Bloodborne HIV: Don't Get Stuck!

Protect yourself from bloodborne HIV during healthcare and cosmetic services

Tanzania and Covid-19: Some Accidental Truths?


A British journalist based in Tanzania claims in The Spectator that the WHO is ‘concerned’ about the government’s lack of transparency during the Covid-19 pandemic. Writing under the pen name ‘Tom James’, the journalist gives the impression that there is an extremely serious Covid-19 outbreak in the country, one that the government is refusing to address.

However, the story is undermined by the journalist’s description of how things are in Dar es Salaam, the country’s biggest city, during this outbreak. For a start, he admits that there is little or no evidence for any deepening crisis, but he continues to write as if the absence of evidence means things must be worse than the government says.

The journalist could return to Britain, although he chooses not to do so (because he wants to look after his dogs). But clearly, things are not so bad that he must leave; he’s got a job and a home; he has a car that he is still able to run, so no fuel shortages; he can go to the market to buy supplies, so no panic buying, hoarding or sudden spikes in prices of staples.

It sounds, if the journalist is to be believed, as if everyone there is just getting on with it. We get a description of normal, everyday life in Tanzania: the police are patrolling the highways, fining people for anything and nothing; a motorbike taxi with three passengers is on the road; only the driver has a mask, but no helmet; again, nothing unusual. What, I’d like to know, would ‘Tom James’ prefer?

The English Guardian claims that Tanzania’s president is undercounting cases and deaths. But the US is overcounting, something the Guardian seems oblivious of; so is the UK, and they are collecting records that cannot be reanalyzed, should anyone ever wish to know the true numbers of cases, deaths and excess deaths.

If President Magufuli is ‘playing down’ the threat of Covid-19, the US and the UK are talking it up (Norway is considering the possibility that their own lockdown was unnecessary).

The media frequently uses the word ‘authoritarian’ when referring to the Tanzanian president. So, what if Magufuli did impose a lockdown? Wouldn’t that be even more authoritarian than not doing so? In most African countries, people can’t just stop working, self-isolate at home, work from home, get their food delivered or hop in their car, unlike the more fortunate ‘Tom James’.

I doubt if he and others criticizing Magufuli would like to see Tanzania follow the example set by Kenya. Human Rights Watch describes a country completely unprepared to ‘isolate’ thousands of possible Covid-19 cases, as unprepared as all poor countries are.

In Kenya, people have been rounded up and held with numerous other people who may or may not have the virus. Even in the UK one doctor writes: “many patients acquired the infection while already hospitalised for other causes“. Infection control in East African hospitals is not great; how much worse will it be in these temporary holding facilities in Kenya?

Kenya imposed a curfew early on in the pandemic and police have been beating people who break the curfew. But, as the Human Rights Watch article shows, conditions in the country don’t allow everyone to drop their normal routines and get home before 7. People can’t easily ‘socially distance’ in overcrowded slums, cramped public transport and other overstretched services.

An article in African Arguments describes just how authoritarian, and how destructive, the lockdown is in Kenya (although the same publication in April called for a lockdown in Tanzania).

Al Jazeera point out that opposition leaders in Tanzania accuse the government of lying about Covid-19 and of failing to address the crisis. But what country’s opposition doesn’t accuse their government of lying and of making unwise decisions? It’s an election year, and Magufuli wants to win, as does the opposition, and these phenomena are not peculiar to Tanzania, nor even to African countries.

Usually the first to shout ‘fire’ in a crowded building (and they have done plenty of shouting about Covid-19 in Tanzania), the BBC has a short piece entitled “Tanzanian doctors ‘not overwhelmed by pandemic‘.” (You need to page down a long way to find it. It’s worth noting that the BBC’s content about Tanzania seems to depend heavily on contributions from the public, social media and other questionable sources.)

One of the worst things that can happen to poor countries during a pandemic is that people panic, as it can bring about the very conditions that will only deepen the crisis. ‘Tom James’ appears to want someone to shout ‘fire’, although he doesn’t quite do it himself. But, however inadvertently, his article suggests that no one in Tanzania is listening to him or his media colleagues. Let’s hope that continues.

Coronavirus Lockdown: Atlas Drugged


The New Humanitarian (formerly the UN’s IRIN) cites a US Embassy Tanzania statement about Covid-19 (C19): “Despite limited official reports, all evidence points to exponential growth of the epidemic in Dar and other locations in Tanzania.”

Think about the first clause, and how it relates to the second, and you may get more than a hint of contradiction. There is no evidence whatsoever pointing to exponential growth of C19 in Dar, Tanzania, East Africa or anywhere else on the continent.

The authors depend on a handful of anonymous ‘doctors’, and on Twitter, to pad out their article. They allude to ‘secret burials’, something we heard about during earlier outbreaks of media scaremongering, such as the 2014 Ebola epidemic in West Africa.

One source says they don’t have enough PPE, another says they do. One says that people are not going to hospitals, which is nothing new. Nor is it even unambiguously worrying; it has long been recognized that hospitals in outbreak areas are among the most likely places to be exposed to Ebola, for example.

Another source says there is no free flow of information, and that’s preventing people from making informed choices. Major international healthcare programs have been run in Tanzania and other developing countries, with little international concern about the issues of free flow of information or informed choices!

Haven’t The New Humanitarians heard of mass male circumcision, injectable Depoprovera, healthcare associated outbreaks of HIV and hepatitis C? Have they ever read any healthcare Service Provision Assessments for African countries, showing how often running water and other hygiene facilities are absent?

The majority of people in poor countries can’t stay at home, work from home or even distance themselves from other people, especially in cities. That’s the way developing countries are. If Magufuli advised people to do any of these things, there would be a lot more confusion than there is now.

Some genuine insights into C19 have been made by Michael Fumento, who has written about many of the major outbreaks, epidemics and pandemics over the last several decades. His recent article entitled ‘The Swedish alternative: Coping with a virus while preserving livelihoods and liberties’ is a good start.

Tanzania and Sweden probably have little in common, but the mainstream media can’t condemn Sweden loudly enough, even though they have full access to data and information; perhaps The New Humanitarian and others can wait until they have access to data and information before publishing sensationalist articles based on gossip and innuendo?

The New Humanitarian article admits: “Amid the swirl of rumours and the absence of reliable news, many businesses have closed their doors. But there is public support for the government’s position not to issue a stay-at-home order.”

An article from Tanzania about Magufuli allows him to explain what he is doing, without comment. Some might say the media in Tanzania have to be careful what they publish. However, media here in the UK has chosen to be especially careful, and none of the more liberal press, particularly The Guardian and the BBC, would dare to deviate from a narrow set of approved mantras.

Some of the conservative media, such as The Telegraph and The Spectator, have taken a more enlightened stance, advising that vulnerable people be protected from C19 and other conditions, but without closing down the entire economy and scaring the shit out of everyone.

Now is not the time for The New Humanitarian to echo and manufacture ‘news’. Tanzania has refused to give in to the international press, institutions and others who have been ‘advising’ them for decades. So let’s wait and see who is right, and not try to bring about the kind of panic and subsequent damage we purport to warn about.

Tanzania’s Magufuli and Covid-19: Justifiably Cautious?


In an article on what Ben Taylor calls ‘Tanzania’s Gamble’, he states that: “We no longer have any reliable estimates of the number of cases or deaths from COVID-19.” True, Tanzania has not carried out many tests. But President Magufuli has asked pertinent questions about how useful the tests are.

Despite carrying out tens of thousands of tests a day, the UK is in a very similar position to Tanzania. This is because they record many deaths that may not be from Covid-19 as if they resulted from the virus, and there is no way of analyzing the figures to work out what proportion is accurate.

In the US, one source has said that the number of deaths ‘from’ Covid-19, as opposed to the number of deaths of people ‘with’ Covid-19 is vanishingly small, probably less than 10%. Presumably we can apply the same comment to recorded cases (link to embedded video: https://tinyurl.com/y83vtm3w).

Some quick comparisons: globally, nearly a million people die of malaria every year. 1.5 million people die of TB. Nearly 800,000 die of HIV, despite enormous sums of donor funding being poured into this single disease. There are no vaccines for any of these diseases, or for most of the big killers, although many are preventable.

Taylor complains of politicization of statistics and media in Tanzania. He writes: “Controlling the narrative means silencing facts that contradict the official line.” Taylor believes that statistics about Covid-19 are no exception. No doubt, Taylor is right.

But the shocking thing in the UK is how few people seem to be questioning the lockdown, the use of figures from a model that has always been wide of the mark in the past, the censorship of social media and the provision of ‘official’ and ‘approved’ versions.

Magufuli is not wrong in claiming that ‘international’ media have often created sensationalist stories about Tanzania and other African countries. Many of these are offensive, demeaning and racist, but you don’t hear the likes of Taylor questioning ‘international’ media, and calling out the lies.

Fear-mongering is not exclusive to African leaders or media. Many of the current lockdowns in the UK, US and elsewhere are based on making people feel afraid to go about their normal day to day lives; they are made to feel ashamed if they have the temerity to ‘contravene’ government guidelines in the slightest way.

According to Taylor, Magufuli has “emphasised the importance of working hard, keeping the economy going strong, and maintaining a healthy supply of food and other goods.” He finishes with a couple of facile comparisons with the 1918 ‘Spanish’ flu epidemic, and the Maji Maji Rebellion in 1905.

Perhaps Magufuli’s critical stance towards Covid-19 would be more constructively contrasted with his far less critical stance towards HIV. 1.6m Tanzanians are living with HIV, 24,000 people died from HIV in 2018 and there were 72,000 new infections.

If the president had said what the WHO and UNAIDS have known for several decades, that crumbling and unsafe healthcare infrastructures are probably responsible for more HIV infections than heterosexual sex, they could have started reversing this trend long ago.

Magufuli went along with other high HIV prevalence countries, took the considerable amounts of money offered, and allowed the epidemic to continue, although incidence has been dropping slowly since the 1990s.

Magufuli is no public health expert, and I don’t think he claims otherwise. But the ongoing response of many countries to Covid-19 is not a viable option, and it’s good to hear that a (very) few countries are saying so. I hope the president does ask for help, given Tanzania’s lack of healthcare capacity and poor health infrastructure.

But Tanzania would be a lot better off turning to Cuba, for example, a country that did a much better job with HIV and healthcare in general in their own country, Ebola in West Africa, and in training people in many other developing countries that lacked trained healthcare professionals (including Tanzania).

There are plenty of issues Taylor could have looked at before wagging yet another neo-imperialist finger at Magufuli, but here’s just one: with an estimated 800 million people affected by hunger every year, globally, and over 9 million people dying of starvation, closing down any of the fragile African economies is not a viable option.

Hyperendemic HIV: a WASP factor?


A few weeks ago, I noted that the bulk of HIV infections in sub-Saharan African countries occur in former British colonies, accounting for 72% of people living with HIV and Aids (PLHA). Extending this study to include countries outside of the African continent, the picture is only a little different.

More than two thirds (69%) of PLHA globally live in countries that were either colonized by the British or were heavily influenced by them. India, Brazil, United States, Bahamas, Indonesia and Thailand are the only non-African countries that appear in the top 20, with India and United States being former British colonies.

Similarly, 11 of the top 20 countries for HIV prevalence are former British colonies; the number goes up to 12 if you include Namibia, whose history, politics, administration, infrastructure, etc, have arguably been more shaped by British than by German or South African influences.

Several figures that were not used in the previous post have now been tabulated. Almost two thirds (65%) of annual new HIV infections occur in countries with these overlapping histories. Out of the top 20 countries for new HIV infections per 1000 uninfected people, 12 of them fall into this category.

Although I have not prepared the figures for morbidity by religion, the figures presented show that many of the countries with a predominantly non-Catholic Christian population are also most affected by HIV. In contrast, many of the countries with a predominantly Catholic population (for example, former French, Belgian and Spanish colonies) are less affected by HIV.

Mozambique, alone, stands out as the only one in the top 10 countries by prevalence which was not colonized or strongly influenced by British colonialism. Catholicism is also the biggest religion there, at nearly 30% of the population.

Another figure not included in the previous blog on this subject is for HIV deaths. Just under two thirds of annual deaths (64%) are accounted for by countries previously colonized or heavily influenced by the British.

The table below summarizes the above findings. The top 20 countries account for 81% of new HIV infections, globally, and also 81% of PLHA globally.

The thrust of this site is that HIV epidemics, especially in some sub-Saharan Africa countries, are likely to be driven more by unsafe healthcare and other bloodborne modes of transmission, and less by the ‘unsafe’ sexual behaviour that big HIV institutions would have us believe.

The above data makes no attempt to suggest that there is such thing as ‘WASP-influenced’ sexual behaviour; the received view that 80-90% of HIV transmission is a result of sexual behaviour, but only in the most affected countries, is not founded on evidence.

But the data may show that there is something about certain healthcare infrastructures and/or healthcare administrative structures that explains why the bulk of HIV morbidity and mortality, globally, occurs in countries formerly colonized by the British, or heavily influenced by the British.

The aim of HIV research and analysis should be to prevent further transmission of the virus, not to point the finger at who or what is driving epidemics. But as long as UNAIDS and other HIV focused institutions choose to blame the victims and point the finger at their ‘unsafe’ sexual behaviour, BloodborneHIV.com will continue to search for patterns that emerge from those same institutions’ data.

HIV Risks: Greed and Officialdom


It’s refreshing to experience a work of drama that describes a HIV outbreak which occurs in a healthcare setting, without a hint of the prurience that is so common in most accounts of the subjects of HIV and Aids. The play closes tomorrow in the Hampstead Theatre in London (review).

The King of Hell’s Palace tells the story of Dr Shuping Wang, who risked her life, and the safety of her family and friends, to raise awareness of exceptionally high rates of HIV transmission in Henan Province, China, in the 1990s. These were evidently a result of unsafe practices in plasma donation programs, which were a source of income for hundreds of thousands of people in the province.

Estimates of how many people were infected with HIV and hepatitis C through these programs vary, from 10s of thousands to hundreds of thousands, and it’s impossible to say how many were infected. It’s also likely that many of those infected by the plasma programs went on to infect others, directly and indirectly.

Dr Shuping Wang succeeded in closing down the plasma donation programs. Safety procedures were put in place before they were allowed to restart. An awful lot of damage was done, and those who were benefiting most from the programs were reluctant to see their source of income threatened. But the efforts of one person undoubtedly saved hundreds of thousands of people, perhaps millions.

Most people who watch movies will have seen movies that have been made about HIV and Aids. But the bulk of them are about HIV transmission among men who have sex with men. Some bring in injected drug use, and some include transmission among heterosexuals, especially where sex workers are involved.

However, most HIV positive people in the world are not sex workers, they are not men who have sex with men, they don’t inject drugs and most of them are certainly not white people from wealthy countries.

The majority of HIV positive people live in certain parts of certain sub-Saharan African countries. In other words, they are not distributed evenly among populations, as you might expect of a virus that is, according to the HIV industry, almost always transmitted via ‘unsafe’ sex.

Most people in all countries in the world, African countries included (surveys of sexual and other behaviors), do not engage in the very high levels of ‘unsafe’ sex that would be required to account for massive outbreaks that are found in countries such as South Africa, Botswana, Eswatini (Swaziland) and Lesotho.

Some people in all countries in the world do engage in high levels of ‘unsafe’ sex, but most do not. In fact, even among sex workers in wealthier countries, HIV prevalence is low unless they also have other risks, such as injecting drugs.

What you do find in African countries is unsafe healthcare, badly trained healthcare professionals, quacks and low skilled practitioners who pass themselves off as doctors, nurses and midwives, dispensaries that will give you anything if they can make money out of it, including injections of things you don’t need, and that may do more harm than good.

And yet there has never been a single investigation in sub-Saharan Africa of the kind that closed down the unsafe plasma programs in China in the 90s. There were investigations in Pakistan (still going on), Cambodia, Libya, Russia, Tajikistan and a number of other countries (list of countries which have and have not responded to outbreaks).

The Chinese administration officials in 1990s Henan Province are depicted as greedy, and as being unwilling to risk losing their job and reputation, even though they knew that Dr Suping Wang was right; they were infecting countless people with deadly pathogens just so they could cash in on the demand for plasma.

Similarly, there are officials in UNAIDS and other UN offices, such as the WHO, officials in the CDC, various country administrations in high HIV prevalence countries, academics all over the world and even journalists who see themselves as having a role in highlighting serious injustices; why are they not calling for investigations into outbreaks that affect more than half of young women in some towns in South Africa, Western Kenya, parts of Tanzania, Mozambique and Malawi?

There have been protests and movements demanding rights for men who have sex with men, transsexuals, and others in wealthy countries, where the majority of HIV positive people fall into those groups.

But where the majority of HIV positive people are black, and they are neither men who have sex with men nor injecting drug users (HIV positive females outnumber HIV positive males in high prevalence countries), there are no protests.

About 70% of HIV positive people live in sub-Saharan Africa and over 70% of HIV positive people in the region live in certain towns and cities in just a handful of countries: that’s where the investigations need to be carried out. Surely, no one’s interest is served by continuing to insist that HIV prevalence is high in a few places just because of ‘African’ sexual behaviour?

Can UK Tattoo Artists Guarantee the Safety of their Services?


Apparently some tattoo studios in the UK suggest that they can’t, because they have refused to allow HIV positive people to get tattoos. Legally, they are not allowed to ask their clients to reveal their HIV status. But if they are worried that tattoo artists themselves, or their HIV negative clients, risk being infected if they accept HIV positive clients, they must believe that the precautions they take to avoid transmitting pathogens are not adequate.

The Vice article linked to above mentions the possibility that people who don’t know they are HIV positive may choose to get tattoos or body piercing, which is important. But there are also risks of other serious pathogens, such as hepatitis C, being transmitted. The Vice article concentrates on HIV positive people being discriminated against; but a much more important issue is whether anyone’s safety is guaranteed when they get a tattoo, body piercing or any skin piercing procedure.

Tattoos and body piercing are not the only cosmetic procedures that carry risks of transmitting bloodborne pathogens. It is now possible to get injectable steroids, tanning products, botox and other things that are administered by skin piercing tools, such as syringes, needles, lances and the like. You can order these products online, to be sent to your home, and get them at certain clinics and service providers. So they could be administered by people with little training, or even none at all; people can self-administer them and/or administer them to friends.

Anything that pierces the skin can carry a risk. Sometimes the risk is small, but sharing injecting and other skin piercing equipment can carry a very high risk. Someone else’s blood should never come in contact with yours unless you’re getting a blood transfusion, and your blood should never come in contact with someone else’s.

These incidents outlined by Vice highlight that the complainants have been denied their right to confidentiality, and would be discriminated against for revealing that they are HIV positive. But it also highlights the fact that people providing any cosmetic services that may involve breaking the skin do not all have adequate knowledge about skin piercing and dangerous pathogens. These procedures could even include manicures, pedicures, shaving and hair-styling,

Vice reports one person working at a clinic as saying “Well, if someone has HIV we take extra precautions, especially if they have cuts or broken skin”. But tattooing, piercing, etc, involve cutting/breaking skin, by definition. The very reason they should be taking precautions is because what they do breaks skin!

People providing such services should already ensure that they do not reuse unsterilized instruments, including machinery, paints and anything else that may lead to transmission of a pathogen. No pathogen whatsoever from one client should come in contact with another client, or with the person providing the services.

If service providers do not already take these precautions they should be closed down, and all their clients should be checked for bloodborne pathogens. If they believe they need to, or even believe that can take additional precautions just because their client is HIV positive, they should not be not be providing those services.

HIV: A British Colonial Hangover?


Data Source: UNAIDS

Despite continued claims that the vast majority of cases of HIV transmission in sub-Saharan Africa are a result of heterosexual sex, no clear explanation has been given for the substantial heterogeneity at the national and subnational levels.

In other words, what is so different about sexual behaviour in Morocco, where HIV prevalence is less than 0.1%, and that in Eswatini (Swaziland), where it is 27.2%, 272 times higher?

As an example at the subnational level, what is so different about sexual behaviour in the Kenyan county of Wajir, where prevalence is less than 0.1% and the county of Siaya, where prevalence is 21.0%, over 200 times higher?

Petabytes of data have been collected about sexual behaviour all over the world. Everywhere, some people have a lot of sex, some people have little or none and the rest are somewhere in between. But few useful correlations between heterosexual behaviour and HIV transmission have been found, at national or sub-national levels.

At the national level, the majority of the highest prevalence countries, and the countries with the largest number of people living with HIV are former British colonies. Prevalence ranges from 0.1% (Egypt) to 27.2% (Eswatini), with a median of 6.5% (Uganda).

Data Source: UNAIDS

In contrast, the range in former non-British colonies is 0.1% (Algeria and Tunisia) to 12.4% (Namibia). The median is about 1.5%. A third of these countries have prevalence figures of 1% or below. Less than one third of people living with HIV live in former non-British colonies.

Data Source: UNAIDS

The copious quantities of sexual behavior data referred to above confirm that the British did not introduce a liberal or enlightened attitude towards sex, nor did they promulgate forms of ‘risky’ sexual behaviour not found in French or Belgian colonies. So there must be something unrelated to sex involved, right?

Although modes of HIV transmission have been identified, it seems likely that the contribution of non-sexual transmission via unsafe healthcare and other skin-piercing processes in sub-Saharan African countries has been seriously underestimated by UNAIDS and the other recipients of massive HIV funding.

Currently, people in sub-Saharan Africa receive incessant warnings about sexual risks, with non-sexual risks through unsafe healthcare and other skin-piercing processes dismissed as minor. And although risks of bloodborne infection, especially in healthcare facilities, were identified and addressed in wealthier countries from the 1980s, there have been many outbreaks in poorer countries later shown to be a result of unsafe healthcare.

There are examples of bloodborne HIV outbreaks that have been investigated and confirmed to have been a result of unsafe healthcare. One in Ratodero, Pakistan, is currently being investigated. There was a recent one in Roka Commune in Cambodia that was also investigated. Outbreaks in Romania, China and other countries received international press attention.

However, no bloodborne outbreaks in sub-Saharan Africa have been investigated. Instances that should have been seen as possible bloodborne outbreaks have been ignored. But lurking in the history of healthcare development and practices in Africa, both pre- and post-independence, may be a clue as to why HIV should be so prevalent in former British colonies.

Antimicrobial Resistance and PrEP: Medical Disasters


Here are two antimicrobial resistance (AMR) scenarios, one rapidly spiraling out of control, and the other (arguably) incipient:

The AMR scenario that is spiraling out of control is described in an article in The New York Times. The development of AMR is blamed on overuse and misuse of cheap antibiotics, usually without prescription. Ever-increasing use and misuse of antibiotics results in ever-increasing development of resistant strains of pathogens.

The NYT article describes the appalling conditions that an estimated one billion people live in; slums where waterborne, foodborne and airborne pathogens thrive. Unable to escape the risks, people try to treat the symptoms with antibiotics, inevitably leading to resistance to most or all available treatments.

The scenario described is a loop: widespread disease leads to overuse of antimicrobials; this leads to development of resistance; people with resistant conditions, if they survive, are taken to healthcare facilities, which also overuse antimicrobials, amplifying resistance and transmission of resistant strains; this loops back to the slum, resulting in an even higher disease burden, and greater levels of resistance.

The loop could be broken by: 1) improving the environment, including water, sanitation, habitation, food, etc and 2) improving conditions in healthcare facilities, infection control, safety, hygiene, etc. This will reduce antimicrobial use and, therefore, resistance.

The approach suggested by the Global AMR R&D Hub, on the other hand, risks speeding up the loop leading to AMR. They aim to “tackle the threat of resistant pathogens” by developing “new antibiotics and treatments against infections.” Producing antimicrobials of ever-increasing power, without addressing 1 and 2, above, only continues the cycle of ever-increasing resistance.

The other scenario is described on websites such as iwantprepnow.co.uk (and prepster.info and others). They advise on the use of PrEP (pre-exposure prophylaxis), antiretrovirals taken by HIV negative people to reduce the risk of HIV infection. For example, if “you have sex in a variety of situations where condoms are not easily used or not always used”, PrEP, if properly used, can reduce risk of infection with HIV by more than 90%.

There are (at least) two problems with this. Firstly, overuse or incorrect use of antiretrovirals can give rise to a resistant strain of HIV developing in an infected person, and that resistant strain can also be transmitted to others.

Secondly, the advice from iwantprepnow.co.uk (and other similar sites, such as PrEPster.info) is aimed at people who frequently have sex without protection from other sexually transmitted infections (STIs). Exposing yourself repeatedly to infection with STIs increases the development of resistant strains of, for example, gonorrhea, shigella and Mycoplasma genitalium.

Use of PrEP without condoms also increases transmission of hepatitis C virus: “Incidence of acute hepatitis C virus (HCV) among men who have sex with men who use PrEP in Lyon increased tenfold between 2016 and 2017”. HCV has doubled among HIV positive people.

The Center for Strategic and International Studies spectacularly fail to notice the positive feedback mechanism, whereby improper use of PrEP could increase transmission of STIs and the development of resistance in countries where HIV prevalence is highest, sub-Saharan African countries:

“In areas where there is so much HIV circulating, every sexual encounter is high risk, and widespread PrEP could be a prevention lynchpin.” The same article even acknowledges that “High rates of sexually transmitted infections (STIs) increase the risk of HIV acquisition”, without noticing how PrEP will increase STIs and resistance!

According to The WHO, health is a “State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.” In the two AMR scenarios described above, producing stronger antimicrobials and PrEP are examples of medicalization of health, viewing it as merely the absence of disease or infirmity. These kinds of medicalization will radically increase AMR.

Cherie Blair and ‘Rape in Africa’ Stereotypes


Cherie Blair was accused of perpetuating and reinforcing stereotypes and usurping African voices with her comment that “most African ladies’ first sexual experience is rape”. The English Guardian and NPR both weigh in, with a number of reasons why Blair’s remarks were met with outrage.

Critics of Blair are not wrong in calling her out on these comments. But they don’t go far enough. Yes, Blair should have acknowledged, for example, that rape and gender based violence are faced by women everywhere, not just in African countries. But Blair is only repeating stereotypes she would find throughout the mainstream media, and in a lot of specialized published sources.

Blair is far from being alone in perpetuating and reinforcing stereotypes, such as those of the ‘promiscuous African’, ‘the violent African male’, ‘the widespread exchange of sex for money’, ‘the disempowered African female’, etc. Most of these stereotypes are a lot older than Blair, and date back to colonial times, at least.

Nor have the long-held stereotypes mellowed with age. The bulk of HIV programming (and spending) is based on the very assumption that “sexual transmission [is] the major mode of spread of HIV-1 in Africa”, with some estimates suggesting that sex accounts for 80-90% of all transmissions in high prevalence countries (which are all in sub-Saharan Africa).

On the subject of rape, the Center for Strategic and International Studies (CSIS) claims that: “Girls and women [in South Africa] also face an epidemic of rape and gender-based violence; many young women express more concerns about getting raped or getting pregnant than getting HIV. At one site we visited, the girls stated that getting raped was their number one fear.”

CSIS was commenting on the fact that in some parts of South Africa, 60% of women are HIV positive. Many new infections are among girls 15-24 years old. However, the entire CSIS article assumes, without ever arguing for it, that all HIV transmission is sexual. This assumption may suggest that stereotypes such as those above are based on empirical findings, rather than being rank prejudice.

Far from being based on research, stereotypes about ‘African’ sexual behavior are flatly contradicted by vast quantities of data collected by Demographic and Health Surveys, every five years, about sexual behavior in African countries. Just select any sub-Saharan country; rates of ‘unsafe’ sexual behavior are low, and there is little or no correlation with HIV prevalence.

Cherie Blair is unlikely to have come across views that diverge from the mainstream prejudices about HIV in SSA, and that challenge those prejudices. But many of those challenges can be found, for example, in a paper by John Potterat, and in the bibliography for that paper. One of the main suspects in high rates of HIV transmission is unsafe healthcare; others are unsafe cosmetic and traditional practices.

If Blair would like to reconsider the sort of stereotypes about sexual behavior and violence also expressed in the CSIS article, this is a good time to do so. Those outraged by her comments about ‘Africans’ and their alleged sexual behavior may wish to avail of the same research. Otherwise they all risk reinforcing and perpetuating stereotypes.

Ebola: A Strategy of Misinformation?


In an article in The New England Journal of Medicine entitled ‘An Epidemic of Suspicion — Ebola and Violence in the DRC’ Vinh-Kim Nguyen writes about violent attacks on Ebola treatment units and other health facilities. Nguyen argues that: “Epidemics thrive on fear — when they are frightened, patients flee hospitals, sick people stay away to begin with, and affected communities distrust groups trying to respond to the epidemic.”

But there’s an important sense in which the opposite may be true. When people fear something that has proven dangerous in the past, avoiding that something may be the only rational response, the only way to avoid the danger. After all, several well-documented epidemics have been shown to thrive on unsafe healthcare. Examples are Ebola Virus Disease (EVD), hepatitis C (HCV), extensively drug resistant tuberculosis (XDR TB) and MRSA (Methicillin-resistant Staphylococcus aureus).

The second ever outbreak of EBV, which occurred in Yambuku (in Zaire) in 1976, was a result of unsafe healthcare: “Peter Piot…concluded that it was inadvertently caused by the Sisters of Yambuku Mission Hospital, who had given unnecessary vitamin injections to pregnant women in their prenatal clinic without sterilizing the needles and syringes.”

WHO has recently announced that “The outbreak [of EBD] in Katwa and Butembo health zones [in DRC] is partly being driven by nosocomial [=originating in a hospital] transmission events in private and public health centres. Since 1 December 2018, 86% (125/145) of cases in these areas had visited or worked in a health care facility before or after their onset of illness. Of those, 21% (30/145) reported contact with a health care facility before their onset of illness, suggesting possible nosocomial transmission.”

Globally, hepatitis C virus (HCV) has infected an estimated 130 million people…. [T]he wave of increased HCV-related morbidity and mortality that we are now facing is the result of an unprecedented increase in the spread of HCV during the 20th century. Two 20th century events appear to be responsible for this increase; the widespread availability of injectable therapies and the illicit use of injectable drugs. A significant healthcare associated outbreak occurred in Egypt in the 1970s.

Associated with poor infection control in health facilities, one of the first outbreaks of XDR-TB was discovered in Tugela Ferry Hospital, KZN, South Africa, in 2005. And a significant proportion of healthcare associated infections are resistant to methicillin (ie, MRSA).

Nguyen goes on: “In areas where the epidemic response has not involved security forces…people ask to be vaccinated.”

But rolling out vaccinations in environments where infection control is inadequate (for example, healthcare facilities) might increase the risk of viral strains developing resistance (for example, among healthcare practitioners). Going to a healthcare facility during an outbreak of Ebola may be the worst thing a person can do. When people didn’t go to health facilities during earlier outbreaks, case numbers were limited, and the outbreak didn’t last long.

Nguyen has also highlighted the importance of trust, and the consequences of mistrust of authority, experts and science. But if people are right to question the safety of healthcare facilities, as it would appear from above considerations, how can the trust of people at risk of exposure to ebola and other pathogens be regained?

As long as continued Ebola transmission is blamed on what is depicted as an irrational fear of healthcare and vaccinations, people will stay away from healthcare. Because their fear is far from irrational, it is supported by scholarly research, expert opinion and even communications from the WHO. XDR TB, MRSA, HCV and other outbreaks have been shown to be healthcare associated outbreaks. Healthcare facilities also contribute the lion’s share to anti-microbial resistance (AMR).

Modern healthcare facilities are potentially dangerous places. If patients were informed about the dangers, they would know better how to avoid them, and healthcare facilities would be compelled to address those dangers. Some of the earliest EBV outbreaks occurred when people came together around healthcare facilities, and died out when healthcare facilities closed, often because healthcare staff had been wiped out by Ebola.

Trust in healthcare in developing countries may be regained, slowly, if people are adequately informed about the greatest risks they face, such as poor infection control, lack of hygiene, AMR, etc. Trust will not be regained by dreaming up new misinformation, nor by reinforcing old misinformation.