Bloodborne HIV: Don't Get Stuck!

Protect yourself from bloodborne HIV during healthcare and cosmetic services

Category Archives: blood

More MDG Scapegoats: Industrial Disputes and Gay People


Another Millennium Development Goal (MDG) scapegoat. It sounds like bloody cheek to suggest that Kenya’s failure to reduce new HIV infections as quickly as predicted is a result of health personnel strikes. True, there have been strikes, but the country’s health services were decimated years ago by the strictures of international financial institutions and sheer neglect, and allowed to rot. Successive governments have also done an appalling job when it comes to industrial relations.

According to the article, Prevention of Mother to Child Transmission (PMTCT) coverage “fell by 20 percent in 2011-2012”, from 66% to 53%, representing 13,000 children newly infected with HIV. The 2015 target is close to 100% but, at 38%, Kenya seems unlikely to reach it, and the same could be said for most other African countries. However, there is nothing to back up the ridiculous claim that strikes played a significant part in such a massive fall in coverage.

The article does state that “Experts agree on the main reason behind the reduction in PMTCP – disruptions in the health services”, but that’s hardly a smoking gun. There have been numerous antiretroviral drug stockouts and other disruptions, for various reasons, and these may have a lot more to do with such a large drop in coverage.

Another possible problem in meeting the MDGs could be a transition process that PEPFAR funded programs have been going through. In South Africa it is estimated that “between 50,000 and 200,000 people may have fallen out of care in the transition”. Indeed, there are probably several reports available that would point to the reason for the fall in coverage, but journalists and politicians don’t seem to like reading reports.

Yes another article from Kenya has come up with an even more impertinent suggestion. It claims that there has been an ‘upsurge’ in gay sex, which is slowing the ‘war’ on HIV. The article suggests that Kenya has achieved a lot, with prevalence dropping from 7.2% to 5.6%. Perhaps they are expecting the next set of results to be less flattering.

Men who have sex with men face very high risk of being infected with HIV, and of transmitting it. But Kenya and most other African countries have refused to accept that this is a group that needs special attention, preferring to accept the HIV industry’s contention that most HIV transmission in African countries is a result of unsafe heterosexual sex. It sounds far more manly, doesn’t it.

Because transmission has decreased in some populations, the contribution of infections from men who have sex with men may look like it is increasing. But the claim that the country may not meet some of its MDGs because of an ‘upsurge in gay sex’ is as outrageous as the claim that industrial disputes are disrupting progress in reducing new HIV transmissions.

These are cheap shots at health personnel, gays and traditional birth attendants. But governments, NGOs, UNAIDS, donors and the lucrative HIV industry need all the help they can get when it comes to explaining why billions of dollars did not seem to result in particularly rapid declines in HIV transmission. There will be more to come.

Predicting the Millennium Development Goal Scapegoats


Come 2015 a lot of people will still be flailing about looking for scapegoats to explain their country’s falling short of various Millennium Development Goals. But one group of scapegoats must be well accustomed to having the finger pointed at them; traditional birth attendants (TBA). In an article from Uganda appearing on AllAfrica.com, TBAs are being “blamed for HIV among newborn babies”.

Is the finger of blame being pointed at them on the basis of research this time, or is it the usual politico/journalistic reflex? The sheer vagueness of the article suggests that it is based on the latter. What self-respecting politician or journalist would read research, anyhow? No checkable source is cited, though that’s nothing unusual for AllAfrica.com; and one of the people cited says “there are many deaths and new HIV infections among new babies that go undocumented and […] the statistics may be falling short of the exact number”.

If some of the new infections among babies are documented, why are they not also investigated? Are the mothers HIV positive? Or are some of the mothers HIV negative? HIV negative mothers with HIV positive babies are not uncommon, but investigations into this phenomenon in African countries is very rare indeed.

An obvious question for politicians, journalists and others who wish to indulge in the perennial practice of blaming people, whether they be TBAs, men who have sex with men, women, foreigners, truckers or whoever else, is why HIV prevalence tends to be a lot higher in areas where people have better access to health facilities. TBAs tend to be more common in isolated and rural areas, where HIV prevalence is generally a lot lower.

The suggestion is that TBAs are not able to protect babies of HIV positive mothers from being infected, whereas qualified health personnel may be able to prvent mother to child transmission. True as this may be, how are TBAs supposed to be able to resolve this problem themselves? If it is the case that about half of all deliveries are overseen by TBAs, rather than conventional health personnel, this is hardly the fault of TBAs. They are not drawing big salaries, nor are they receiving thorough training or any other incentives for their work.

There are severe shortages of skilled health personnel in Ugandan health facilities. The facilities are stretched beyond their limits already. Is the government going to import enough doctors, nurses and others to fill the 50-60% shortfall that many facilities are experiencing? And more importantly, if the health facilities are going to be even more oversubscribed than they currently are, how safe will they be then? They are not currently safe places to give birth and some health figures show that those attending health facilities could be at higher risk of being infected with HIV.

Before blaming TBAs, it would be a good idea to carry out some research to find out exactly how so many babies are being infected with HIV, and how many have HIV negative mothers. Once that is clear, Uganda will be in a position to figure out what to do next, though it remains to be seen whether the country will be provided with the means to do anything effective. Donors are often keen on providing various health services for high profile, newsworthy conditions, but they are a lot less enthusiastic when it comes to ensuring that health services are safe.

Justine Sacco: Dangerous Truths and Dangerous Falsehoods about HIV


An American on her way to South Africa is said to have Tweeted “Going to Africa. Hope I don’t get AIDS. Just kidding. I’m white!” This is a heartless and insensitive remark to make. But what makes it most heartless and insensitive for a white American to say it is the fact that it is so true. In the US, African Americans accounted for 44% of all new HIV infections in 2010, despite representing only 12-14% of the population. Also in the US, men who have sex with men are said to represent about 4% of the population, but account for 63% of all new HIV infections in 2010, and a disproportionate number of them are black/African American.

Even in South Africa HIV prevalence among white people is very low. But national prevalence is amongst the highest in the world and there are more HIV positive people in South Africa than in any other country. While America has the worst HIV epidemic in the developed world, with over 1.1 million HIV positive people, the majority of infections arise among men who have sex with men and (to a lesser extent) intravenous drug users. HIV infection among white heterosexuals who have no serious risks, such as receptive anal sex or intravenous drug use, is very low.

The American who tweeted the first stupid, but sadly true, remark offended so many people that she arrived in South Africa to find that a storm had erupted on Twitter and she had lost her job. So, to make matters worse, she made a statement to a South African newspaper which contained a dangerous but often heard falsehood:

“For being insensitive to this crisis — which does not discriminate by race, gender or sexual orientation, but which terrifies us all uniformly — and to the millions of people living with the virus, I am ashamed.”

This is completely untrue, as the figures for the US show so clearly. About two thirds of people living with HIV globally are black Africans. An estimated 60% of HIV positive people in Africa are female, compared to only 20% of new infections in the US in 2010. Hispanics and Latinos in the US made up 21% of new infections in 2010; the rate of infection was 2.9 times higher in Latinos than it was in white males; it was also 4.2 times higher in Latinas than in white women.

HIV most definitely does discriminate by race, gender and sexual orientation. This is not a new discovery, either. It may be an acceptable thing to say in certain circles, but we should never forget the differences between HIV in Africa, where the majority of HIV positive people live, and HIV in developed countries, where HIV is less prevalent overall, and is rare among heterosexuals who have no serious risk behaviors.

Justine Sacco, who tweeted the remark, is so right to think that she is very unlikely to be infected with HIV; a lot less likely than a black African, and also less likely than a black or Latino/Latina American. It is disturbing to think that so many people continue to believe or say otherwise. Why is HIV prevalence so high among black Africans and black/African Americans, yet comparatively low among white people, especially white men who engage in no serious risk behaviors?

Happy New Year to All our Visitors


In our first two full years online the Don’t Get Stuck With HIV website and blog has received 48,000 page views, over 31,000 of them in 2013. The number of monthly views has increased to a high of 3,600 in December 2013 and the daily average has reached 116 views in the same month.

With over 7,000 views, our Blood-borne Risks page (‘Estimated risks to transmit HIV through various skin-piercing events’) was the most popular, followed by the home page, at 6,000 views. Sexual transmission risks, our pages about dental care, tattooing, hairstyling (etc), bloodtests and injections all received over 1,000 views each.

Also, a couple of blog posts were very popular, especially ‘Have we ignored a very simple procedure that could significantly reduce the risk of sexual transmission of HIV to men from women?‘ (nearly 2,000 views) and ‘Denied, withheld, and uncollected evidence and unethical research cloud what really happened during three key trials of circumcision to protect men‘ (1,600 views). A post on genital hygiene also received almost 1,000 views.

An analysis of about 4,000 search queries, comprising about 500 search terms, revealed that searches about syringes, other medical instruments and their uses accounted for about one quarter of all queries. Tattoos, dental care, manicures and pedicures and HIV transmission risk accounted for another 1,300 queries. About 260 searches were about circumcision if you add in searches for ‘Prepex‘, which is a fairly popular subject.

We have had visitors from 177 different countries, although we only 10 or fewer page views from 64 of those countries. With nearly 20,000 views from the US since February 2012, no other country comes close, although nearly 5,000 have been from the UK. India, Canada and Australia have accounted for another 7,000 views.The highest number of views from an African country was 864, from South Africa.

Our top referrer, accounting for over 30,000 views, was Google, mostly Google.com; about 3,000 were from Google.co.uk. Facebook, Reddit, Twitter and a few other tools account for a few hundred views each, although stimulating referrals from Facebook and Twitter required a disproportionate amount of work.

We thank visitors for viewing our site and blogs. We hope you found what you were looking for. We welcome comments and feedback and are grateful for what we have received so far. Using the above data, we intend expanding and reorganizing Don’t Get Stuck With HIV over the next year and hope we keep expanding.

All the best for 2014!

Guardians of the Orthodoxy: Writing about Rights and Rites


[Cross posted from the Blogtivist site]

Following a facile article in favor of mass male circumcision on the Poz.com site (which I discuss on another blog), where the author went to some lengths to pretend he was not in favor of it, there is an article defending circumcision as a religious rite for Jewish people, with even a single mention of Muslims (at a time when even vaguely pro-Muslim, or non-anti-Muslim, sentiment in the media is particularly unfashionable) in the English Guardian. The title of the Guardian article reads: “A ban on male circumcision would be antisemitic. How could it not be?” The article purports to be a response to the Council of Europe’s ‘comparisons’ of male genital mutilation with female genital mutilation, with the author claiming there is no acronym for the former, suggesting that she has familiarized herself with neither the literature nor the operation.

But enthusiasm for circumcision is not confined to the operation as a religious rite. The big money is behind it as a ‘preventive’ against HIV and several sexually transmitted infections. Starting with adults and teenagers as targets for mass male circumcision campaigns, proponents have long been setting their sights on infants. Never mind the fact that most infants don’t engage in any kind of sexual behavior, least of all a kind that would be claimed to increase the risk of HIV transmission in those who have not been circumcised, not even by the most rabid proponent of the operation. Proponents of circumcision *want* to circumcise everyone, at all costs. What could be easier than starting with Africans, about whom few in the media care very much.

What has the Poz.com argument got to do with the Guardian article? After all, Poz.com is promoting circumcision for its claimed protection against HIV and the Guardian is promoting it as a religious rite. Well, both articles argue for the mainstream, financially sound view, the view that doesn’t fly in the face of current political sentiment and, more importantly, doesn’t fly in the face of important funders and supporters. Poz.com depends on big pharma for its funding, along with some other wealthy institutions. The Guardian does not (entirely), but the Guardian’s Development section is funded by the Gates Foundation. That is higly significant when it comes to circumcision: the Gates Foundation is not just pro-circumcision, it funds one of the three main websites that promote circumcision, the Clearinghouse on Male Circumcision for HIV Prevention (the other two are the WHO and USAID).

In fact, the Foundation has also funded research carried out on African participants, research that is highly questionable, ethically as well as empirically. The Guardian’s article doesn’t appear on their Development section, but the connection with as huge a figure in the realm of circumcision promotion as Bill Gates is of a significance that should not be dismissed lightly. In addition, the Guardian article defends circumcision as a religious rite, but the Poz.com article, by implication, opposes non-circumcision as a cultural right. Ethically and empirically dubious arguments are being shoved down the throats of Africans who do not currently circumcise, by people who do not consider for one moment that others have the right to choose not to circumcise, for cultural reasons. In Kenya, for example, it is for cultural reasons that members of the Luo tribe do not circumcise, and the same goes for many other Africans. It is not because they, like the Europeans, do not believe that the reasons given for mass male circumcision are completely unconvincing (arguments that have changed many times over the decades, except in the fervor with which they are expressed).

Back to Tanya Gold’s arguments in the Guardian. The Council of Europe, astutely enough, used the phrase violation of the physical integrity of the body’ to describe male circumcision. Even defenders of the operation could hardly deny that it violates the physical integrity of the body, could they? After all, that’s the point of it, as a rite and as a putative protection against HIV. Gold doesn’t tell us if she would object if the Council had attempted to suggest that parents be allowed to wait until their boys were old enough to decide whether to be circumcised or not. After all, compromises have been made before. Religious and cultural rites have been modified, even abandoned altogether. Tattooing and body piercing are not banned, but people are not permitted to tattoo and pierce parts of their babies, or even their children. These also violate the physical integrity of the body, although many people believe that they are worth having, for cosmetic or other reasons.

Even Gold is ‘repulsed’ by certain conditions that may surround circumcision, as if these conditions are not common. But most circumcisions are carried out in non-sterile, non-clinical conditions. In fact, like the violation of the physical integrity of the body, this is what makes them a matter of religious or cultural rite, rather than an operation that people can have carried out in a hospital, preferably when they are old enough to decide if they want to have their foreskin removed. Gold is not arguing for these conditions, but she is arguing for the religious right to perform circumcisions, and (perhaps) for the cultural right (or maybe she only considers Jewish circumcision to be worth defending? She is not clear on this.) Would Gold consider allowing parents to wait until their son could decide for himself? We expect those who perform rites and rituals we (in the West) consider repulsive, harmful, etc, to compromise or even abandon those rites and rituals. Why not discuss such a compromise with those who practice circumcision?

Gold objects to calling ritual circumcision a ‘violation of children’s rights’. But if there are exceptions to a law against violation of children’s rights, and violation of the physical integrity of the body in particular, how does this affect other children’s rights, even human rights in general? Can you argue that certain rights should be denied to those infants where parents believe that that would constitute a denial of their own religious rights to circumcise their child? Are human rights not interrelated, interdependent and indivisible: Gold seems to believe that circumcision does not involve violation of the physical integrity of the body, which is ridiculous, though she may prefer a different way of expressing the same thing. But she also seems to believe that circumcising infants is not a violation of their rights, and that banning infant circumcision denies parents their rights. She doesn’t make the distinction between infant circumcision and adult circumcision, but she seems to believe that the Jewish rite necessarily requires that it be carried out on infants.

Sadly, Gold has confined her arguments to the rights of Jewish people and chosen to write about antisemitism, rather than dealing with the broader issues of circumcision, human rights, the right to choose (particularly the right to choose not to circumcise), children’s rights and the like. True, she stuck her neck out by using the word ‘Muslim’ once and had the temerity not to include any other words beloved by journalists and home office officials as an accompaniment to the word ‘Muslim’, but she is clearly not in the business of standing up for what she believes in. It’s almost as if it’s not her job to believe in things. She invokes the typical ‘slippery slope’ argument: if circumcision is a “human rights violation against children… This is a trend – and so of course the next stage is prohibition.” We wouldn’t want to use emotive arguments, would we? There is a “dark marriage between human-rights agitators and racists”, according to Gold.

Which means that in objecting to infant circumcision, either as a religious rite or as a means of ‘preventing’ HIV, I am not just an antisemite, but I am also in bed with racists. I am supporting the “removal of Jews from Europe”. There was me thinking that I was arguing for human rights and against abuses of human rights, especially ones that journalists typically ignore, such as the rights of people who are not wealthy, or powerful, or perhaps people who are not even Guardian readers (who?), although I read the Guardian myself. Gold ends her piece with a sentiment that I would agree with if it were about journalists: “some Jews are always packed in their minds”. But I can’t reassert my credentials as a defender of human rights by accusing a journalist of having views that are formed independently of thought, evidence, logic or humanity; that’s shooting fish in a barrel.

What Happens when an ‘Activist’ Site is Bought off by the Multinationals?


The website ‘poz.com’, which is about HIV, but from a US point of view, has a recent article on circumcision by Ben Ryan, who is apparently a journalist. The strapline reads “Major studies support circumcision as prevention in Africa but a small yet vocal group argues the science is flawed. Can circumcision lower U.S. HIV rates?” The question is odd, because the article is not primarily about whether the operation can or can not lower transmission in the US (Ryan seems to suggest the answer is ‘yes’, but in a country where HIV transmission is predominantly among men who have sex with men and intravenous drug users, ‘no’ seems much more likely to be correct). The article is not really about the science either, but rather how that ‘science’ is used. (Even the title, ‘Cut to Fit’, sounds like an ironic reference to the author’s journalistic style.)

Ryan gives a selective review of the ‘science’ as he sees it, listing the major players in circumcision promotion, major in terms of the funding they receive, anyway. But all this is contrasted to an ‘ideological war’, by what Ryan brands as a small group of ‘dissidents’. The fact that many of those who oppose the imposition of mass male circumcision on tens of millions of African men who are not already circumcised, and male infants born to people who would not normally choose circumcision in infancy, are also scientists doesn’t seem relevant. The facts that skepticism is not inherently unscientific and that not all those who oppose mass male circumcision can correctly be referred to as ‘dissidents’ also seem unimportant to Ryan.

Although Ryan enjoys the term ‘intactivist’ to refer to people who oppose mass male circumcision on the grounds that the ‘science’ is highly flawed, this is not a widely used term by opponents. Some, like myself, oppose mass male circumcision on human rights grounds, and on the grounds that insisting on every man conforming to what is an American preference is an outrageous instance of cultural imperialism; but I certainly wouldn’t call myself an intactivist. According to Ryan, those who oppose mass male circumcision are mainly Americans and Europeans, without pointing out that those who promote it are almost all American, and all their funding is from America.

Part of the pretence of ‘giving both sides of the story’ involves interviews with people whom Ryan subtly belittles. One of those interviewed is John Potterat, who has carefully outlined the reasons for skepticism about the ‘scientific’ literature, which is freely available on the Social Science Research Network. According to Ryan and his favored informants, ‘dissidents’ are ‘hampering progress’, ‘spreading misinformation’ and ‘creating skeptics among those who stand to benefit’, the last referring to African people, whose future is being put in jeopardy because of a handful of unscientific people who are not epidemiologists or health scientists, and therefore should not hold an opinion on human rights or cultural imperialism, or so Ryan wants us to believe.

Ryan also interviews Rachel Baggaley, MD, who reassures us that the three million figure the WHO claims have been circumcised under the program sounds very low beside the 20 million originally hoped to ‘benefit’ from the operation because 20 million was an ‘aspirational’ figure; that the WHO had “underestimated the complexities and social sensitivities required to successfully promote the program in certain populations”. Could some of these ‘social sensitivities’ be similar to the views of the people Ryan considers to be a mere fringe of ‘dissent’? What Baggaley is delicately referring to is a dearth of safe health facilities, experienced health personnel and supplies needed to provide mass male circumcision that doesn’t result in a lot of botched operations and a huge increase in hospital transmitted HIV; also, that infuriating barrier to US cultural imperialism: foreigners, non-Americans.

Another ‘dissident’ cited is David Gisselquist, who has spent years publishing articles showing that unsafe healthcare and cosmetic practices may be making a significant contribution to the most serious HIV epidemics in the world, which are all in sub-Saharan Africa. The evidence for various types of non-sexually transmitted HIV is spread over hundreds of papers, written by people from various backgrounds, including public health, medicine, epidemiology and others. Indeed, one of the most important factors in transmitting HIV in African countries is circumcision itself, not just medical circumcisions carried out in unsafe health facilities, but also circumcisions that are carried out for cultural reasons, generally carried out in unhygienic conditions.

While presenting arguments against mass male circumcision in a context that makes them sound futile, Ryan lists the arguments for the program as if they were some kind of holy grail of truth, true for all time, in all places, as true for non-Americans as for Americans. Those pushing for the program keep going on about how similar the results of all the randomized controlled trials were, without this being held up to any kind of questioning; were these crusaders really so lucky, that all three trials came up with almost the same results? Why were the trials carried out in those areas, among those people, with those specific (poorly described) methodologies? Were any other trials carried out that may show the opposite effect? And why are the mass male circumcision programs going ahead in areas where HIV prevalence is already higher among circumcised men than uncircumcised men? What about current programs that are currently suggesting that mass male circumcision programs seem to be increasing HIV transmission, for example in Botswana and Kenya?

Oddly enough, Ryan gives the last word to Baggaley, who now refers to those who oppose the US funded mass circumcision of African men as ‘denialists’. She says they are generally not from high HIV prevalence countries, as if those promoting the program are. Seeing herself as having the perspective of a ‘young man in South Africa’, she finds objections to the operation to be ‘paternalistic’. Evidently she doesn’t see the paternalism in spending billions of US dollars on persuading people to be circumcised by telling them that there are numerous advantages to be enjoyed. How is that different from the various (also US funded) efforts to persuade poor people to be sterilized? How is that different from various syphilis ‘experiments’ carried out on African Americans, or similar ones carried out in Guatemala?

In stark contrast to Ryan’s stance of appearing to be ‘giving both sides of the argument’ while achieving no such thing, Brian D Earp has written a very cogent rebuttal of all the bits and bobs that Ryan thinks of as science. Earp does put his cards on the table: he is not undecided about whether mass male circumcision is a good or bad thing. But neither is Ryan, he just pretends to be. If you are interested in reading solid rebuttals of the arguments of those claiming to be ‘scientists’, and others, it’s worth reading Earp’s article in full. I can not do it any justice by paraphrasing it.

To conclude, branding people as ‘denialists’ or as being ‘unscientific’, even when the point is not a scientific one, or not entirely a matter of science, has a long history. Journalists pretending to be (or thinking that they are?) even handed is also an old trick. So people have to think for themselves: would you do it to someone you love, or would you wait till they were old enough to decide for themselves? And even if your answer is ‘yes’, and you would circumcise your son when he’s still an infant, does that mean tens of millions of African men should be persuaded by the US (and by US funded ‘Kofi Annan’ type figures) to do the same, using a hotch-potch of scare stories, half baked theories and outright lies, all dressed up as some kind of scientific canon, and that tens of millions of African infants should also be circumcised, their parents having been primed using the same body of ‘evidence’?

Risk of Blood-borne Viruses from Skin-piercing Beauty Treatments


In the light of several recent news reports, the Don’t Get Stuck With HIV site has created a new page on possible risks associated with use of skin-piercing products such as Botox and Malanotan. Injection of anabolic steroids and other performance enhancing drugs can carry similar risks, especially if they are administered in an unsterile environment, and/or administered by untrained or inexperienced providers. The UK Government has issued a warning, saying that steroid users are at higher risk of HIV and viral hepatitis. The Don’t Get Stuck With HIV page offers easy to follow advice to people considering such treatments.

Similar information and advice on injections in general is available throughout the Don’t Get Stuck With HIV site; healthcare risks aside from injections are discussed here. There is also information on risks from other cosmetic treatments, such as tattooingear and body piercingmanicures and pedicures and hair styling and shaving. However, beauty treatments that pierce the skin may be more risky than some of these other cosmetic treatments because instruments such as needles go deeper below the skin than tattoo needles, for example.

recent article on the BBC website draws attention to the concerns of a health watchdog about the safety of Botox injections in the UK. They are also questioning the safety of anabolic steroids, tanning agents and dermal fillers. These treatments can be obtained in salons, or they can be self administered. The article warns that sharing equipment can carry a risk of infection with HIV, hepatitis or other blood borne diseases. The UK’s National Institute for Health and Care Excellence (NICE) is currently preparing guidelines on these issues.

Botox is a prescription only drug. However, an Australian news network ran an article late last year about a ‘backyard botox’ clinic, a specific clinic in Western Australia where infection control practices were found to be lacking, highlighting some of the health risks involved. It is said that the risk of infection with blood-borne diseases is small, but nevertheless real. Some practitioners may offer such treatments in the home, where conditions are likely to be unsuitable.

In 2008, the BBC reported that a growing number of people in the UK are injecting themselves with an unlicensed hormonal tanning drug called Melanotan. It is possible that this drug is being sold illegally online, in salons, in gyms and in health and fitness centers.

Mainstream scientists have not explained Africa’s HIV epidemic. Why not?


John Potterat, a senior and well-published international expert on sexually transmitted diseases, has taken part in scientific debates about the relative contribution of sex vs. blood (injections, tattooing, etc) in Africa’s HIV/AIDS epidemics. He’s been frustrated for years. The loudest voices with the most money talking about HIV/AIDS in Africa — UNAIDS, WHO, USAID, Gates, and others — want to blame it all on sex. But they haven’t got the evidence to support what they say and what they want everyone to believe. Why are so many scientists who build their careers on HIV/AIDS in Africa so unscientific, so uncurious, and so careless about what they say and about the evidence?

Earlier this month, John Potterat published a brief but pointed and thoughtful critique of HIV research in Africa. You can download his article free from the SSRN website: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2310200

As a teaser, here’s the Abstract of the article:

The Enigma of HIV Propagation in Africa: Mainstream Thought Has Narrowly Focused on ‘Heterosexual Sex’

John J. Potterat, Independent consultant
August 14, 2013

Abstract:

Introduction: Three decades after the identification of AIDS, epidemiologists still do not fully understand HIV transmission dynamics in sub-Saharan Africa, nor its differential geographic and demographic spread.

Discussion: Despite mounting evidence suggesting a substantial role for nonsexual (puncturing) exposures in HIV transmission, researchers have not systematically investigated its impact on HIV propagation in Africa. Mainstream researchers initially reacted to this idea skeptically, then dismissed it in the short run as apostasy and chose to ignore it in the longer run. This research design flaw has been the Achilles Heel of efforts to explain the rapid propagation of HIV in Africa, a flaw that continues to this day — much to the detriment of scientifically trustworthy interventions.

Conclusion: A science that ignores potentially important modes of transmission, especially when confronted by challenging and respectable evidence, is inadequate and needs remedial attention.

Cock-ups happen. Parental Advisory: Read this first – your baby can’t


This is a guest blog by Jim Thornton, re-posted from Ripe-Tomato.org. This reposting does not include the disturbing pictures of mutilated baby’s penises. To see the complete posting with pictures, go to: http://ripe-tomato.org/2013/02/16/cock-ups-happen/

The World Health Organisation Manual for Infant Circumcision’s (available at: http://www.who.int/hiv/pub/malecircumcision/manual_infant/en/) sample information sheet for parents (p. 110) is not adequate. Here is the bit on surgical harms:

Complications during male circumcision are rare, being estimated to occur in 1 of every 500 procedures. These complications, which can be severe, include poor cosmetic outcome, bleeding, infection, injury to the penis and the removal of too much or too little skin.

Using “rare” for a 1 in 500 risk, when earlier the benefit of “avoiding the need for circumcision later in life” (about 1 in 2,000) is mentioned without qualification, is biased. The figure also applies to the best series. Less well organised services report rates up to 20%, e.g. Nigeria, available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560152/?tool=pubmed). Since the manual is for use in developing countries the possibility of higher complication rates should be mentioned. Finally, Complications, which can be severe, include poor cosmetic outcome… is clearly designed to play down severity.

But more importantly, catastrophic complications are omitted altogether. Fully informed consent means telling people everything, however rare, which might alter the decision of a reasonable patient/parent. In gynaecology we mention the 1 in 10,000 risk of temporary colostomy after laparoscopic surgery for example. Unless we have a double standard for Africa, the complications below, which all appear elsewhere in the guide, should be mentioned. Italic text and pictures are all taken from the guide.

HIV, and other blood borne infections.

In male circumcision programmes a major concern is the potential transmission of bloodborne […] HIV and hepatitis B virus, to […] patients. The risk of acquiring HIV from an HIV-infected person through a needle-stick injury is estimated at 0.3% […] . The risk of acquiring hepatitis B virus infection, after being stuck with a needle that has been used on a person with hepatitis B infection, ranges from 6% to 37%, […] Most instances of transmission of infection in health-care facilities can be prevented through the application of standard precautions. If “it is a major concern” and only “most […] can be prevented”, it should be mentioned.

Amputation of the penis [picture available at ripe-tomato.org]

This extremely rare complication can be minimized by using good surgical technique but is unlikely to be eliminated. Unfortunately, even under ideal circumstances and with experienced surgeons [it] continues to occur.

Destruction of the penis by electro cautery.

One should NEVER use an electric current [..] with a metal Gomco clamp. […] The use of electrocautery […] has resulted in total ablation of the penis during male circumcision. To avoid this devastating complication, surgeons must be educated that electrocautery has to be strictly avoided when using a Gomco clamp.

Urinary retention from retained Plastibell rings.

Some of the most serious complications ever seen [retention and bladder rupture] […] have resulted from retained Plastibells. Educating the family to closely monitor the wound and the infant’s urine output is paramount with the use of this device.

Penile necrosis following the Plastibell technique [pictures available at ripe-tomato.org]

These two poor fellows aren’t going to be great in the sack.

Degloving – removal of the skin of the shaft [picture available at ripe-tomato.org]

None of these complications are common, but they all occur. If infant circumcision programmes get rolled out widely in developing countries, it is inconceivable that everyone will read all 140 pages of the WHO manual In the real world sterilisation goes wrong, mismatched Yellen clamps get packed together, and diathermy and wrong sized Plastibells get used. Even if they don’t, infants wriggle. Parents should be told.

93% of South African Maternity Wards Unsafe for Mothers and Babies


Despite the constant claim from UNAIDS and the HIV industry that HIV is almost always transmitted through unsafe heterosexual sex in African countries, though nowhere else in the world, it has yet to be demonstrated how appalling conditions in hospitals in high HIV prevalence countries hardly ever result in HIV and other serious diseases being transmitted. After all, relatively unsafe conditions in Western countries have resulted in incidents of healthcare transmitted HIV on numerous occasions. TB has been transmitted in hospitals in South Africa. So why not HIV and other bloodborne diseases?

A recent audit carried out in South African hospitals found that 93% of maternity wards are not safe for mothers or babies. This is no surprise to people who have frequently commented on the fact that HIV prevalence is often higher among women who give birth in health facilities than it is among women who give birth at home. But South Africa has the highest HIV positive population in the world. Do UNAIDS and the HIV industry really want to stick to their contention that these conditions hardly ever result in HIV transmission?

In the past, UNAIDS’ response has been that they would prefer to see people attending health facilities, as it is better for their health. But there is a lot of evidence that health facilities are not safe places. Even the UN itself has issued guidance to their own employees to carry their own medical equipment when working in high HIV prevalence countries, as safety in health facilities can not be guaranteed unless they are ‘UN approved‘. So they can’t have it both ways: if health facilities are unsafe for UN employees, they are unsafe for South Africans.

In the absence of any other explanation, I would suggest that UNAIDS and the HIV industry exhibit a profound form of institutional racism and sexism (because far more women are infected with HIV than men). I could be wrong and the industry may have the best interests of South Africans at heart. But if that’s the case, why is almost all the industry’s literature about sexual behavior and a few other things considered to be illicit or even illegal, such as intravenous drug use, male to male sex and commercial sex work?

HIV transmission through contaminated blood is extremely efficient, which is why intravenous drug use is so dangerous. But the highest use of syringes and other skin piercing instruments is found in health facilities (and also in traditional medicine practices, pharmacies, hairdressers, tattoo parlors and various other contexts to which UNAIDS and the industry appears to be completely blind). Hundreds of millions of injections are given every year; the majority are either unnecessary or the treatment could be administered non-invasively.

Apparently the maternal mortality rate is a massive 310 deaths per 100,000 live births in South Africa. In addition to threatening the lives and health of mothers, these conditions threaten the lives and health of babies and young children too. People are not made aware of the dangers of hospital transmitted infections. And what hospital transmitted infection could be more of a risk in extremely high prevalence areas than HIV? The virus tends to be far more common in built up areas, close to main roads and hospitals. In contrast, it tends to be a lot less common in more rural and isolated areas.

Yes, people need accessible healthcare, but no, not at all costs. If healthcare is unsafe, as it clearly is in South Africa and many other African countries (where conditions can be so bad that most people don’t use health facilities, and HIV prevalence is a lot lower), this will not reduce the transmission of HIV or other diseases. The worst place to go if you want to avoid a transmissible disease is a hospital if conditions there are as bad as they are in most African countries. Indeed, some epidemics, such as ebola, have hospitals as their epicenter, and the epidemic is only stopped when the hospital is closed.

This is not to say that all health facilities are dangerous, though the majority of them seem to be in South Africa. Nor is it to say that all healthcare workers could be doing more harm than good, though a lot seem to be doing harm in South Africa. Congratulations to the country on publishing the report, but it won’t do anyone any good until people are aware of the risks they face, and especially of the fact that HIV is not always transmitted sexually. Some of the worst HIV epidemics were almost definitely started by unsafe healthcare practices. How do we know that these same practices are not still contributing to some of the worst epidemics?

Out of 3,880 hospitals audited, some other findings include:

  • Only 32 of the facilities audited complied with infection prevention and control;
  • Only two facilities could guarantee patients’ safety;
  • Just 161 facilities were clean enough to meet the audit’s tough standards; and
  • Staff attitudes towards patients were awful – just 25% of staff in clinics were found to embody positive and caring attitudes

It’s time to stop treating South Africans and other Africans as if they are somehow different from non-Africans, as if their sexual behavior is almost uniquely dangerous, as if everyone who is HIV positive must have engaged in some kind of illicit behavior. People need to know that hospitals are dangerous places so they can take steps to avoid being infected with HIV, TB, hepatitis or any other disease while in hospital. That means UNAIDS and the HIV industry need to give up their obsession with ‘African’ sexuality, sexual behavior and sexual mores. It’s not all about sex, so let’s act accordingly.