Bloodborne HIV: Don't Get Stuck!

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UNAIDS and Uganda: Prejudice Begets Prejudice

Comments Off on UNAIDS and Uganda: Prejudice Begets Prejudice Posted by on July 11, 2014

Using UNAIDS’ inherently flawed Modes of Transmission spreadsheet, the Zambian government have decided that men who have sex with men (along with their assumed female partners) give rise to 1.4% of new HIV cases every year. Not a high percentage. But even African countries which use alternative means of estimating also come up with a relatively low figure.

Despite the fact that the contribution is known to be low, some don’t seem to be able to resist the temptation to whip out the homophobia card at every opportunity. The current anti-gay frenzy in Uganda may have been stirred up by various conservative evangelical Christian groups, but it has become a useful political tool; whenever anyone mentions anything political, someone starts spewing out homophobic bilge. What are purely homophobic attacks are then dressed up as part of an anti-HIV strategy.

Spurious figures from UNAIDS for the proportion of HIV transmission said to be a result of some kind of illicit sexual behavior are used to support an assumption that anyone with HIV has engaged in illicit sex. Therefore, even though the contribution of men who have sex with men is not high, it’s an easy step to just point the finger at any group you hate, or whose behavior you consider to be wrong (or ‘sinful’), and blame them.

But the Ugandan government has tried to claim that its homophobic act (the Anti-Homosexuality act of 2014) does not put healthcare employees in the position where they must choose between running the risk of accusations of ‘promoting the act of homosexuality’ or ‘abetting homosexuality’ and the like, which carry a heavy sentence, or breaching their ethical and professional codes of conduct (and international human rights agreements). The government’s “Ministerial Directive on Access to Health Services without Discrimination” does not explain how healthcare workers should resolve this dilemma.

The trumped up nonsense about gay people ‘recruiting’ youth is reminiscent of other rabid conservative fundamentalist claptrap that has fed the media for decades. But the ‘blame the victim’ mentality and the finger pointing at assumed sexual behavior of African people in the field of HIV comes directly from UNAIDS and the HIV industry. There’s a gem of wisdom from their former Chief Scientist on this blog post, but it’s pure redneck, so prepare to be offended.

The best way to defuse this obsession with linking HIV to things various atavistic parties consider evil, such as male to male sex, or sex between African people (and between African Americans), is to trace the non-sexual as well as the sexual contacts of people testing positive. It will then become clear that the virus can also be transmitted through unsafe healthcare, cosmetic and traditional practices, and not just through unsafe sexual behavior.

AIDS, blood, HIV, iatrogenic, nosocomial , , , , , , , ,

Denial Reigns Supreme in the HIV Industry

Comments Off on Denial Reigns Supreme in the HIV Industry Posted by on July 10, 2014

Just a couple of days ago I mentioned the industry myth that everyone is at risk of being infected with HIV, but I didn’t expect to come across this piece of 1980s PR again so soon. Nor did I expect to find it in the New Republic.

Most disturbingly, the article is about “interactive maps depicting where AIDS infections were most prevalent [in the US]”. These maps corroborate what statistics have shown for a long time, that the people most likely to be infected live in certain identifiable places, that the epidemic is often associated with poverty, and that black people are far more likely to be infected than white people.

I find this disturbing because, having depicted so clearly that people living in certain parts of the country where the population is either poor, black or both are far more likely to be infected, the lead researcher is quoted as saying that “the fundamental, scientific truth of HIV hasn’t changed. Anybody can still get it.”

This is not a ‘scientific truth’, nor any other kind of truth. It was realized a long time ago that many powerful people would not support a program to address a disease that was said to be prevalent mainly among men who have sex with men and injection drug users. So campaigns were based on spurious ‘expert opinions’, and data was massaged to suggest that everyone was at risk.

Fair enough, in the US it may have seemed at the time that men who have sex with men and injection drug users were already discriminated against, and this prejudice would need to be addressed before much progress could be made against the recently discovered virus. The campaigns were supposed to take the heat off these (at that time) marginalized groups.

It probably worked in the case of men who have sex with men, although it wasn’t so successful for those who inject drugs. But one of the biggest fallouts from the campaign was the effect it had on what became the received view of HIV in African countries, some of which still had very low prevalence at the time, but would eventually suffer the worst epidemics in the world.

The HIV industry was built around the promulgation of the view that if HIV prevalence was highest among people who only engaged in heterosexual sex, as it was found to be in high prevalence African countries, they must have engaged in massive amounts of sex, and it must be very unsafe sex.

But even after the industry abandoned its claim about everyone being at risk, they didn’t abandon the myth that most HIV transmission in African countries is a result of unsafe heterosexual sex. As a result, three decades of unsafe healthcare has almost entirely escaped the attention of the industry, along with the billions thrown at the virus.

Some in the industry still pontificate about more women than men being infected in African countries, the fact that babies are still being infected despite scaling up of antiretroviral drugs, high death rates despite the amount of money spent on treatment, etc, but none of them have asked about non sexual risks, through unsafe healthcare, cosmetic and traditional practices.

It was OK to talk about non-sexual transmission in the early days, and it’s still OK to talk about it when children are infected (and, on rare occasions, white, middle-class heterosexuals in Western countries, presumably). So why is it difficult to accept that adults in African countries, even adults who are sexually active, can also face non sexual risks?

Groups of people said to be at higher risk of infection in African countries were identified left, right and center, but none of them were identified for their non sexual risks, only for their assumed sexual risks. Almost all women (of course), ‘mobile’ people (not just transport workers, but also migrant workers, soldiers and many others), those engaged in certain occupations, such as fishing and mining, etc.

But women who are sexually active tend to visit health facilities, sex workers visit sexually transmitted infection clinics, so do soldiers and transport workers (and others), big employers such as mines often provide some kind of rudimentary health services, as do some government departments; healthcare is not as ubiquitous as sex, but it is pretty widespread in certain places.

Those who were not at risk, in contrast, often seemed to be poorer people, uneducated people, rural dwelling people, people who didn’t live very close to infrastructure or health services, unemployed people and others, whose low risk is explained away by rubbish about smaller sexual networks and the like.

The myth about everyone being at risk of HIV is dangerous because it is so closely related to the myth that HIV is almost always transmitted sexually in African countries. If people don’t know the non sexual risks, they will not know that they need to avoid them, or how to avoid them; if risky practices in health, cosmetic and other facilities are not addressed, they will continue to occur.

AIDS, blood, HIV, iatrogenic, nosocomial , , , , , , ,

Philippines: It’s All About Sex, Even When it Isn’t

1 Comment Posted by on July 9, 2014

An official at the Department of Health in the Philippines has called for “the public with risky sexual behaviors to undergo HIV testing”. This is said to be due to UNAIDS’ ‘Global AIDS Report’, which claims that the country is one of nine where cases of HIV “rapidly increased by 35% in the last 10 years, from 2001 to 2011.

While it is true that the number of people estimated to be living with HIV in the country has gone from about 5,000 in 2001 to about 15,000 in a decade, this is in a country of almost 100,000,000 people. Prevalence is estimated at 0.1%. Also, what the report I have (from 2013) underlines is an increase in infections among injection drug users, no mention of sex (for a change).

The article concludes that “HIV infection is transmitted through sexual intercourse, by blood transfusion and from an infected mother to her child”. But this is not helpful to those who may have been infected as a result of unsafe healthcare, traditional or cosmetic skin-piercing procedures.

Luckily for the Philippines Department of Health, in 2007 a team of people carried out and published an “Assessment Survey of Injection Safety and Safety of Phlebotomies, Lancet Procedures, Intravenous Injections and Infusions in Government Health Facilities in the Philippines“, using a survey developed by the WHO (Tool C).

The survey found, among other thngs, that “the frequency of re-use of needles and evidence for attempts to sterilize used needles was low (less than 16%)”. Given the billions of injections administered every year around the world, I wouldn’t consider 16% to be low, but we’ll allow them their opinion.

The survey also noted “High frequency of noncompliance to best injection safety practices are widespread in the government facilities including…use of multidose vials with needles left neglected onto the diaphragms”, “High frequency of high risk practices prone to needle stick injuries”, a widespread lack of adequate sharp disposal systems, incomplete protection for hepatitis B and that “Almost all facilities were unable to show a manual of injection safety or a manual of waste management”.

Unluckily, UNAIDS is not going to take any notice of such a report because, even though the Philippines is not in Africa, where it is claimed that almost all infections with HIV are a result of sexual behavior, the institution can not accept that unsafe healthcare plays any role whatsoever in HIV transmission in poor countries, with understaffed, under-equipped and overcrowded health facilities.

AIDS, blood, HIV, iatrogenic, nosocomial , , , , ,

Foundation Myths: Why Tracing HIV Infections is Anathema to HIV Industry

2 Comments Posted by on July 8, 2014

A short article about HIV from the British Medical Journal, written in 1992 (pre-UNAIDS) sheds some light on an early piece of HIV myth-making. Though over 20 years old, the article has a very recent feel to it. Apparently someone at the time predicted that “by the year 2000, 90% of HIV infections would be acquired through heterosexual intercourse”.

UNAIDS, in all its extravagance, currently claims that 80% (sometimes 80-90%) of HIV transmissions are a result of heterosexual sex. The 1992 article also goes through the same illogical contortions that UNAIDS now specializes in: “At an antenatal clinic in Kigali, Rwanda, no less than a quarter of women with only one lifetime partner had been infected with HIV, presumably by their steady partner.”

It probably wasn’t yet clear in 1992 that HIV prevalence among those receiving antenatal care (ANC) were not representative of the population as a whole. Even if ‘a quarter’ of women were infected, it was shown later that nowhere near that proportion of men were infected; also, prevalence in Kigali, being a city, is far higher than in the country as a whole.

The paragraph begins by talking about risk, before going on to women who only have one lifetime partner; hence the ‘presumption’ that it is the men who take the risk and then infect their wives/partners. These twin assumptions, that in Africa HIV is almost always transmtted through sex and that it is almost always men who ‘spread’ the virus, became the backbone of UNAIDS and HIV industry dogma, and remain so to this day.

Enough is now known about transmission rates to suggest that 25% of ANC patients were not infected through heterosexual sex, that many of them, perhaps all of them, were infected through some other route. Perhaps the women even went on to infect their partners, rather than the other way around.

But UNAIDS now has a rigorously flawed model to ‘prove’ that most of the people ‘at risk’ of being infected through heterosexual sex (ie, most people in high prevalence African countries) do not engage in risky behavior at all. Some of the flaws are highlighted in a post that appeared on this blog recently.

At some early stage in the history of HIV it became anathema to talk about how someone may have become infected with HIV in Western countries, and the industry came up with the myth that everyone was at risk, something many people still believe. However, it was well recognized by those working with HIV that few people were at risk unless they were men who had sex with men or injecting drug users.

But we are not supposed to say that. It was quickly established that HIV positive people in African countries were not very often men who had sex with men (even then there were more women infected than men) or people who injected drugs. So it was hypothesized, on the basis of no evidence to support and plenty to contest, that heterosexual sex must be responsible for the bulk of transmissions.

Continuing a long tradition of blaming the victims in developing countries, and refusing to investigate unsafe healthcare, (peer-reviewed) paper after paper begins with the unquestioned assumption that almost all HIV transmission in African countries results from heterosexual sex. But we wouldn’t want to stigmatize people; so we don’t attempt to trace their infections, dear me no.

AIDS, blood, HIV, iatrogenic, nosocomial , , , , ,

Institutional Barebacking: HIV, Colonials and Neocolonials

1 Comment Posted by on July 4, 2014

The top 30 countries in the world by numbers of people living with HIV and Aids (PLHA) account for 86% of all PLHAs. Those living in countries formerly colonised by European powers account for 74% of all PLHAs. Two countries that were colonized by the British, Swaziland and Lesotho, but do not fall in the top 30 by number of PLHA, are numbers one and three in terms of prevalence.

Those living in former colonies with a 70% or higher Christian population account for a bit less than half of all HIV positive people, although that excludes several countries with a substantial Christian population and a large number of PLHAs, such as Nigeria, Tanzania, Ethiopia and Mozambique.

Breaking the figures down a bit further, about 60% of all PLHAs live in a country formerly colonized by the British. I include the US in this figure for reasons I shall mention below. 50% of PLHAs live in a country with a 70% or higher Christian population and 40% live in a country which has a 70% or higher Christian population, and was also colonized by the British.

In African countries, 75% of PLHAs live in countries formerly colonized by the British and 60% live in countries with a 70% or higher Christian population (and that rises to 68% if you add in the Christian populations from Nigeria and Tanzania). So in Africa 55% of PLHAs live in predominantly Christian countries that were colonized by the British (rising to 64% if you include the Nigeria and Tanzaian proportion).

The Don’t Get Stuck With HIV website and blog is about HIV transmission resulting from unsafe healthcare, cosmetic and traditional practices, as opposed to the pure sex theory that the HIV industry relies on. So, could there be something about the history of being colonized that would explain why HIV has infected many people in some places and few in others?

I don’t think the fact that many PLHAs live in predominantly Christian countries provides an answer. I think Christianity can be a marker of former colonization and colonial incursions. Some people suggest that Christian attitudes towards sexual behavior differ from those held by Muslims and adherents of other belief systems, but I’ll have to consider this on another occasion.

But colonial powers, for whatever motives, and by whatever means, controlled the lives of as many of the people as possible in the countries they claimed as their property. They controlled movement of people, labor, the economy, the environment, the ecology, family life, agriculture, food supply and nutrition, belief systems, education, social intercourse and just about everything else.

Most importantly, they brought ‘modern medicine’ to the colonies. Jacques Pepin, although he distances himself from the view that a significant proportion of HIV transmission has been a result of unsafe healthcare for the last thirty years, has written extensively about how unsafe healthcare was certainly responsible for most HIV transmission in the sixty years before that.

Pepin was also looking at French and Belgian colonial healthcare. Yet is it in former British colonies that HIV has reached the highest prevalence rates, with a few exceptions. The top seven countries by prevalence are former British colonies (Swaziland, Botswana, Lesotho, South Africa, Zimbabwe, Namibia and Zambia), as are numbers 9 to 12. Mozambique, a former Portuguese colony, is number 8.

But this is not just about British colonialism, no more than it is about Christianity, or any particular brand of Christianity. Many of the countries the British claimed had been claimed by others before that. South Africa by the Dutch, Tanzania and Namibia by the Germans, etc. Also, Christianity was probably also spread by non-colonial influences.

This is not to reject modern medicine, far from it, but to emphasize the point that unsafe medicine spreads viruses such as HIV and hepatitis far more efficiently than any other means yet identified. They are bloodborne viruses, so skin piercing procedures carry the highest risk. This has been made clear by enough research to merit thorough investigation of the role of unsafe healthcare in high HIV prevalence countries.

UNAIDS insisting that HIV is almost always spread by unsafe sex in African countries, and not by unsafe healthcare, is an act of institutional barebacking. It leaves people in high HIV prevalence countries exposed to non-sexually transmitted HIV and, at the same time, stigmatizes them for being promiscuous, careless and stupid. Far from reversing the damage former colonial powers did, these institutions merely adopt the same position and go through the same processes all over again.

AIDS, blood, HIV, iatrogenic, nosocomial , , , ,

South Africa: With This Kind of Research, Who Needs Ignorance?

Comments Off on South Africa: With This Kind of Research, Who Needs Ignorance? Posted by on July 3, 2014

Following a recent article about HIV among ‘old’ people in Tanzania which I discussed a short while back, another article has appeared about an increase in HIV among people over 50, this time from Gauteng, South Africa. Prevalence in Gauteng is high, though it is not the highest in the country. The article concentrates, as is customary for articles about HIV, on sexually transmitted HIV, noting ‘unsafe’ sexual behavior, in addition to ‘caring for infected children’.

However the apparent lack of concern older people are said to feel about being infected, along with their ‘ignorance’ which the authors note, may stem from the fact that people in this age group do not engage in as much ‘unsafe’ sex as imagined, that the sex they engage in may not be as ‘unsafe’ as imagined, and that they may face many non-sexual risks as a result of not being informed about these; constant emphasis of sexual transmission and under-emphasis of non-sexual transmission doesn’t help either.

Are the researchers even aware that every skin piercing procedure could be a risk, not just reused injecting and other equipment, but also reused cosmetic instruments (tattooing, piercing, shaving) and reused instruments in traditional practices (traditional medicine, scarification, circumcision)? If older people do not, as the authors suggest, see themselves as being at risk of being infected with HIV, perhaps this is because the non-sexual risks they face through caring for HIV positive people, and risks they face themselves in healthcare, cosmetic and other facilities, have rarely been addressed by HIV intervention programs.

The most worrying aspect of this paper is that it is assumed that sex is the only, or the biggest risk, for HIV. This means that non-sexual risks, which may increase in older people who may have greater healthcare needs, are given so little attention that people do things which they don’t even realize are a risk. Worse still, those providing healthcare, cosmetic and traditional procedures may not realize the risks, or they may be a lot less vigilant in their day to day activities.

Despite the emphasis the authors put on sexual transmission, “using the same needles or sharp objects” was mentioned by at least one of the interviewees. Also, two traditional healers were among those interviewed and seemed aware of their risk to themselves, but not the risk that their clients face, which may be a lot higher. But the use of ‘protective clothing’ by those caring for HIV positive people is far too vague to be of any practical value. What about mentioning skin piercing procedures, needlestick injuries, reuse of needles, syringes, razors and other skin piercing instruments?

This seems to be another missed opportunity to address the substantial non-sexual risks people face from infection with HIV and other bloodborne diseases through skin piercing procedures, whether carried out for medical, cosmetic or traditional reasons. Older people, the subject of this paper, and others around them, may face increased risks from skin piercing procedures, especially those found in health facilities. Instead, the authors obsess about the purported sexual behavior of South African people and fail to make any recommendations about reducing non-sexual HIV transmission.

AIDS, blood, HIV, iatrogenic, nosocomial , , , ,

Hepatitis B Virus and Kenya’s Mass Male Circumcision Programs – Why the Secrecy?

Comments Off on Hepatitis B Virus and Kenya’s Mass Male Circumcision Programs – Why the Secrecy? Posted by on July 2, 2014

With all the posturing in the recently released Kenya Aids Indicator Survey (2012) about mass male circumcision, whether performed in completely unsterile conditions found in traditional settings or the (hopefully) more sterile settings of health facilities, nothing was mentioned about hepatitis B or C. But an article in the East African describes a piece of research carried out by the Kenya Medical Research Institute into hepatitis B (HBV) which finds that prevalence is increasing.

Amazingly, the article admits that the “modes of transmission [for HBV] are similar to HIV — sexual transmission, contaminated blood products and mother to child transmission”; it is “passed from person to person through bodily fluids such as blood, semen or vaginal fluids”. Following a recent paper on HIV transmission through medical injections, it is very important to stress that HIV, like HBV, can be transmitted through non-sexual routes, such as unsafe healthcare, cosmetic and traditional practices.

The article is equally frank about the lack of research into HBV in Kenya: “scientists say the reason for the rise in HBV in Kenya is still unknown since no scientific study has been done to explain the phenomenon”. In contrast, the HIV industry is a lot less frank about non-sexual HIV transmission, even though the country’s Infection Control Policy admits that “Epidemiological data on HAIs [Healthcare Associated Infection] in Kenya is currently lacking, but the risk for HAIs is high”. Slowly, some of these glaring gaps in research are being filled in, though the HIV industry displays a confidence that seems entirely unjustified.

Importantly, HBV among blood donors in Kenya is rising. Are those donating their blood being exposed to contaminated medical instruments through the blood transfusion services? The Kenyan Blood Transfusion Service is not able to supply enough blood to keep up with current demand, so they would need to make sure that people who donate are not being put at risk of infection with HBV or other blood borne viruses. While no one would want to scare people away from health facilities or from blood donation, keeping risks a secret would surely be a lot worse, wouldn’t it?

The article suggests that the counties finding high rates of HBV are in the Northern parts of Kenya (which often have the lowest HIV rates). It is suggested that “The likely causes of HBV in the region are cultural practices like tattooing, circumcising without using sterilised implements and because the regions are dry and people may not be able to get proper nutrition that ensures strong immunity.” As usual, there is a reluctance to ask if health facilities might also be somewhat responsible; does that mean these facilities will not be investigated, and that conditions, if unsafe, will not be improved?

There are various hepatitis related campaigns, but are WHO and other international health institutions going to ensure that all the people involved in the country’s mass male circumcision programs, will be protected from infection with HBV and hepatitis C virus (HCV) as well? WHO makes vague claims about huge proportions of HBV and HCV being transmitted as a result of unsafe healthcare. But what exactly are the figures for ‘priority’ mass male circumcision countries? Again, it’s likely that healthcare safety is more of a risk in these ‘priority’ countries, some of the poorest countries, with amongst the lowest levels of healthcare spending in the world, than it is in Western countries; why are we only given one, generalized figure, when the viruses must be much more prevalent in some countries than others?

Egypt, as (just one) example of a country with a serious hepatitis problem, has seen the figure for years of life lost (YLL) through HBV increase by 3,930% in the 20 years from 1990 to 2010. Liver cancer has increased by 361% in the same period. Cirrhosis has increased by 40% to become the number three cause of YLL, accounting for 1,127,000 YLLs, or 7.1% of all YLLs. Whether the almost 100% prevalence of circumcision in the country contributes to these figures is another question, but it shows what can happen in a country where there is a very high level of access to healthcare, yet where healthcare safety is not adequately addressed. One of the main reasons HCV prevalence is higher in Egypt than anywhere else in the world is because of schistosomiasis vaccination programs, which were carried out using inadequately sterilized glass syringes.

Reusable syringes and needles are no longer commonly used, but the WHO data shows that there is still a problem with unsafe injection practices. So the last thing high HIV prevalence African countries need is a vastly increased risk of bloodborne virus transmission through unsafe healthcare, whether this involves reuse of injecting equipment or other items that are used to pierce the skin during healthcare procedures. Mass male circumcision programs will likely increase the incidence of unsafe healthcare practices, including injections, and the WHO’s claimed benefits in terms of averted infections may not be enough to outweigh the risks involved.

Even if levels of protection against sexually transmitted HIV outweigh the risks, and this is highly debatable (and debated, outside of the HIV industry), what about the risks of infection with HBV, HCV or other bloodborne pathogens, including HIV, during the circumcision procedure itself? Some recent research has questioned the safety of Kenya’s health facilities. There are clearly more risks than those pushing the circumcision programs would like to admit; so will those who succumb to HIV industry pressure be advised of those risks? I suspect they will not.

AIDS, blood, HIV, iatrogenic, nosocomial , , , , , , ,

HIV Eradication May Require Regime Change in HIV Industry

Comments Off on HIV Eradication May Require Regime Change in HIV Industry Posted by on June 30, 2014

Having collected the data in 2012, the Kenya Aids Indicator Survey (KAIS) was released last week. Prevalence has fallen in most provinces. The exceptions are Northeastern Province, where data was not collected due to civil unrest, and Nyanza, where prevalence has increased from almost 14% in 2008 to 15% in 2012. 37% of Kenya’s HIV positive people reside in Nyanza. So the news is not so bad if you don’t come from Nyanza, especially if you don’t come from any of the exceptionally high prevalence towns on the shores of Lake Victoria.

Prevalence is now 5.6%, closer to Tanzania’s 5.1% than Uganda’s 7.2%. As usual, HIV prevalence is generally higher among women (6.9%) than among men (4.4%), higher among urban dwelling people than rural dwelling people and higher among employed people than unemployed people. Prevalence is lowest among females and males who have less education and higher among those who have completed primary or reached secondary or beyond. Prevalence tends to be higher among wealthier quintiles in rural areas and among poorer quintiles in urban areas, which may represent a change in HIV prevalence by wealth quintiles in earlier surveys.

With about 100,000 people being newly infected each year, incidence is said to be 0.5% and the highest number of new infections occurred among people aged between 25 and 34 years, with incidence estimated at 1.2%. Incidence has barely changed between 2007 and 2012, what the report refers to as ‘stable’. The entire epidemic could be described as stable, rather than declining, as prevalence has remained much the same for more than ten years.

Predictably, there are quite a few figures relating to the mass male circumcision program. You don’t put tens of millions of dollars into a program without making sure that you collect data showing that the program was successful. Clearly the program is not successful yet, with the bulk of circumcisions claimed for Nyanza province, which has a prevalence figure nearly three times the national figure. But there is a lot of triumphalist stuff about how high HIV prevalence is among uncircumcised people. Of course, none of the data throws any light on why HIV prevalence is so high among people in this province, so high among Luo people especially, yet not among Kisii or Kuria people.

The level of bullying and manipulation by those running mass male circumcision programs (which the HIV industry likes to refer to as voluntary medical male circumcision or VMMC) becomes apparent when you read some of the literature. Although the invasive operation’s claimed protective value against HIV (and goodness knows what else) has never been very convincing, people are systematically browbeaten over a period of years about hygiene benefits, which have never been demonstrated at all, ‘modernity’ of circumcision, ease of using condoms, increased sexual pleasure and a host of other things for which there is no evidence whatsoever.

According to the abstract “older men should adopt the practice to serve as role models to younger men”, as if there is some moral value in circumcision being provided by a benevolent dictator. UNAIDS addsn a commonly heard claim about “queues of young men and boys awaiting” mass male circumcision, which is clearly drawn from publicity materials rather than from any kind of independent research.

Talking of invasive operations, there is a chapter on blood and injection safety, ironically appearing straight after the mass male circumcision chapter. The figures for blood safety do not sound very encouraging, especially remarks about ‘misclassifications’ in donor records. UNAIDS’ ‘all men are bastards, all women are victims’ theory of HIV transmission gets a bit of a knock as well since nearly four times as many men as women said they donated blood in the 12 months before the survey. The findings about injection safety have been mentioned already on this site  when a full paper was published on the subject in May.

The question now is ‘what next’? Mounds of data have been collected over many years, mostly high level data that gives few clues about how people are becoming infected. Data about ‘attitudes’, sexual behavior, economic circumstances, education, etc, have not allowed any useful ‘targeting’ because the usual conclusion is that ‘it is all about sex’ and other kinds of victim blaming. So it’s heartening to hear that data is being collected about blood and injection safety, albeit a very small amount.

The next step needs to involve comprehensive contact tracing, finding out about people’s non-sexual as well as their sexual contacts, visits to health facilities, traditional practitioners, cosmetic providers and anywhere skin-piercing procedures are carried out. If someone is HIV positive it must be asked who, or what did they come into contact with, whether as a result of sexual or any other kind of behavior. Will the deep prejudices of the HIV industry allow them to take these investigations where they need to go, or will the eradication of HIV have to wait until there’s a regime change in the HIV industry?

AIDS, blood, HIV, iatrogenic, nosocomial , , , , ,

Why Contact Tracing is Vital in High HIV Prevalence African Countries

Comments Off on Why Contact Tracing is Vital in High HIV Prevalence African Countries Posted by on June 27, 2014

A recent blog post I wrote received some comments from ‘Brad’, at The Mosaic Initiative, a grassroots organization based in the US. Although Brad seems to think that what I wrote accords in some way with what he believes, it is quite clear to me that we both think very different things about HIV.

For a start, I believe that HIV epidemics in African countries are NOT like HIV epidemics in the US and other Western countries. The bulk of HIV transmission in Western countries is a result of either male to male sex or injected drug use. The bulk of HIV transmission in African countries is not a result of either of these, in any country.

The very point of the Don’t Get Stuck With HIV website and blog is that no African country has made a convincing estimate of the proportion of HIV transmission that is a result of sexual, as opposed to non-sexual transmission. It is just assumed that about 80% is a result of heterosexual sex and most of the remaining 20% is accounted for by mother to child transmission; these assumptions have been held for more than 20 years and emanate from WHO, the World Bank, UNAIDS and other institutions that control HIV funding, globally and in African countries.

I also disagree with Brad that it is merely “important to know how HIV is spreading”; it is vital to know whether someone was infected through sex, through unsafe healthcare, through some traditional practice or in a tattoo studio. There is no “generalized pandemic” that Brad speaks of. In Western countries, the vast majority of people are not at risk of being infected with HIV. Even in African countries some people are more likely to be infected than others; in Burundi HIV prevalence is low, but in Botswana it is high. In cities, even Bujumbura, prevalence tends to be high.

Prevalence is almost always higher among women than men in high prevalence African countries, higher among employed people than unemployed people, higher among wealthier people than poor people, etc. There is a huge level of heterogeneity, between and within countries. This heterogeneity does not seem to correlate very much with sexual behavior, though you may believe otherwise if you have immersed yourself in HIV industry literature.

For example, birth rates are high in Kenya’s Northeastern Province, condom use is low, education is low, poverty is high, intergenerational marriage and sex rates are high, all things thought to relate to high HIV transmission; but HIV prevalence is the lowest in the country, lower than in some US cities.

The problem with the approach of UNAIDS and others is not that they employ ‘targeting’, as Brad suggests, but that their assumption implies that all sexually active people who engage in heterosexual sex are equally at risk in African countries. You can’t ‘target’ everyone in a population, or even half or a quarter of hundreds of millions of people.

Although UNAIDS and others claim that the bulk of HIV transmission is a result of heterosexual sex between people in long term monogamous relationships, with the implication that one or both partners must have had ‘unsafe’ sex outside of their relationships, they do not carry out contact tracing, that is, investigating ALL the possibilities for how each person was infected.

Most of the emphasis is on sexual transmission, and even then, sexual partners are usually not tested; when they are tested the HIV types are usually not matched. Therefore, it is almost always unknown how each person was infected, even though it is almost always assumed, in the absence of data to prove it, that each infection was a result of ‘unsafe’ heterosexual sex.

Effectively, UNAIDS and others in the HIV industry are not targeting any group because they don’t have a clue where to look. They assume that almost everyone who is HIV positive engages in ‘unsafe’ sex; they also assume that anyone who engages in any kind of sexual activity they consider to be ‘unsafe’ is a ‘risk group’, and that IS every sexually active heterosexual (or heterosexual who has sex with heterosexuals, or whatever nomenclature you care to adopt).

HIV status is not an indication of sexual activity, ‘safe’ or ‘unsafe’; and sexual activity is not an indication of HIV status or HIV ‘risk’. People in the US and other Western countries may object to contact tracing but in African countries it is vital. It has been avoided in African countries precisely because some have decided that it is a ‘bad thing’, that it ‘stigmatizes’ people, but as a result ALL African people in high prevalence countries have been stigmatized. The situation in Africa is not like the situation in Western countries and the sooner the HIV industry realizes that, the better.

AIDS, blood, HIV, iatrogenic, nosocomial , , , , ,

Tanzania: HIV Industry Still Failing to Collect Data on Non-Sexual Transmission

1 Comment Posted by on June 26, 2014

One of the many damaging consequences of assuming that HIV is almost always transmitted through usafe sex is that those working with HIV tend not to notice non-sexual transmission, such as through unsafe healthcare, traditional and cosmetic practices. This blog and site is littered with examples of these modes of transmission, and of the HIV industry studiously ignoring every instance of transmission that they can’t explain away as being somehow related to sexual transmission.

High rates of transmission among ‘older’ people, which refers to people who are more than 49 years old (my current age), always comes as a surprise to those working for the industry. The Victorian prudishness that seems to affect people working with HIV means that they believe everyone gives up sex at some arbitrary time in their lives. Bizarre!

But older people, and that means people over 50 in developing countries, where life expectancy is much lower than in Western countries, don’t only continue having sex. They may also require health services more frequently than younger people. While that may not surprise those in the HIV industry, they have had a lot of trouble with the notion that understaffed, underfunded, underequipped health facilities may not be able to provide the safest health services in the world.

Research carried out in Tanzania finds that HIV prevalence among people from 50-98 years was 7.8%, compared to the national figure of 5.1% for people aged 15-49 years. HIV prevalence was higher in urban than rural areas, in common with figures for Tanzania as a whole [note that this is the opposite to what is stated in the abstract but I’m assuming the following text and data are correct]. While prevalence was a very high 12.9% among people 50-59 years old, it dropped to 5.7% among the 60-69 years age group and 3.7% among the 70+ age group.

The two areas for which data was collected, Mufindi and Babati, are in one of the highest (Iringa) and one of the lowest prevalence regions (Manyara), respectively, in mainland Tanzania. Prevalence among 50-98 year olds was 3.7% in Babati and 11.3% in Mufindi. The figure for Mufindi is not so shocking compared to Iringa’s 9.1% prevalence; in contrast, the figure for Babati is more than double the figure for Manyara region, which stands at 1.5%.

But it’s a pity the breakdown for male and female figures for each area is not available. The ratio of female to male prevalence in Iringa is 63%, similar to the national figure of 61%. But the same ratio in Manyara is 11%; there are about 9 HIV positive women for every HIV positive man. Is this shocking ratio maintained among people between 50 and 98 years old?

As is usual with these studies, no data was collected about non-sexual transmission, whether through unsafe healthcare, traditional or cosmetic practices. While the authors conclude that interventions should now target ‘older’ people, they fail to consider non-sexual HIV transmission, which means that some of the most important risk factors will continue to be ignored, and HIV will continue to be transmitted, independent of anything the HIV industry spends its millions on.

AIDS, blood, HIV, iatrogenic, nosocomial , , , ,

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