every year and the world's media, public and private, hang on to every word that emanates from official HIV industry mouthpieces. They are not shy about trumpeting their successes, their needs, their problems and their highly suspect philosophy. But they are amazingly reticent when it comes to non-sexual HIV transmission. It's as if the very non-sexuality of it is as taboo as the sexuality is in other contexts.
Another thing the HIV industry is reticent about is prevention, but that's understandable. They have frittered away billions in useless programs and spent years researching others which will never fly. They have come up with tonnes of worthless strategies and now they haven't a clue what to say about HIV prevention any more. So they have come up with the idea of saying that treatment is prevention. And so it is, in a sense. If all HIV positive people were to be aware of their status and everybody at risk of becoming infected were to be tested regularly, perhaps every year, then treatment could play a big part in prevention.
But we are very far from that position. It's possible that 20% of HIV positive people know their status. But very few people test regularly. And many of the people who are at risk of being infected don't know they are at risk. The reason they don't know they are at risk is because the HIV industry will not speak about non-sexual risk, nor will they allow anyone associated with them to speak about it. So even their 'treatment as prevention' sleight of hand will fail for the very reason that they will not admit that non-sexual HIV transmission could be as common as sexual transmission and may be even more common.
The HIV industry machinery is concentrating on the usual, money. Some of the biggest sources of funding are being cut or flatlined. I think this is a mistake because the countries with the worst epidemics are most in need of more money, not less. But given how badly the billions of the last 20 years have been spent, is it wise to continue allowing the same people and the same institutions to receive whatever money is being made available? Is it wise to continue spending money on the same failed policies of the past? It's a bad time to knock everything down to the foundations, but which part of the HIV industry is worthy of being allowed to continue? These questions will probably remain unanswered, even unasked, at the Vienna Aids Conference. But if HIV is ever to be eradicated, there will have to be an answer.
Sunday, July 18, 2010
But the Media Doesn't Want to be Free
It's odd how countries that have a 'free' press seem content to publish whatever is put in front of them. Coming up to the Vienna Aids Conference, UNAIDS puts out a press release about their new 'platform', called 'Treatment 2.0', with which they are going to conquer the virus that they have, so far, failed to influence in any way since the UN spawned this curious agency. And the world's press simply echoes what UNAIDS says. You can search for any of their expensively honed terminology and you'll find the same thing, repeated like a fart in a whispering gallery, until it's overtaken by their next performance. And the world's busy dung beetles do what their species does best, rolling out articles as indistinguishable as balls of shit. It's not (yet) as if the global media is entirely owned by the likes of that arch dung-heap master, Rupert Murdoch. But out they come, without thought, comment or criticism. Of course they roll, they're spherical!
Before the World Cup, which apparently involved football and sex, the busy creatures were set to work on UNAIDS' predictable offering. This involved making the connection between football supporters away from home drinking a lot and the possibility of their availing of some of the personal services said to be on offer in South Africa. Every news agency did the usual and warned people to avoid having sex with anyone and if they had to have sex, to make sure they used a condom.
Now that the World Cup is over, news agencies can still churn out articles with the popular mixture of football and sex in the form of warnings to those who may have indulged in any kind of unprotected sex while in South Africa, to go for a HIV test. If their pre-World Cup messages had any effect, many football fans probably used condoms and should be ok. For those who were not reading or heeding the articles, it is a good idea to get tested for HIV and all other sexually transmitted infections.
But one thing these guardians of our health and wellbeing never mentioned is that HIV is not only sexually transmitted. In fact, they have been trotting out the sex message for so long, people have probably heard it by now. UNAIDS and therefore the world's press, meanwhile, have kept what they know about non-sexually transmitted HIV to themselves. UNAIDS are quite explicit in the advice they give to their own employees who may be working in African countries: avoid using health facilities that are not approved or provided by the UN. If the risks are high for UN employees, they may be higher for football supporters and even higher still for Africans.
Football fans visiting South Africa probably had a far greater likelihood of contracting HIV, hepatitis B or C, when visiting a clinic, dentist or tattoo parlor. UNAIDS are well aware of this. But they do not tell Africans, who have no option but to use any facilities they can afford. And they didn't bother to tell football fans. And now, when the press are doing their duty by wallowing through the latest releases, they too are neglecting to mention this risk. People who had unsafe sex may go and get tested, but people who had medical or cosmetic treatment are far more likely to transmit HIV or anything else to their partner before discovering, probably some years from now, that they picked up something during the World Cup.
The BBC runs a typical article, mainly targeting men, despite the fact that women who had medical or cosmetic treatment in South Africa could be just as much at risk. The article is about a campaign being run in the UK, which trots out the half-truth about HIV being sexually transmitted, even though it has always been known that HIV can be transmitted in other ways. Although the article mentions holiday makers in general, many of whom may be visiting developing countries, there is still no acknowledgement of the risks people face in health and cosmetic facilities.
One commentator referred to the campaign as "amusing and engaging". It may well be, but what's the point in amusing people and engaging their attention when the message has been mangled, for whatever perverse reason? South Africa is not just the country with the highest number of HIV positive people in the world. In common with most other African countries, South Africa also has appalling health conditions and run down facilities which are barely accessible to most people. Holiday makers may not have to use the facilities that ordinary Africans have to use. But there is as much of a risk to holiday makers from unsafe medical and cosmetic practices as there is from unsafe sex, perhaps more. So why the failure to mention this?
Before the World Cup, which apparently involved football and sex, the busy creatures were set to work on UNAIDS' predictable offering. This involved making the connection between football supporters away from home drinking a lot and the possibility of their availing of some of the personal services said to be on offer in South Africa. Every news agency did the usual and warned people to avoid having sex with anyone and if they had to have sex, to make sure they used a condom.
Now that the World Cup is over, news agencies can still churn out articles with the popular mixture of football and sex in the form of warnings to those who may have indulged in any kind of unprotected sex while in South Africa, to go for a HIV test. If their pre-World Cup messages had any effect, many football fans probably used condoms and should be ok. For those who were not reading or heeding the articles, it is a good idea to get tested for HIV and all other sexually transmitted infections.
But one thing these guardians of our health and wellbeing never mentioned is that HIV is not only sexually transmitted. In fact, they have been trotting out the sex message for so long, people have probably heard it by now. UNAIDS and therefore the world's press, meanwhile, have kept what they know about non-sexually transmitted HIV to themselves. UNAIDS are quite explicit in the advice they give to their own employees who may be working in African countries: avoid using health facilities that are not approved or provided by the UN. If the risks are high for UN employees, they may be higher for football supporters and even higher still for Africans.
Football fans visiting South Africa probably had a far greater likelihood of contracting HIV, hepatitis B or C, when visiting a clinic, dentist or tattoo parlor. UNAIDS are well aware of this. But they do not tell Africans, who have no option but to use any facilities they can afford. And they didn't bother to tell football fans. And now, when the press are doing their duty by wallowing through the latest releases, they too are neglecting to mention this risk. People who had unsafe sex may go and get tested, but people who had medical or cosmetic treatment are far more likely to transmit HIV or anything else to their partner before discovering, probably some years from now, that they picked up something during the World Cup.
The BBC runs a typical article, mainly targeting men, despite the fact that women who had medical or cosmetic treatment in South Africa could be just as much at risk. The article is about a campaign being run in the UK, which trots out the half-truth about HIV being sexually transmitted, even though it has always been known that HIV can be transmitted in other ways. Although the article mentions holiday makers in general, many of whom may be visiting developing countries, there is still no acknowledgement of the risks people face in health and cosmetic facilities.
One commentator referred to the campaign as "amusing and engaging". It may well be, but what's the point in amusing people and engaging their attention when the message has been mangled, for whatever perverse reason? South Africa is not just the country with the highest number of HIV positive people in the world. In common with most other African countries, South Africa also has appalling health conditions and run down facilities which are barely accessible to most people. Holiday makers may not have to use the facilities that ordinary Africans have to use. But there is as much of a risk to holiday makers from unsafe medical and cosmetic practices as there is from unsafe sex, perhaps more. So why the failure to mention this?
The media seems to need a reminder that they are allowed, they are even encouraged, to analyse, criticize and comment on what they write about. They are even permitted to disagree. If UN agencies like UNAIDS spew out dung, there is no reason why the media should passively roll it up and pass it on to their readers. If every news agency carries the same story, word for word, as they do in the case of HIV and sexual transmission, without ever mentioning non-sexual transmission, there is only need for one news agency. Right now, it almost seems as if there is only one news agency, run entirely by dung beetles.
Friday, July 16, 2010
HIV Industry Parties As Virus Spreads
The HIV industry has a very important junket coming up in Vienna and some of the industry's biggest donors are threatening to reduce funds. The World Bank's Global Fund and the US PEPFAR fund (President's Emergency Fund for Aids Relief), which represent a large proportion of global HIV funding, will be reduced over the next few years. Industry representatives are busy writing press releases, lobbying governments and doing everything in their power to fight for their right to party.
That sounds very cynical, but many people will die of Aids during the coming Vienna Aids Conference and during the many expensive junkets the industry treats itself to. The amount of money spent on such events must be astronomical and they are not usually even held in countries with high HIV prevalence. The same amount of money spent on HIV prevention or treatment could save a lot of lives. But HIV policy is mainly written by Westerners in expensive Western offices and when the policy is written, the writers celebrate in Western bars.
With all the hype around the much touted 'Treatment 2.0', it's hard to believe there will be much left to talk about at the conference. Ironically, there is a lot of talk about the use of mobile phones, laptops, wireless and various other technologies in the fields of HIV and global health in general. But you wouldn't think it to see all these people rushing to some expensive city, first class, expenses paid. Treatment 2.0 does involve a lot of technology, but not the sort that reduces costs or carbon emissions or anything like that.
According to PlusNews, one of the five priorities at the conference is 'universal' access to HIV drugs. This, despite what you might expect, involves putting 80% of people who need drugs on ART (antiretroviral therapy). The target was to achieve this by the end of 2010 but this will not be met by most countries. Even the target of putting everyone with a CD4 count (a measure of immune strength) of 200, rather than the WHO recommended 350, will not be reached.
Another technological approach is called 'treatment as prevention', the idea that people who are responding to HIV treatment will be less infectious and so will not be likely to transmit HIV. In ideal conditions, this works well. However, with so many countries still a long way from their targets, it is unlikely to have much impact in high HIV prevalence countries. In most of these countries, a substantial percentage of HIV positive people don't even know their status, so they will not be on ART. Treatment as prevention has been talked up for nearly two years now but no one has dared to admit that it is an ideal and will always remain an ideal. Even the jokers who came up with the 'no sex month' idea don't believe it.
Even nuttier than that is an approach called pre-exposure prophylaxis (PrEP). This involves putting those 'most at risk' of being infected with HIV on ART. If we had any idea who was most at risk we could have prevented a lot of infections by now. But we have been pretty unsuccessful in predicting who was most at risk in the past. And recent Modes of Transmission Surveys have shown that many of the people who are becoming infected are not in at risk groups. In fact, one of the characteristics of high HIV prevalence countries is that many of the people most likely to become infected are at low risk, according to official definitions! Figure that one out.
So there are a lot of technologies available but they are either not being used or they are not proving too effective in the field. It is difficult enough to persuade people to get tested for HIV once, let alone once a year for the rest of the time they are sexually active. Many who are HIV positive are either not taking the drugs, not taking the drugs properly or do not have access to the drugs or some other aspect of treatment (shocking, but no, you can't just hand out pills). Perhaps a lot of people are on treatment, but many of them will, eventually, develop resistance and need to go on to a far more expensive 'second line' drug. Technology is not simple, but conditions in developing countries are basic.
So what are the problems, if all this money has been spent for so long? Well countries need infrastructure, especially health infrastructures. They need education, especially health education. They need adequate levels of nutrition and food security. They need clean water and sanitation and many other goods that are considered to be human rights. You cannot roll out a high tech treatment or prevention program without countries having some level of development. It may seem possible to the HIV industry, donors or the public. But not only is it not possible, we've spent years demonstrating the impossibility.
In addition to these technical problems and the problems relating to our relative lack of understanding about exactly how HIV spreads, there is another problem, which is harder to characterize. This is the problem of the HIV industry's refusal to accept that we cannot explain high prevalence, generalized epidemics (where the majority of those infected are not members of high risk groups, such as intravenous drug users, men who have sex with men or sex workers) by almost exclusive reference to heterosexual sex. If you refuse to accept the racist, sexist explanations of HIV transmission in African countries being due to the fact that Africans have lots of unsafe sex, you will also refuse to accept that HIV prevention programs that target sexual behaviour, and nothing else, will reduce transmission to the extent that HIV will eventually be eradicated. I don't see what there is to celebrate.
(For further discussion of PrEP, see my other blog, pre-exposureprophylaxis.blogspot.com)
That sounds very cynical, but many people will die of Aids during the coming Vienna Aids Conference and during the many expensive junkets the industry treats itself to. The amount of money spent on such events must be astronomical and they are not usually even held in countries with high HIV prevalence. The same amount of money spent on HIV prevention or treatment could save a lot of lives. But HIV policy is mainly written by Westerners in expensive Western offices and when the policy is written, the writers celebrate in Western bars.
With all the hype around the much touted 'Treatment 2.0', it's hard to believe there will be much left to talk about at the conference. Ironically, there is a lot of talk about the use of mobile phones, laptops, wireless and various other technologies in the fields of HIV and global health in general. But you wouldn't think it to see all these people rushing to some expensive city, first class, expenses paid. Treatment 2.0 does involve a lot of technology, but not the sort that reduces costs or carbon emissions or anything like that.
According to PlusNews, one of the five priorities at the conference is 'universal' access to HIV drugs. This, despite what you might expect, involves putting 80% of people who need drugs on ART (antiretroviral therapy). The target was to achieve this by the end of 2010 but this will not be met by most countries. Even the target of putting everyone with a CD4 count (a measure of immune strength) of 200, rather than the WHO recommended 350, will not be reached.
Another technological approach is called 'treatment as prevention', the idea that people who are responding to HIV treatment will be less infectious and so will not be likely to transmit HIV. In ideal conditions, this works well. However, with so many countries still a long way from their targets, it is unlikely to have much impact in high HIV prevalence countries. In most of these countries, a substantial percentage of HIV positive people don't even know their status, so they will not be on ART. Treatment as prevention has been talked up for nearly two years now but no one has dared to admit that it is an ideal and will always remain an ideal. Even the jokers who came up with the 'no sex month' idea don't believe it.
Even nuttier than that is an approach called pre-exposure prophylaxis (PrEP). This involves putting those 'most at risk' of being infected with HIV on ART. If we had any idea who was most at risk we could have prevented a lot of infections by now. But we have been pretty unsuccessful in predicting who was most at risk in the past. And recent Modes of Transmission Surveys have shown that many of the people who are becoming infected are not in at risk groups. In fact, one of the characteristics of high HIV prevalence countries is that many of the people most likely to become infected are at low risk, according to official definitions! Figure that one out.
So there are a lot of technologies available but they are either not being used or they are not proving too effective in the field. It is difficult enough to persuade people to get tested for HIV once, let alone once a year for the rest of the time they are sexually active. Many who are HIV positive are either not taking the drugs, not taking the drugs properly or do not have access to the drugs or some other aspect of treatment (shocking, but no, you can't just hand out pills). Perhaps a lot of people are on treatment, but many of them will, eventually, develop resistance and need to go on to a far more expensive 'second line' drug. Technology is not simple, but conditions in developing countries are basic.
So what are the problems, if all this money has been spent for so long? Well countries need infrastructure, especially health infrastructures. They need education, especially health education. They need adequate levels of nutrition and food security. They need clean water and sanitation and many other goods that are considered to be human rights. You cannot roll out a high tech treatment or prevention program without countries having some level of development. It may seem possible to the HIV industry, donors or the public. But not only is it not possible, we've spent years demonstrating the impossibility.
In addition to these technical problems and the problems relating to our relative lack of understanding about exactly how HIV spreads, there is another problem, which is harder to characterize. This is the problem of the HIV industry's refusal to accept that we cannot explain high prevalence, generalized epidemics (where the majority of those infected are not members of high risk groups, such as intravenous drug users, men who have sex with men or sex workers) by almost exclusive reference to heterosexual sex. If you refuse to accept the racist, sexist explanations of HIV transmission in African countries being due to the fact that Africans have lots of unsafe sex, you will also refuse to accept that HIV prevention programs that target sexual behaviour, and nothing else, will reduce transmission to the extent that HIV will eventually be eradicated. I don't see what there is to celebrate.
(For further discussion of PrEP, see my other blog, pre-exposureprophylaxis.blogspot.com)
Thursday, July 15, 2010
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.
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.
Wednesday, July 14, 2010
Two Point Zero Means We Haven't A Clue
A prominent UNAIDS spokesperson said "We haven't a clue what to do, really, we have never known. But we have noticed that putting '2.0' after anything will get you mentioned in all the press. And it's true, it works! We haven't had any ideas since we were established but we keep on repackaging tired old ideas that didn't work and the press tell the world what a great job we're all doing".
Sadly, a UNAIDS spokesperson didn't say that or anything else that could be verified. Such top-heavy, high spending bureaucrats with well padded buttocks are not known for making verifiable statements. But they do churn out a lot of photographs and colored diagrams. Their website, which was reasonably easy to find things on before, has succumbed to a late 1990s style splash page and underneath that, another splash page. Where they have put all their content has yet to become clear. Perhaps it's part of their 'treatment 2.0' effort. But some would say, quite cynically in my opinion, that this is no loss.
I was supposed to work for an organization that turned out to be siphoning off money from donors and using it for other purposes, nothing to do with development. But they had a real knack for finding people who would turn the right knobs when potential donors visited. If they were return donors, the same people could push all the right buttons to convince the donors that their money had been well spent and they would be wise to spend more. I think UNAIDS are similar. They have realised that one thing was missing from their attempts to break down in tears at every opportunity and beg for the massive amounts of money going to HIV treatment not to be cut.
They have realised that telling everyone that there are more people becoming newly infected with HIV than being put on treatment was not a good tactic, perhaps because it was too embarrassingly true. Even some of the more foolish people involved were able to think their way through the wet paper bag and see that this would mean the epidemic would just continue to expand. So now they are manufacturing figures to convince us that the childish 'prevention' programs they have wasted so much time on have worked, that you can just wave a magic wand and get people to do what you want and stop doing what you don't want.
On the surface, it looks like things have improved in Kenya a bit since 2000 and somewhat less so between 2003 and 2008. But the year 2000 was just after HIV prevalence peaked and started to drop. It dropped more quickly as death rates increased. Death rates probably peaked around 2003 or 2004 and HIV prevalence has changed little since then. It is claimed that hundreds of thousands of people are now on treatment so prevalence could be expected to have gone up as a result. But it doesn't seem to have done so yet. In fact, death rates are still quite high in Kenya. A few figures have improved between 2003 and 2008, people know the right answers to questions by now, but it is likely that HIV transmission is high enough to keep the epidemic going for some time to come.
If you buy the HIV industry's standard excuse (perhaps there's even an ISO number for it), that HIV is mostly caused by heterosexual sex, then you could easily find the figures seductive. More people now say they are having their first sexual experience later, they are having few partners, they use condoms more often, etc, etc. The behavioral paradigm holds that people (in African countries) have too much unsafe sex and all you have to do is persuade them to have less and HIV transmission will go down. The trend for 'safe' sex indicators has been going up since before HIV was ever heard of so, jumping on that bandwaggon, you could conclude that slight drops in HIV transmission have been a result of 'behavior change'.
If sexual behavior has changed significantly it is possible that some people are less likely to become infected with HIV. It all depends on things like whether they are male or female, urban dwelling or rural dwelling, of childbearing age, married or widowed and various other things. Females and urban dwellers are more likely to be infected. But far more people live in rural areas and out of the 1.5 million HIV positive Kenyans, about one million of them are rural dwellers. Also, the ratio of urban to rural infections is changing, with the percentage of rural infections rising. And while there are more women than men infected, that ratio is also changing. The percentage of men infected is catching up.
I have never seen any clear evidence that you can expect whole populations to say 'Oh, very well, then' when some foreign bureaucrats say 'Ok, you're having too much unsafe sex. Abstain, be faithful and use condoms.' People are more likely to say 'Butt out' or even 'What?'. But even if these 'prevention' efforts have had any effect, HIV is not just transmitted sexually. This is not news, it has been realized since HIV was first identified as the virus that causes Aids. It's just that, somehow, the HIV industry that subsequently developed didn't see non-sexual HIV transmission as worthy of their attention. Perhaps it's not 'treatment 2.0' enough.
So the articles about UNAIDS' non-new new approach are all over the place, bureaucrat-speak for 'We've really screwed up, but hey, that's our job, right?'. UNAIDS need to get clear about where HIV is coming from, who is transmitting it, in which areas and exactly how it is being transmitted. They have got by on 'modeled' figures for too long, figures that depend on too many unwarranted assumptions. Many people have been warning for years now that the behavioral paradigm is a piece of racist, sexist clap trap. They have written articles and books demonstrating how deceitful and misleading it is but UNAIDS and the entire HIV industry still takes this flat-earthist line.
The trouble is that when you set up a cabalistic peer-review system it eventually starts to poke up its own ass. All the 'experts' get together to scratch each other's backs, a sort of mutual delousing, and they agree that their articles are very worthy and must be published at once. Anyone from outside the cabal is ignored. There are millions of people being infected with HIV every year and after 25 years of research, all we can come up with is the same regurgitated nonsense in a new package? Why does UNAIDS still exist, after falling stillborn from the prolific UN? Is this is all they can come up with? People in developing countries, both HIV positive and HIV negative, deserve a lot better.
Sadly, a UNAIDS spokesperson didn't say that or anything else that could be verified. Such top-heavy, high spending bureaucrats with well padded buttocks are not known for making verifiable statements. But they do churn out a lot of photographs and colored diagrams. Their website, which was reasonably easy to find things on before, has succumbed to a late 1990s style splash page and underneath that, another splash page. Where they have put all their content has yet to become clear. Perhaps it's part of their 'treatment 2.0' effort. But some would say, quite cynically in my opinion, that this is no loss.
I was supposed to work for an organization that turned out to be siphoning off money from donors and using it for other purposes, nothing to do with development. But they had a real knack for finding people who would turn the right knobs when potential donors visited. If they were return donors, the same people could push all the right buttons to convince the donors that their money had been well spent and they would be wise to spend more. I think UNAIDS are similar. They have realised that one thing was missing from their attempts to break down in tears at every opportunity and beg for the massive amounts of money going to HIV treatment not to be cut.
They have realised that telling everyone that there are more people becoming newly infected with HIV than being put on treatment was not a good tactic, perhaps because it was too embarrassingly true. Even some of the more foolish people involved were able to think their way through the wet paper bag and see that this would mean the epidemic would just continue to expand. So now they are manufacturing figures to convince us that the childish 'prevention' programs they have wasted so much time on have worked, that you can just wave a magic wand and get people to do what you want and stop doing what you don't want.
On the surface, it looks like things have improved in Kenya a bit since 2000 and somewhat less so between 2003 and 2008. But the year 2000 was just after HIV prevalence peaked and started to drop. It dropped more quickly as death rates increased. Death rates probably peaked around 2003 or 2004 and HIV prevalence has changed little since then. It is claimed that hundreds of thousands of people are now on treatment so prevalence could be expected to have gone up as a result. But it doesn't seem to have done so yet. In fact, death rates are still quite high in Kenya. A few figures have improved between 2003 and 2008, people know the right answers to questions by now, but it is likely that HIV transmission is high enough to keep the epidemic going for some time to come.
If you buy the HIV industry's standard excuse (perhaps there's even an ISO number for it), that HIV is mostly caused by heterosexual sex, then you could easily find the figures seductive. More people now say they are having their first sexual experience later, they are having few partners, they use condoms more often, etc, etc. The behavioral paradigm holds that people (in African countries) have too much unsafe sex and all you have to do is persuade them to have less and HIV transmission will go down. The trend for 'safe' sex indicators has been going up since before HIV was ever heard of so, jumping on that bandwaggon, you could conclude that slight drops in HIV transmission have been a result of 'behavior change'.
If sexual behavior has changed significantly it is possible that some people are less likely to become infected with HIV. It all depends on things like whether they are male or female, urban dwelling or rural dwelling, of childbearing age, married or widowed and various other things. Females and urban dwellers are more likely to be infected. But far more people live in rural areas and out of the 1.5 million HIV positive Kenyans, about one million of them are rural dwellers. Also, the ratio of urban to rural infections is changing, with the percentage of rural infections rising. And while there are more women than men infected, that ratio is also changing. The percentage of men infected is catching up.
I have never seen any clear evidence that you can expect whole populations to say 'Oh, very well, then' when some foreign bureaucrats say 'Ok, you're having too much unsafe sex. Abstain, be faithful and use condoms.' People are more likely to say 'Butt out' or even 'What?'. But even if these 'prevention' efforts have had any effect, HIV is not just transmitted sexually. This is not news, it has been realized since HIV was first identified as the virus that causes Aids. It's just that, somehow, the HIV industry that subsequently developed didn't see non-sexual HIV transmission as worthy of their attention. Perhaps it's not 'treatment 2.0' enough.
So the articles about UNAIDS' non-new new approach are all over the place, bureaucrat-speak for 'We've really screwed up, but hey, that's our job, right?'. UNAIDS need to get clear about where HIV is coming from, who is transmitting it, in which areas and exactly how it is being transmitted. They have got by on 'modeled' figures for too long, figures that depend on too many unwarranted assumptions. Many people have been warning for years now that the behavioral paradigm is a piece of racist, sexist clap trap. They have written articles and books demonstrating how deceitful and misleading it is but UNAIDS and the entire HIV industry still takes this flat-earthist line.
The trouble is that when you set up a cabalistic peer-review system it eventually starts to poke up its own ass. All the 'experts' get together to scratch each other's backs, a sort of mutual delousing, and they agree that their articles are very worthy and must be published at once. Anyone from outside the cabal is ignored. There are millions of people being infected with HIV every year and after 25 years of research, all we can come up with is the same regurgitated nonsense in a new package? Why does UNAIDS still exist, after falling stillborn from the prolific UN? Is this is all they can come up with? People in developing countries, both HIV positive and HIV negative, deserve a lot better.
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