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Magafuli and Covid19: Skin in the Game


The first nuanced article I have seen on Covid19 in Tanzania comes from a surprising source, Devex, an NGO focused ‘platform’. Read the whole article to find the balance. 

The article acknowledges measures that Tanzania has taken in response to advice from WHO and other parties. It is argued that communications and messaging became confused and ineffective after the country’s initial response. 

However, this analysis raises the question of who was confused? President Magafuli reassured his people that the country would not be taking action that would risk immediate shortages of food and vital supplies, cease most economic activity, and countless other consequences. 

At the same time, NGOs and ‘civil society’, who depend mainly on foreign income to exist, wanted the country to take any measures that their funders insisted were necessary to prevent a major disease outbreak. 

Another news source that beats the drum for NGOs is The New Humanitarian, formerly the UN’s IRIN. They cover Covid19 in Kenya’s most media-friendly slum, Kibera. 

The first photograph, alone, is enough to suggest that Covid19 will never be the biggest threat that people face, on a daily basis, in urban slums. But the article also illustrates how immediate an impact a rash lockdown has on subsistence living, at the best of times. 

We get some insight into NGOs’ need to keep their eye on the diseases, social issues and other developments that are currently attracting funding. The author focuses mainly on one NGO, but they all need funding.

Close to the end of the Devex article we read that some have said: “the decision to avoid a full lockdown might have made sense in the Tanzanian context.” That’s exactly what I would expect people living and working in developing countries to say, although the source of the quote is not clear. 

Devex goes on to quote an NGO in Tanzania that spells out why you can’t impose a rich country solution in a poor country: “You might even be flattening the curve for 10 years without making it possible for our health sector to cope if our caseload and severity had been comparable to the U.S. and the U.K.” 

Data collected a couple of years ago in Tanzania was published recently, with Covid19 bits bolted on, and it finds that compliance for hand hygiene in health facilities is extremely low (7%), glove use is 75%, disinfection of reusable equipment is 5% and waste management scores just over 40%. 

Devex comes closer than others to distinguishing between Covid19, the pathogen, and a country’s response. The virus is said to have infected about 1m people on the African continent, which is about 0.1% of the population. But systematic reporting on negative consequences of the response is rare, notably so in rich countries. 

Confirmed deaths from Covid19 in Africa are about 0.0022% of the population. So, Tanzanian deaths from HIV in one year (2019), even with widespread coverage of antiretroviral drugs, still outnumber deaths from Covid19 for the whole continent. 

Deaths from pathogens that debilitate and/or kill people far exceed those from Covid19, and many of these are also preventable or treatable.

Some would argue that the biggest killers are not pathogens. They are background conditions, such as inadequate healthcare, unhealthy habitation, poor diet and lack of water and sanitation. 

Agreed, things could have been smoother, with Tanzania continuing to issue the data and communications international health and other agencies demanded. But the country seems to have been able to avoid the destructive scaremongering and panic that you’ll find in almost every other country. 

The New York Times claims that “More than 88 days have passed since Tanzania reported even a single new coronavirus case”. Everything reported in the article is at least 88 days old, as well. But it concludes with a reminder about the coming election, in October. 

Civil society, the press, international institutions and foreign experts have little to lose if they are wrong. Tanzanians, including the President, have skin in the game. Magufuli has maintained calm, avoided civil unrest, protected local economies and stood up for his electorate, and will answer to his people. How many others can say the same? 

Covid-19 – Tanzania Refuses to Peter Pan


Voice of America claims that “Tanzania has taken a controversially relaxed approach to tackling the coronavirus pandemic”. That’s an odd view of ‘controversy’ when you compare it to violently enforced lockdowns in several neighboring countries, resulting in starvation on a massive scale.

The East African asks if some middle ground can be found between campaigning for upcoming elections in East Africa, and what is seen as an ongoing need to avoid large gatherings. Tanzania’s election is due in October of this year and Uganda’s in January of next year.

The article argues that Covid-19 restrictions seen in many countries could reinforce “a long-established culture of unfair competition” and “serve the interests of the incumbency”. However, Tanzania only imposed relatively mild restrictions, and they were lifted two months ago. 

There’s little comparison between Tanzania and Uganda. Uganda’s president has been in office for 34 years, has worked hard to ensure that he will be able to stay in office for at least another five years, and can run for office again in 2026. That is, by anyone’s definition, controversial. 

But the East African’s argument implies, perhaps inadvertently, that Tanzania’s Magafuli, who has only been in office for five years, is willing to risk campaigning for reelection without depending on the kind of de facto martial law that Uganda’s Museveni has imposed. 

Also controversial is the director of the US National Institute for Allergies and Infectious Diseases, Anthony Fauci. Aside from holding this office for longer than Museveni (and even Cambodia’s Hun Sen), Fauci has a long history of what Michael Fumento calls “nightmare scenarios”.

One of Fauci’s earliest scenarios was that HIV might be transmitted by casual contact, before he went on to champion a threat of high rates of HIV transmission between heterosexuals, both of which turned out to be dangerously inaccurate. 

Most countries, rich and poor, experienced relatively low levels of transmission of HIV. But a handful, all in sub-Saharan Africa, experienced levels of transmission among heterosexuals that went well beyond Fauci’s dreams. Transmission among people with no identifiable sexual risks is still high in those same high prevalence countries. 

An English Guardian article suggests that poor countries are not able to afford the kind of measures that the UK, US and other rich countries have imposed. But that doesn’t go far enough to explaining why some poor countries appear to have been more successful than richer countries in their efforts to reduce the spread of Covid-19.

What poor countries cannot afford to do is to close down their economies, stop working, producing food and other goods, and run off to their bunkers until effective vaccines and/or cures are available for all dangerous pathogens, known and unknown. Even a few European countries already suspect they may have imposed some ineffective measures. 

Poor countries can’t afford lockdowns of a few days, but they may also know that the longer-term damage to economies will hit them, regardless of whether they impose the sort of restrictions that most rich countries have imposed. Of course, it is possible that rich countries will realize the same; there’s a lot we don’t yet know. 

Tanzania may have found a strategy that other countries, bombarded by conflicting advice and unaffordable loans from rich countries, can follow to minimize the risks of a Covid-19 epidemic, whatever those happen to be. Crucially, Tanzania’s strategy also minimizes the risks of reversing progress they have made over the past few years. Perhaps that’s hard for the media to process.

Covid-19 – Tanzania’s Measured Response


A Dutch journalist based in Kenya got ‘stuck’ in Tanzania after borders were closed as a measure against the spread of Covid19. Like the British journalist who decided to stay there to look after his dogs, it’s the fact that both foreigners can move about freely in the country, there is no curfew or infringements on basic freedoms in the name of public health, that is most revealing about how Tanzania’s response to the threatened epidemic has fared. 

The Dutchman did what he calls a ‘survey’, because he finds it hard to believe that numbers infected in Tanzania are low when they are said to be high in other African countries. With all the scare stories about the virus threatening widespread destruction on the continent, the intrepid reporter has missed the fact that only around 0.09% of Africans have been confirmed to have been infected (fewer than 1m). 

He visited the town and found people getting on with their lives, going to and from work, buying and selling goods in the markets; he went to graveyards and found  nothing startling; hospitals looked normal, though staff and guards were wearing masks. He even went clubbing the week before, and neither he nor the people he was with had any virus some time later. 

Aside from rumors among other foreigners, who were warning fellow foreigners to work from home and to ‘be careful’, the Dutchman decided that he would ‘take the risk’ to go back to Kenya. So they all had homes, and jobs that could be done from home.

Meanwhile Kenya, and neighboring Uganda, struggle to keep law and order, if that’s what you’d call their dusk to dawn curfews. Kenya wants to extend their curfew for another month, and people continue to be persecuted, beaten and killed in both countries. An estimated 10 million people face severe food shortages in Sudan

The Dutch journalist should think carefully about returning to Kenya; in fact, he should seriously consider staying in Tanzania. The enormous damage that a disproportionate response can do is already evident in poor countries. According to some sources, the damage will be soon be felt in some rich countries, as well.

Covid-19 in Tanzania: Pursuit of Health Sovereignty?


What’s the difference between Kenya’s response to Covid-19 and Tanzania’s? It’s difficult to know about Tanzania because journalistic practice dictates that if an African leader stands up to western leaders, experts or even mere bureaucrats or journalists, they must be slapped down, ridiculed and hounded for the remainder of their office for their temerity. 

It’s not so difficult to find out about Kenya’s response: a curfew was imposed and violently enforced, many people were held (effectively, interned) in insanitary conditions, some were beaten and some died, children will remain out of school until next January, hospitals are said to be overwhelmed (aren’t they always?), there are restrictions on movement, shortages of food, etc. 

In Tanzania, children were sent home for a few months, but people were encouraged to go to work, feed their families, take care of themselves so that they could take care of people who were not able to. Magufuli refused to go running to the international community for handouts earmarked for (well-behaved) African leaders.

Consequences from Kenya’s response to Covid-19 are far more severe than those from the virus itself. Of course, Tanzania is going to have to face the consequences of the responses of countries around them, and the consequences of their trading partners’ respective responses; for example, there is already a massive drop in tourism, globally, something a lot of poor countries disproportionately depend on. 

But perhaps the difference between Kenya’s and Tanzania’s response to the virus runs deeper than the daily struggle for basic things, such as food, habitation, education, healthcare and the rest. The BBC, in that sneering tone specially honed for Africans, have coupled Magufuli’s approach to Covid-19 with his objections to ‘imperialism’.

In fact, Magufuli objects to the likes of mining operators from rich countries granting his country a paltry 3%, quaintly referred to as ‘royalties’, of anything declared as a profit. He advises people to balance rich countries’ ‘giving’ against what they take, which is not unreasonable. Or perhaps the BBC doesn’t recognise imperialism that hasn’t been branded as such by them?

While the Constitution of the World Health Organization states that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, their response to the virus appears to view health as the avoidance of certain pathogens deemed more catastrophic than others, pretty much at all costs. Tanzania, and all poor countries, have a lot more to worry about than Covid-19. (Don’t we all?)

In their anxiety to depict Magufuli as an unworthy opponent of imperialism, an incapable leader of Tanzania and a generally uninformed person whose tenure verges on dictatorial (and I’m certainly not saying he’s faultless), many commentators have missed something important. Africa and Africans won’t be ‘rising’ when, or because the English Guardian or the BBC plasters it up in banner headlines. 

Perhaps it will happen when leaders like Magufuli, human as he is, stand up to the sanctimony of the western media, the neo-imperialism of wealthy countries, and the complicity of the ‘international’ institutions they fund. But the difference between Kenya’s and Tanzania’s response? Tanzania refused to be cowed into overseeing a complete breakdown of the economy, of law and order; they even refused to take money to do what Kenya and other countries happily did. 

It could be argued that Magufuli is striving for health sovereignty, which is, by definition, autonomous, unlike the top-down, one-size-fits-all ‘solutions’ that rich countries and their institutions are so keen for poor countries to adopt. At least, he seems to be highlighting a tension between the WHO’s definition of health and their approach to health emergencies, especially in poor countries (but not exclusively). 

Much remains to be seen, but what Magufuli has done so far has resulted in a lot less harm than what Kenyatta has done, which is just more of the same. In contrast, Magufuli has stood up, with his people; he has refused to be goaded, and to be induced into handing over everything to rich countries and institutions. He refused to betray the Tanzanian people, refused the readies. How many other leaders, in Africa and elsewhere, can claim the same? 

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.

Mistakes explain Africa’s HIV epidemics: Evidence from a double-barreled smoking gun


A recent double-barreled smoking gun calls attention to mistakes that fuel Africa’s HIV/AIDS epidemics.[1] The first smoking barrel is the discovery of an HIV outbreak in South Africa which is best explained by bloodborne transmission during health care.[2] The second smoking barrel is the subsequent silence by public health and HIV/AIDS experts and officials about the likelihood that unsafe health care caused the outbreak. (A “smoking gun” is “an object or fact that serves as conclusive evidence of a crime or similar act…”[3])

First smoking barrel: HIV outbreak in Kwazulu-Natal, 2013-14

South Africa has one of the world’s most intense HIV epidemics with more than 20% of adults infected.[4] Things are even worse in some places: for example, in a large mostly rural study area in KwaZulu-Natal province more than 60% of women aged 30-49 years were HIV-positive in 2016.[5]

In 2010-14, researchers collected HIV from a random sample of adults in the KwaZulu-Natal study area mentioned in the previous paragraph. The team then sequenced 1,376 HIV samples (i.e., determined the order of HIV’s constituent parts). Because HIV changes over time, similar sequences from two or more people suggest recent and close transmission linkages. Among the 1,376 sequences, the study team found a cluster of 63 very similar HIV. The study team estimated that HIV from one person in June 2013 had somehow reached and infected 63 people within 17 months through November 2014.[2]

The cluster reported from the study area is similar to clusters that governments outside sub-Sahara Africa have investigated and traced to unsafe health care. For example, the diagram linking 63 infections in KwaZulu-Natal (see slide 10 in reference [2]) is similar to diagrams linking HIV sequences from outbreaks in Libya in 1995-99 and in Cambodia in 2013-14.[6,7]

Because the 1,376 HIV came from a random sample of an estimated 9% of HIV-positive adults in the study area, the observed cluster of 63 infections may well be 9% of a much larger cluster in the study area. Moreover, because many of the 63 HIV came from a town on the border of the study area, the cluster likely extends outside the area; and transmission appeared to be ongoing when the study stopped collecting HIV samples in 2014.

Because it is almost impossible for such an outbreak to come from anything other than bloodborne transmission, the government of South Africa could protect public health by investigating to find and fix whatever caused it: asking people in the cluster what skin-piercing procedures they received and where during 2013-14, and then inviting others who visited suspected facilities to come for HIV tests. From 1986, at least 11 governments outside sub-Saharan Africa have investigated unexplained HIV infections to find and fix health care procedures that had caused large HIV outbreaks, infecting more than a hundred to as many as 50,000 people in China.[8,9]

The study that reported this KwaZulu-Natal outbreak suggested it might be from sex, but provides no information about sexual risks for anyone in the cluster. In any case, the possibility that sex could transmit HIV from 1 to 63 infections (much less hundreds) in 17 months is vanishingly small, considering:

  • Even between spouses who are unaware one spouse is infected, it takes on average years for one to infect the other. In a 2016 national survey in South Africa fewer than half of men and women with HIV-positive spouses were themselves infected.[4]
  • According to self-reported sexual behavior, having multiple partners had little to do with HIV transmission in the study area. Repeat surveys in the study area during 2004-15 identified 1,265 new HIV infections in adults with information on sexual behavior; only 43 (3.4%) of adults with new infections reported more than one sex partner in the previous year, while 189 (14.9%) said they were virgins (Table 1 in reference [10]).
  • Widely quoted estimates of the risk to transmit HIV through penile-vaginal sex say transmission occurs in fewer than 1 in 1,000 coital acts.[11]

Even if someone, nevertheless, wants to argue or believe that sex could somehow account for all infections in the cluster, bloodborne transmission during health care remains a possible explanation. That possibility challenges the government of South Africa to investigate to protect public health.

Second smoking barrel: Expert and official silence about the likelihood unsafe health care cased the outbreak

Researchers from the African Health Research Institute and the University College London, who collected HIV from the study area in 2010-14, subsequently sequenced HIV samples and discovered the cluster in 2017. They reported their discovery on 5 March 2018 at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.[2] Although the cluster suggests unsafe health care transmitted HIV:

  • We have found no evidence government of South Africa has investigated to protect public health.
  • During their 2018 presentation at CROI the research team did not acknowledge the possibility that unsafe health care caused the outbreak, and none of the discussants even mentioned such risks.[2]
  • To the best of our knowledge, as we are writing this more than two years after the cluster was reported in 2018, no expert in HIV sequencing and no official in any international or foreign health organization or agency has publically acknowledged the possibility the cluster comes from unsafe health care.

Considering the many experts knowledgeable about sequencing and about Africa’s HIV epidemics, the fact that no one has said the obvious – that the cluster likely (or at least possibly) comes from unsafe health care – is strong evidence that people are choosing to keep silent. That in turn suggests they are aware of pressures not to say what is obvious. (The only exceptions to this silence are blogs on this website [search “KwaZulu-Natal] and several papers posted on SSRN by the authors of this blog, for example [1]).

Silence is strong circumstantial evidence – smoking gun evidence – that influential officials who control research funds and jobs for people working on HIV do not want them to talk about health care transmitting HIV in Africa. If anyone wants to challenge evidence-based suspicions that organizations such as the United States’ National Institutes of Health enforce such silence, the way forward is not to debate whether that is so but simply to break the silence – to acknowledge the cluster likely came from bloodborne transmission, and to recommend government of South Africa to investigate. Setting aside debate, the priority should be protecting patients and stopping Africa’s epidemics.

Perspective and context: 35 years of evidence and silence about HIV transmission during healthcare in Africa

Genetic evidence from the HIV cluster in KwaZulu-Natal, and subsequent silence about that evidence, are only the latest in decades of evidence and silence about health care transmitting HIV in Africa.[12-14] The double-barrelled smoking gun discussed in this note is remarkable because it involves experts in gene sequencing, a group that has only recently gotten more involved in HIV-related research in Africa and therefore has had no investment or involvement in decades of dismissive silence about unexplained and likely bloodborne HIV infections in Africa (such as HIV-infected children with HIV-negative mothers, HIV-positive virgin men and women).

Those who are silent are not explaining why they are silent. But insofar as Africans are at risk, the reasons for experts’ and officials’ silence is not important. What is called for, to protect Africans at risk, is not to explain why experts and officials are not doing their jobs, but rather to get some investigations underway and to warn Africans about risks to get HIV from health care as long as those risks are not found and fixed.

References

  1. Gisselquist D, Collery S. Africa’s HIV epidemics: Evidence from a double-barreled smoking gun. Social Science Research Network, 1 May 2020. Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3590251 (accessed 1 May 2020).
  2. Coltart CEM, Shahmanesh M, Hue S, et al. Ongoing HIV micro-epidemics in rural South Africa: the need for flexible interventions. Oral abstract. Conference on Retroviruses and Opportunistic Infections, 4-7 March 2018. Available at: http://www.croiwebcasts.org/console/player/37090?mediaType=slideVideo&&crd_fl=0&ssmsrq=1522772955419&ctms=5000&csmsrq=5001(accessed 7 March 2020).
  3. Smoking gun. Wikipedia, 5 March 2020, at: https://en.wikipedia.org/wiki/Smoking_gun
  4. ICF. South Africa Demographic and Health Survey 2016. Rockville (MD): ICF, 2019. Available at: https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf (accessed 1 May 2020).
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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?