Bloodborne HIV: Don't Get Stuck!

In the early 1980s, AIDS was first recognized among men-who-have-sex with men (MSM) and injection drug users (IDU) in the United States (US). Because hepatitis B was common in both groups but rare in the US general population, it was apparent almost immediately that whatever caused AIDS threatened groups at high risk for hepatitis B. That included the general population in Africa, where 70%-90% of adults had current or resolved hepatitis B infection.[1]

The first studies using HIV tests in Africa in the mid-1980s found that Africans were getting HIV from blood exposures and sex. Experts debated how much came from each risk, but what they did not do is give Africans the information they needed to address either one of them. Instead, experts bombarded them with misinformation, telling them almost all adults’ infections came from sex, a fabrication inconsistent with evidence.

Not warning Africans about HIV from health care

WHO assured Africans their health care was safe, even though WHO and donor governments warned staff to avoid health care in Africa. In Mexico, Russia, Romania, and India in the late 1980s government investigations of unexplained infections not only found and stopped large outbreaks from medical procedures but also warned – educated – the public  to beware blood-borne risks. But no government in sub-Sahara Africa similarly investigated any unexplained infection, and no international organization or donor recommended investigations in Africa.[2]

Not letting Africans see who was infected so they could avoid sex risks

WHO, donors, and governments did not make HIV tests easily available. Across most of Africa, HIV tests were difficult to get until some years after 2000. This was deliberate: WHO tied tests to counseling and urged caution rather than action[3]: “National AIDS programmes that decide to develop voluntary testing and counselling services where none now exist should proceed cautiously by initiating and evaluating a trial project.” WHO staff opposed access to home-based tests, denying (despite evidence) that testing had a role to play in preventing heterosexual transmission.[4]

Hence, few people knew if they or their sex partners were infected. Not until 2012, 25 years after low cost rapid tests were developed, did WHO recommend couple counseling to allow people to see their sex risks.[5] In 2016, four years later, WHO recommended home-based self-testing kits (which had been available from the 1990s) and helping HIV-positive adults inform and warn their sex partners.[6]

Lying about HIV sexual transmission

Since WHO and donors did not want to admit HIV from health care, they had no choice but to blame sex. Not later than 1988, WHO and donors invented and spread the lie that almost all adults’ infections in Africa came from sex. Yes, sex was a risk; but the claim that almost all adults’ infections came from sex was contradicted by evidence available at the time.[7] But it was a useful lie, distracting attention from infected children with HIV-negative mothers, infected virgins, and infected teens and adults with one HIV-negative lifetime sex partner. Moreover, blaming sex was useful in another way: The lie silenced people who had gotten HIV from health care by threatening them with disbelief and suspicions of sexual misbehavior if they talked about their infections. Blaming sex became an industry that was bad for Africans’ health but made a lot of money for donor, government, and NGO health staff. It is a testament to families in Africa that most husbands and wives trusted each other and stayed together in the face of experts’ lies about sexual transmission.

Bad policies allowed AIDS disasters

These bad policies have harmed millions. As of 2021, the percent of adults HIV-positive (adult HIV prevalence) ranged from 2.3% to 27.9% in 17 countries in sub-Sahara Africa, whereas outside sub-Sahara Africa, only 0.3% of adults were infected, and no country had as many as 2% of adults HIV-positive. Outcomes have been even worse for women: across sub-Sahara Africa 1.7 women are HIV-positive for every infected man (UNAIDS’ 2021 estimates: 15.2 to 8.9 million infections), whereas outside the region, 1.8 men were infected for every woman (8.1 to 4.5 million).[8]

References

1. Kiire CF. The epidemiology and prophylaxis of hepatitis B in sub-Saharan Africa: a view from tropical and subtropical Africa. Gut 1996; 38: S5-S12. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1398049/pdf/gut00509-0010.pdf (accessed 19 May 2023).

2. Gisselquist D. Stopping Bloodborne HIV: investigating unexplained infections. London: Adonis & Abbey, 2021. Available at: https://sites.google.com/site/davidgisselquist/stoppingbloodbornehiv   (accessed 29 December 2022).

3. Global Programme on AIDS. Statement from the consultation on HIV testing and counselling for HIV infection, Geneva 16-18 November 1992. Geneva: WHO, 1993. Available at: https://apps.who.int/iris/handle/10665/58905 (accessed 23 May 2023).

4. Mertens TE, Smith GD, Van Praag E. Home testing for HIV. Lancet 1994; 343: 1293. Available with pay-wall at: https://www.thelancet.com/journals/lancet/issue/vol343no8908/PIIS0140-6736(00)X8037-3 (accessed 23 May 2023).

5. WHO. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serdiscordant couples. Geneva: WHO, 2012. Available at: https://apps.who.int/iris/handle/10665/44646 (accessed 19 May 2023).

6. WHO. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. Geneva: WHO, 2016. Available at: https://apps.who.int/iris/handle/10665/251655 (accessed 22 May 2023).

7.  Gisselquist D, Potterat JJ, Brody S, Vachon F. Let it be sexual: how health care transmission of AIDS in Africa was ignored. Int J STD AIDS 2003; 14: 148-161. Available at: https://www.cirp.org/library/disease/HIV/gisselquist1/gisselquist1.pdf (accessed 23 May 2023).

8. UNAIDS. HIV estimates with uncertainty bounds 1990-2021. Geneva: UNAIDS, 2022. Available at: https://www.unaids.org/en/resources/documents/2022/HIV_estimates_with_uncertainty_bounds_1990-present (accessed 12 May 2023).