Bloodborne HIV: Don't Get Stuck!

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Living forward – understanding and stopping Africa’s HIV disasters

“And now these three remain: faith, hope and love. But the greatest of these is love.”

Bible, New International Version, 1 Corinthians 13: 13

Introduction: understanding more important than justice

In this blog, I apply 1 Corinthians 13: 13 to Africa’s unnecessary HIV disasters – unnecessary because they have been driven for decades by easily avoidable blood exposures during health care, not by sex (a minor contributor).

Note the verse says nothing about justice. In the case of Africa’s HIV epidemics, going for justice can be an obstacle to seeing and fixing what went wrong. Going for justice motivates people to hide mistakes, not only from others but also from themselves – not recognizing what they have done and/or inventing excuses to avoid self-judgment. (Personal note: Considering what I’ve done over 75 years, I’d rather have mercy than justice anytime.)

Instead of going for justice, let’s have hope and faith that people will see and fix errors. Love looks forward – wanting people to be healthy in body and spirit. Justice looks backward.

I say this to introduce a fairly simple issue: Explaining what went wrong to cause Africa’s HIV epidemics. It’s not possible to explain what went wrong without saying people made mistakes – in effect, blaming them for causing Africa’s disasters. But my blaming here is intended simply to explain what happened, and does not ask for justice.

Thumbnail sketch of errors that cause Africa’s HIV epidemics

The crucial error that allowed Africa’s HIV disasters was not warning people about HIV from bloodborne risks. For the sake of understanding how that error led to Africa’s HIV epidemics, it’s useful to consider several groups:

  • The source of misinformation: Beginning in the mid-1980s experts in WHO and in African and foreign governments and universities who were trained to understand disease transmission and charged to explain Africa’s HIV epidemics betrayed their training and ethical responsibility. Instead of explaining Africa’s epidemics, they promoted a specific and deadly double standard: Assuring Africans their health care was safe enough for them, but warning foreigners to avoid skin-piercing procedures in Africa. Continuing this double standard for more than 35 years, public health experts leading the international response to Africa’s HIV epidemics have neither warned Africans about risks to get HIV from medical procedures, nor done what is necessary to find and stop bloodborne transmission.
  • Infecting patients: Following bad expert advice, thousands of front-line health staff in Africa unknowingly infected patients through procedures they thought were safe, but were not. Some surely recognized infections best explained by unsafe health care, but did not push for investigations to find their source, accepting experts’ assurances that such infections were rare.
  • Spreading misinformation and stigma: Following and believing bad expert advice, millions of teachers, reporters, NGO staff  and others disseminated misinformation – encouraging people to trust unsafe heath care and stigmatizing HIV-positive youth and adults for imagined sexual misbehavior.
  • Parallel human rights failure: Beginning in the 1980s, human rights experts and organizations accepted the above double standard (health care safe enough for Africans, but not foreigners) as well as HIV-related research that violated established ethical guidelines. Human rights experts should have called out bad advice that killed Africans, but they didn’t.

How understanding what happened can help stop Africa’s HIV epidemics

The way to stop bloodborne HIV transmission is simple and proven: Investigate unexplained infections. As has happened elsewhere, investigations that uncover outbreaks with hundreds to thousands of people with HIV from medical procedures will motivate everyone – including the general public – to do whatever is required to stop bloodborne transmission. That stops Africa’s HIV disasters.

Across sub-Saharan Africa, HIV testing year-by-year exposes unexplained infections in people with no sexual or mother-to-child risks. No doubt  many people who have or know of such infections have talked with friends and neighbors, getting information about other local unexplained infections and considering which clinics or other facilities might have infected them through skin-piercing procedures.

In communities outside sub-Saharan Africa – in Libya, Cambodia, Pakistan, and elsewhere – such informal investigations have gotten into the press and pushed  governments to help with expanded investigations. Building on local informal investigations, governments organized widespread testing, finding more victims and thereby tracing HIV transmission to specific medical facilities and procedures. So far that has not happened in sub-Sahara Africa.

Understanding is important from the bottom up: The more people in the general public are aware of the lies they have been fed – that bloodborne risks infect few Africans – the more likely it will be that they will press reluctant governments to investigate. As people in one community after another ask African governments to help with expanded investigations, and as governments investigate, the truth will overcome experts’ decades of misinformation.

What to do about those who made errors?

Errors caused deaths and sorrows. As of 2022, Africa’s HIV epidemics killed more than 20 million from the time HIV was recognize in the 1980s (see UNAIDS estimates for 1990-2021; warning Africans about bloodborne risks from the mid-1980s could have prevented most of these deaths from bloodborne as well as follow-on sexual and mother-to-child transmission). Tens of millions more are living with infections. Numbers compare with some of the worst wars in history. The human experiences are hard to imagine even person-by-person, much less the scope of the disaster.

Even so: I don’t advocate justice. It wouldn’t bring victims back to life or restore them to health. Most importantly: Going for justice obstructs understanding what went wrong, and thereby blocks finding and fixing errors at all levels – by health bureaucrats, scientists, front-line health staff, and others.

The “ring-leaders” of the misinformation that caused Africa’s HIV epidemics are, as noted above, influential health experts in universities and government organizations. My blaming them for that is not intended to lead to justice. Not going to happen. But understanding who did what might reduce trust and respect for people who  should have known and done better. There are future health policy issues to consider – is it good for health in and out of Africa to trust such people to guide future policies?

With bad information from influential experts, many  people got caught up in the disaster. For example, many front line health staff unknowingly infected patients. It is not possible to find all who did so. Uncertainty is unavoidable. Nevertheless, health staff who understand what happened will be motivated to be more careful in the future, and will save lives with their skills. Self-forgiveness can help them recover and continue to deliver (safe) health care.

As for all others who spread misinformation – they have to learn new stories. It’s been too easy for too many people to fall into moralistic or racist explanations. Lots to do, lots to change.

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