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Category Archives: AIDS

Mass Male Circumcision: Cultural Imperialism and ‘Public Health’


Three-quarters of women interviewed in Kenya’s highest prevalence province say they prefer circumcised partners” screams the headline. Except that only 30 women were interviewed.

There’s a whole rash of articles in praise of circumcision on the PLOS ONE site (Public Library of Science) that I simply don’t have the time or energy to read. Articles about how wonderful the operation is in reducing HIV transmission from females to males (not the other way, though) don’t appear to have found anything new in all the years they have been coming out. That is, aside from different ways of exaggerating the very small level of protection circumcision may afford men, other things being equal.

Women interviewed also believed, incorrectly, that circumcised men are ‘more hygienic and cleaner’. I wonder what would lead to them believing such a thing? Many people believe that a woman must wash herself after (and sometimes before) sex to be ‘more hygienic’, yet it has been known for some time that this is not only untrue, but that ‘vaginal douching’ increases the risk of infection with HIV. The same is true of male genital douching, but it was circumcision enthusiasts who established this, so they are not in a hurry to disabuse people of this dangerous myth.

It is hard not to see the push for circumcision, which comes almost entirely from the US, as highly stigmatizing and culturally imperialistic. It sounds as if men (and women), who in this instance belong to a non-circumcising tribe, are being told that Luo men are dirty because they are uncircumcised and that, since HIV is almost always transmitted through unsafe sexual behavior in Africa (a popular HIV industry myth), this ‘lack of hygiene’ is caused by not being circumcised. All they have to do is submit to circumcision and everything will be fine.

The branding of Luos as unclean and unhygienic by Western health practitioners is no less despicable than the views of other Kenyan tribes, who do practice circumcision, about Luos being ‘mere children’ and their leaders being ‘unfit to govern’ the country because they are uncircumcised. It is beliefs like this that have contributed to a lot of the ‘tribal’ violence Kenya has experienced, especially around election time. It seems the Western funded efforts to circumcise hundreds of thousands of Luos, perhaps millions, are not above using ‘tribalism’ to achieve their own ends.

Despite the small numbers, it is alarming that most of the women are said to express a ‘preference’ for circumcised men on the basis of beliefs that even the author accept are unproven: that circumcised men are ‘cleaner’ or ‘more hygienic’, that it takes them longer for them to ejaculate and that they ‘perform better’. Especially as the number who have ‘true’ beliefs, ones propagated by those promoting circumcision, is a lot smaller.

Is this kind of ‘demand creation’, based on complete lies, acceptable just because those doing the highly aggressive promotion claim that circumcision is effective at reducing HIV transmission from women to men (the absolute reduction being about 1.3%)? Or is it completely unacceptable, not because the reduction is very small, or because the randomized trials constantly referred to are highly suspect, but because this is a crude piece of cultural imperialism dressed up as a public health program?

HIV Transmission Via Unsafe Medical Injections in Kenya – Significant Risk


Congratulations to Kenya on being one of the first African countries with a serious HIV epidemic to investigate the role of unsafe healthcare and reuse of injecting equipment in transmitting HIV. The study finds that “Men who had received ≥1 injection in the past 12 months (adjusted odds ratio, 3.2; 95% CI: 1.2 to 8.9) and women who had received an injection in the past 12 months, not for family planning purposes (adjusted odds ratio, 2.6; 95% CI: 1.2 to 5.5), were significantly more likely to be HIV infected compared with those who had not received medical injection in the past 12 months.

But these findings make the conclusion of the article all the more striking: “Injection preference [my emphasis] may contribute to high rates of injections in Kenya.” If someone is infected with HIV as a result of receiving an injection, then it is the behavior of the health care practitioner that is at fault, not the ‘preference’ of the patient. Health facilities make more money from procedures such as injections than they do from just giving advice or handing out prescriptions, so there may be good reasons why patients ‘prefer’ injections; they may have been led to believe that injections are ‘better’. I’d also be surprised if mere patient preference made much difference to the kind of treatment a patient received in Kenya or elsewhere in East Africa.

Those providing health services need to take responsibility for healthcare associated HIV transmission, and that includes Ministries of Health, professional bodies, and also the WHO, UNAIDS, CDC and other parties who have dominated health and HIV policy in high HIV prevalence countries for decades. Reuse of syringes, needles and other skin piercing equipment carries a very high risk of transmission of HIV, hepatitis and other pathogens. It is not enough to blame patients for their ‘preferences’. Practitioners can decide what treatment a patient needs and what is the best means of administering it, if that means is available to them.

The paper recommends that “community- and facility-based injection safety strategies be integrated in disease prevention programs”. If this is UN-speak for the need to accept that HIV is frequently transmitted through unsafe healthcare and these practices need to stop, then I wholeheartedly agree. This is more than thirty years too late, but it’s good to hear the very mention of non-sexually transmitted HIV in the form of unsafe healthcare being taken seriously in a peer-reviewed journal. I look forward to hearing of other high HIV prevalence countries making the same ‘discovery’ and publicizing it, and also taking steps to reducing such transmission risks.

[To read more about HIV transmission through unsafe healthcare, have a look at the Don’t Get Stuck With HIV site’s Healthcare Risks for HIV pages.]

GlaxoSmithKline: “How Modern Clinical Trials are Carried Out”


We would need further details to investigate what actually took place, but the practices outlined certainly don’t reflect how modern clinical trials are carried out. We conduct our trials to the same high scientific and ethical standards, no matter where in the world they are run.

That’s a comment from a GlaxoSmithKline spokesperson following the discovery of mass graves of an estimated 800 children in Ireland, who are thought to have died while taking part in ‘secret’ clinical trials, for which there is no evidence informed consent was ever given. That’s a huge number of deaths, by any standards. It is to be wondered how many deaths (and injuries) it took before the trials were stopped.

It would be nice to think that the GSK spokesperson is right, that such things could never happen today. But there’s a whole list of unethical practices in Wikipedia that GSK have been involved in, and those are just the more recent cases. And what about their current collaboration with the Gates Foundation to develop a malaria vaccine? Such a vaccine would be a godsend, but who is keeping an eye on them, given their record?

I don’t doubt that such things no longer happen in Ireland, nor in other Western countries. But unethical practices in African countries are certainly not a thing of the past.

The Don’t Get Stuck With HIV site has a section on DepoProvera (DMPA) hormonal contraceptive, which evidence suggests may increase infection with HIV among those using, and onward transmission by those using the method. Also on this site David Gisselquist has written about the unethical behavior of health professionals who have failed to investigate or act in any way on evidence that infants and adults may have been infected with HIV through unsafe healthcare.

WHO have been dragging their feet over unsafe healthcare, especially unsafe injections through reuse of injecting equipment, use of DepoProvera in HIV endemic countries and various non-sexual modes of HIV transmission. There are also the mass male circumcision campaigns, which are based on lies about research that was carried out in Kenya, South Africa and Uganda. It has never been explained how people who seroconverted during these trials were infected with HIV, it was just claimed that they must have had unsafe sex. Though many of the men did not have any obvious sexual risks, non-sexual risks were not considered, including the circumcision operation itself.

The list of serious ethical breeches goes on. Some participants taking part in the circumcision trials were not told they were infected with HIV, and were followed to see how long it would take for them to infect their partners, who also weren’t told they were at risk. This resembles the Tuskegee and Guatemala Syphilis ‘Experiments‘, which also ended in the 1960s. Yet mass male circumcision campaigns are ongoing and extremely well funded, despite not having anything like the rate of takeup anticipated by those making a lot of money from carrying out the operations.

There has been some secrecy surrounding DepoProvera, and a lot of data about mass male circumcision may have been collected but never released, but much of the data about these issues is readily available to anyone with an internet connection. Like the results of the Irish trials, much of the research was published in “prestigious medical journals”. But I assume this is not what GSK is referring to when they talk about ‘modern clinical trials’?

Age-disparate relationships do not drive HIV in young women. KwaZulu-Natal, SA


I commented on this back in March when it was reported at a conference. Now the paper has been published (though it is not available free of charge). It concludes: “In this rural KwaZulu-Natal setting with very high HIV incidence, partner age-disparity did not predict HIV acquisition amongst young women. Campaigns to reduce age-disparate sexual relationships may not be a cost-effective use of HIV-prevention resources in this community.”

The HIV industry likes to believe that, although HIV is almost always transmitted through ‘unsafe’ heterosexual sex in African countries, unlike in other countries, it is men’s behavior that is most responsible. This supports their ‘all men are bastards, especially older men, and all women are victims, especially younger women’ mentality.

It’s good timing. After 23 years of monitoring their epidemic in South Africa, HIV experts have seen HIV prevalence increase from less than 1% to almost 30% in that time, and stagnating at over 25% for about the last 10 years. KwaZulu-Natal is the worst affected province, with HIV prevalence in some districts reaching 40% among antenatal clinic attendees.

Perhaps a little less emphasis on sexual behavior and a little more emphasis on non-sexual risks, such as unsafe healthcare, traditional and cosmetic practices, may shed some light on what is driving the epidemic and why efforts to influence HIV transmission in any way seemed to have failed thus far.

[For more about non-sexual HIV transmission via unsafe healthcare, traditional and cosmetic practices, and how to protect yourself from these, have a look at some of our more detailed pages.]

Infinite Regress of Expert Opinion On the Behavioral Myth of HIV in Africa


In an otherwise interesting article by Paul Sharp and Beatrice Hahn about the origins of HIV, the authors make a familiar, but poorly supported claim: that “AIDS is…primarily a sexually transmitted disease”. I always wonder if citations for such claims will actually present evidence, or if they just lead to a blind alley, eventually.

Sharp and Hahn cite a paper by Myron Cohen et al and one by Florian Hladik and M. Juliana McElrath. But Cohen et al only refer to Haldik and a lengthy report by UNAIDS from last year, which doesn’t cite any supporting evidence. It says: “The vast majority of people newly infected with HIV in sub-Saharan Africa are infected during unprotected heterosexual intercourse (including paid sex) and onward transmission of HIV to newborns and breastfed babies. Having unprotected sex with multiple partners remains the greatest risk factor for HIV in this region.”

This completes the mantra about 80% of HIV transmission being a result of heterosexual intercourse and much of the remaining being a result of mother to child transmission.

Hladik and McElrath refer to another report by UNAIDS, this time from 2007. Despite the constant repetition of an assumption about heterosexual transmission, I could not find any supporting citations. UNAIDS do frequently refer to their ‘Modes of Transmission’ surveys, but these are hopelessly flawed and do not support the assumption. Hladik et al decide that, although transmission via infected blood is possible such a phenomenon is beyond the scope of their review.

I could chase around and look at various UNAIDS publications that propagate what has become one of the most enduring myths about HIV transmission in Africa, that it is almost always a result of heterosexual sex, but there are too many such publications, and too many of them just cite other UNAIDS publications. One might hope for peer-reviewed articles, like the ones cited above, to break the vicious circle, the incestuous practice of experts citing other experts until they have created a web of questionable views that are then used to spawn global policies. But years of reading such documents has not led to any clear and independent assessment of the relative contribution of sexual and non-sexual modes of transmission to the most serious HIV epidemics. If I ever stumble upon such an assessment I shall certainly share it widely.

But I don’t believe evidence will ever be produced to show that sex explains almost all HIV transmission in Africa, not even from all the experts and senior bureaucrats who have made it their life’s work to cling to this view, because it simply is not true. There is too much evidence that HIV has been transmitted through unsafe healthcare and various other non-sexual routes. But UNAIDS have resolutely refused to investigate any of this evidence.

[For more about non-sexually transmitted HIV, view our Healthcare Risks for HIV and Cosmetic Risks for HIV pages. For more about some of the terrible consequences of adhering to this behavioral myth of HIV transmission in Africa, see our Male Circumcision and Depo-Provera (DMPA, hormonal birth control) pages.]

 

Uganda: Mystery About Effectiveness of Circumcision Against HIV


The HIV industry’s circumcision division has put a lot of effort into denying that circumcised men may feel that they can safely engage in ‘risky’ sexual behaviors. But some peer reviewed articles have found that circumcised men feel that, being circumcised, they are not at risk of sexually transmitted HIV, or that their risk really is lower as a result of being circumcised.

The problem is, how do they know how circumcised and uncircumcised men become infected? They may believe the HIV industry’s mantra about almost all HIV transmission being a result of unsafe sex in African countries, but nowhere else. But what if the HIV industry is wrong? They have never checked. They have never traced people’s partners systematically or assessed their non-sexual risks, from unsafe healthcare, traditional and cosmetic practices, they have never investigated infections that were clearly not sexually transmitted.

The industry seems to feel that the end justifies the means because HIV prevalence has turned out to be lower among circumcised men in some circumstances. But if they don’t know how some men, circumcised and uncircumcised, became infected, how do they know that circumcision protects them? If circumcision is associated with higher HIV prevalence in some countries and lower prevalence in other countries, perhaps circumcision status is irrelevant. Perhaps sexual behavior is irrelevant, the HIV industry just doesn’t know.

So millions of men are said to be lining up to be circumcised and they don’t know whether it will really protect them, whether it will increase their risk or whether it will have no effect at all. They also don’t know how safe conditions are in the clinic where the circumcision is carried out.

[For more about the ineffectiveness of Male Circumcision against HIV visit our circumcision related pages.]

Control Element More Evident than Prevention in Uganda’s HIV Bill


Another article on Uganda’s idiotic HIV/AIDS Prevention and Control Bill says the country is going have a bill that compels men to test for HIV along with their partners when their partners are pregnant. I can see a lot of fatherhood denials resulting from this. But this bill, which claims to be punishing men (who all deserve to be punished, right?), will be a lot more threatening to women.

HIV prevalence is higher among women (8.3%) than men (6.1%) and women are already under a lot of pressure to be tested for HIV when pregnant. This means that a lot more women are aware of their status and it is unlikely they will be able to claim not to know their status if they have ever been pregnant, especially if they live in an urban area (urban prevalence 8.7%, rural 7%) and can afford some healthcare (richest quintile prevalence 8.2%, poorest quintile 6.3%).

Ugandan politicians are probably not aware of the terrible conditions in health facilities in their country as they and their families always seem to go abroad when they need healthcare. But they should be aware that health facilities there, especially reproductive health facilities, may be dangerous places. A very expensive survey is carried out every now and again called the Service Provision Assessment and they should familiarize themselves with it. Almost all Ugandan women attend an antenatal facility at least once, and more than half give birth in a health facility and receive the assistance of a skilled health professional.

Given such conditions in healthcare facilities, maybe Ugandan politicians should make sure HIV and other diseases are not being transmitted through healthcare and other skin-piercing procedures before passing a bill that seems to assume that transmission is all a result of unsafe sex. They don’t seem to have any idea of the possible consequences of such a bill.

[There have been quite a number of HIV infections in Uganda that have been unexplained by sexual behavior and are probably healthcare related. To read more, visit our Cases and Investigations page for Uganda.]

South Africa Continues to Fail to Reduce HIV Transmission


UNAIDS is strange, perhaps stranger than their numerous UN siblings. They have a single disease as their brief and they have spent 20 years learning next to nothing about it. They keep collecting data about sex, because they insist that HIV is almost always transmitted through unsafe sexual behavior in high prevalence African countries, but nowhere else. They have to shore up their arguments by appealing to prejudices, such as popular beliefs about ‘African’ sexuality, the brutish mentality of African men (yes, all of them) and the pathetic victim status of African women.

So it comes as a bit of a shock to them when they accidentally carry out research that casts doubt on their fondly held prejudices. A paper entitled ‘Sexual relationship power is unexpectedly not associated with unprotected sex in tavern populations in South Africa‘ is a case in point. Of course, alcohol abuse is a terrible social problem in South Africa (and many other countries), and needs to be addressed urgently. So is violence against women, gender based crime and a whole host of other social problems that are endemic in countries with a large proportion of very poor people who live in virtually uninhabitable environments.

UNAIDS is almost as old as South Africa’s epidemic, where prevalence stood at less than 1% in 1990 but rose rapidly to more than 25% over a decade ago and has not dropped below that figure since [I should clarify, these figures are for antenatal clinic attendees, not for the male and female 15-49 year old population, among whom prevalence is 18.8%]. The yearly HIV reports that South Africa shoves out are almost entirely about sexual behavior, with next to nothing about non-sexual transmission of HIV, via unsafe healthcare, cosmetic and traditional practices. I wonder how long it will take before anyone notices that they clearly haven’t even started to understand the worst HIV epidemic in the world.

[For more about sexual transmission risks and HIV prevention, have a look at some estimated risks from various sexual practices.]

What Kind of HIV Risks do Public Sector Employees Face? Sexual? Non-Sexual?


An article in the Arusha Times claims that public sector employees may be more vulnerable to HIV. This is not too surprising because HIV prevalence is higher among employed than unemployed people in Tanzania and a lot of other higher prevalence countries. Prevalence is also higher among urban dwelling people, wealthier people, and various other groups.

But the question is, why is their risk higher, often much higher? One of those cited in the article is said to have urged “married couples to go for tests on their HIV status without any suspicion on who among the two was to blame in case he or she tested positive”. Maybe neither are ‘to blame’. Many HIV positive people are married to or living with only one, HIV negative person. They don’t know how they were infected. However, the HIV industry insists that they were almost definitely infected through unsafe sex. Perhaps public sector employees face non-sexual risks, such as those from unsafe healthcare, traditional or cosmetic practices?

[There have been a number of unexpected infections in infants and young adults in Tanzania in the 1980s and 1990s and these may have been cases of healthcare associated HIV, but they have yet to be investigated.]

US College Students Practice Using Sex in Advertising in Kenya


Some US college students have set up a fake profile on Tinder to “turns flirty conversation into a serious talk about men’s health for the month of June, which is Men’s Health Month in the US”. I’m not sure what that has to do with Kenya, but their work is described as “talking dirty to dirtbags”, so they are certainly in tune with the HIV industry’s ‘all men are bastards, all women are victims’ mentality.

But I thought the US had learned its lesson from other ‘fake’ campaigns; perhaps not.