Bloodborne HIV: Don't Get Stuck!

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Category Archives: institutional racism

Gag at the Stench of Bullshit: Durban HIV Conference


After decades of insisting that HIV in sub-Saharan African countries is almost always a result of ‘unsafe’ sex, and that infections can be averted by ‘abstaining’ from sex, being ‘faithful’ to one partner and using condoms, the massive HIV industry may now be admitting that these ‘behavioral’ approaches don’t work, and never have:

Dube believes that early access to ART (antiretroviral therapy) is the way forward after a decade of trying to change behaviour barely dented the transmission rate.

But the industry still insists that HIV is mostly transmitted via heterosexual (penile-vaginal) sex, in sub-Saharan African countries. Curiously outside of sub-Saharan Africa, the bulk of HIV transmissions are due to receptive anal sex and intravenous drug use.

The reasoning for this is not so complex: the vast majority of people engage in sexual intercourse at some time in their life. Just as the HIV industry really (really, REALLY) wanted behavioral programs to work, because few viable alternatives were acknowledged, now they really want antiretroviral drugs to work.

Instead of identifying people infected with HIV as early as possible, monitoring their health, and putting them on ARVs when they clearly need them, the HIV industry has come up with ‘treatment as prevention’, which means anyone testing positive for HIV will be put on ARVs, for the rest of their life.

Not content with getting as many HIV positive people on ARVs as possible, the industry has also come up with PrEP (pre-exposure prophylaxis). This means that people can go on ARVs before they are infected. The industry can then ‘target’ the people they say are in need of PrEP. After all, who wants to prevent infection with such a lucrative virus?

Hey presto! If almost everyone engages in sexual intercourse at some time, then almost everyone is at risk! The number of people infected with HIV globally is between 30 and 40 million (depending on whose figures you use), which might seem like a very large market for the bloodsucking HIV industry.

But in a few strategic moves, the market rockets to hundreds of millions, perhaps even a billion or so, as rubbish behavioral problems are dropped all over the developing world, to be replaced by the imposition of enormous drug programs. Sure, individuals don’t have to pay, but someone does; who, by the way, is going to pay?

Sex workers are an easy target, always have been. Even deciding who is a sex worker is a matter of debate among the HIV ‘experts’ (but certainly not among sex workers themselves). But how about the biggest HIV positive demographic in South Africa, which has the largest HIV positive population in the world? Teenage girls, many of whom are just becoming sexually active. What about giving PrEP to all of them, says the HIV industry?

Never mind prevention they say, treatment IS prevention they say, as they bank their billions and brand yet more sectors of the population as ‘at risk’. Meanwhile, young people are demanding things that they feel are important, such as sanitary pads and condoms (how much was spent on condoms over the last 20 years?)

Some people are even demanding cancer drugs. Why are some people not able to access these? Is it because cancer is old news? Not ‘sexy’ enough any more? Or is it because many of the patents on cancer drugs have long expired, and the number of people involved is only a fraction of the number of people who can have ARVs for life; cancer drug regimens are not life-long.

If HIV negative people are to be given ARVs to ‘protect them from infection’, what about people who are already HIV positive but still don’t have access to treatment? There are an estimated 20 million HIV positive people thought to be unable to access treatment (again, depending on who is counting, according to which methodology).

Poor Charlize Theron, who says it’s not an honor to host the Durban HIV conference because ‘we should have eliminated HIV by now’. So they didn’t tell her that this is the biggest opportunity in history that Big Pharma has had to put hundreds of millions of people on overpriced drugs that they will need for the rest of their lives?

Take a look at: Seeking the positives, by John Potterat


In an important contribution to the history of medical research, John Potterat’s new book, Seeking the Positives, recounts his involvement in research on sexually transmitted disease and HIV. Chapter 7 recounts researchers’ failure to explain how so many Africans get HIV (chapter 7 is available for download at http://home.earthlink.net/~jjpotterat/book.html).

The AIDS epidemic has been a disaster for tens of millions of Africans. What has not been widely recognized is the damage to medical research – epidemiologists have not done what is required to show how so many Africans get HIV. In a closed-door meeting at WHO in 2003, John described HIV epidemiological research in Africa as: “First World researchers doing second class science in Third World countries.”

How will the medical research community rebuild competence after its deliberate incompetence in not explaining and thereby containing Africa’s AIDS epidemic?

John’s book offers much more than a history of HIV research failures. He and his staff at the Colorado Springs public health department reduced STD in the community. Working with researchers from CDC and elsewhere, they tested new control strategies and documented what works – demonstrating the importance of contact tracing and network analyses to understand and limit STD transmission. Research in Colorado Springs has had an impact on STD prevention programs around the world.

But this is not only history – the human costs of research failures are continuing. According to the latest UNAIDS’ estimate, 1.4 million Africans got HIV in 2014 (see:http://www.unaids.org/sites/default/files/media_asset/AIDS_by_the_numbers_2015_en.pdf). If someone could tell Africans how they are getting HIV, they might be able to protect themselves and collectively to wind down their epidemic.

I recommend the book for reading in epidemiology classes – to foster truthniks and doubters, so we will have the experts we need in future health crises. When you get the book, I recommend you start with a brief look at Appendix 3, which lists individual and STD/HIV program awards.

Charging HIV-positive husbands and wives with adultry — and lying about it


return to first research page

A wife, husband, and children can be hurt when a gossip — with no evidence — spreads rumors that the wife or husband have lovers.

This situation threatens many HIV-positive married men and women in Africa. HIV prevention programs say most infected adults — including wives and husbands with HIV-negative partners — got HIV from lovers, even if there is no evidence they had lovers, and even if they deny it. Such HIV prevention messages are equivalent to rumors — averring without evidence that people had secret lovers and lied about it.

Researchers have supported such unfounded “rumors.” For example, a UNAIDS-funded study in Zimbabwe followed adults to see who got HIV and what were their risks. After finding and reporting that “[t]hirteen of 67 individuals seroconverting in this study reported no sexual  partners in the inter-survey period..” the authors opined: …misreporting of sexual behaviour may explain some of these infections….”[1]

Wife with HIV, husband without

Many women are victimized by such unsupported suspicions. National surveys in 24 African countries during 2010-14 report the percentages of couples with HIV in one or both partners. In 14 of 24 countries, if a married woman was HIV-positive, more than 50% of husbands were HIV-negative (Table 1). This is not explained by women getting HIV before marriage – even among married women aged 30-39 years, an HIV-positive wife was more likely to have an HIV-negative than an HIV-positive husband in 12 of 24 countries (Table 1).

Table 1: Among married women who are HIV-positive, what % of  husbands are HIV-negative?

wife+ husband-

Sources: Demographic and Health Surveys and AIDS Information Surveys for each country available at: http://www.dhsprogram.com/Where-We-Work/Country-List.cfm (from this link, click on the country and then the survey, and then go to the chapter that reports HIV prevalence).

Seeing such data and recognizing “women’s low self-reported levels of extramarital sex, a World Bank economist opines: “…I conclude that the sizable fraction of discordant female couples is extremely difficult to explain without extramarital sex among married women.”[2]

Most countries in Africa routinely test pregnant women for HIV. Hence, the wife is often the first partner to know her status. If the husband subsequently goes for a test, he is more likely to test HIV-negative than HIV-positive in most countries across Africa.

What is he to think? Should he believe his wife? Or should he believe healthcare professionals (behaving like gossips) who propose his wife lied? It is relevant, as well, that healthcare professionals have a conflict of interest – the alternative to blaming wives for adultery is to acknowledge their HIV may have come from unsafe healthcare.

Husband with HIV, wife without

Similarly, blaming all HIV on sex encourages wives to blame HIV-positive husbands for having lovers and lying about it. In 15 of 24 countries, when the husband is HIV-positive, at least 50% of wives are HIV-negative (see Table 2).

Table 2: Among married HIV-positive men, the % of wives HIV-negative

husband+ wife-
Sources: Demographic and Health Surveys and AIDS Information Surveys for each country available at: http://www.dhsprogram.com/Where-We-Work/Country-List.cfm (from this link, click on the country and then the survey, and then go to the chapter that reports HIV prevalence).

References

1. Lopman, Garnett, Mason, Gregson. Individual level injection history: A lack of association with HIV incidence in rural Zimbabwe. PLoS 2008: Med 2(2): e37. Available at: http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pmed.0020037&representation=PDF

2. de Walque D. Sero-discordant couples in five African countries: implications for HIV prevention strategies. Pop Dev Review 2007; 33: 501-523. Abstract available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1728-4457.2007.00182.x (accessed 28 October 2018).

Cambodia


Roka Commune outbreak

In November 2014, a 74-year old man in Roka Commune, Cambodia, tested HIV-positive. He sent his granddaughter and son-in-law for tests. They also tested positive. Alarmed by these unexpected HIV infections, more residents of Roka Commune went for tests; many were HIV-positive.

The next month, December 2014, Cambodia’s Ministry of Health initiated an investigation with collaboration from WHO, the US CDC, UNAIDS, UNICEF, and the Pasteur Institute in Cambodia.[1]

Three papers report results from this investigation.[2,3,4] Results are limited to 242 persons testing HIV-positive through end-February  2015. Comparing HIV-positive residents with neighbors, infected residents had received more injections, infusions, and blood tests. Reports say nothing about specific failures in infection control (e.g., did providers give injections after changing needles but reusing syringes? did providers give infusions with reused plastic tubes and saline bags?). Many persons were co-infected with hepatitis C, which unsafe healthcare had been spreading in the community for years before the HIV outbreak.

Foreign organizations helping with the investigation sequenced several hundred HIV (determined the order of their constituent molecules) from the community. Almost all sequences were very similar, showing fast transmission from 1 to 198 infections in 15 months, September 2013 to December 2014 (see Figure 2b in [4]). These sequences can be presented as branches in a “tree” (see below, Figure 1; this tree uses most of the same sequences as reference 4, but suggests transmission took several years rather than 15 months). The upper right section of the tree shows the cluster of very similar sequences from Roka. (Most sequences in the lower part of the tree are “controls,” which means the HIV came from other times and places.) The tree shows each HIV infection as the right end-point of a short horizontal line. The left ends of these lines show estimated connections to earlier estimated infections. The timeline at the bottom of the figure shows time going from left to right, showing the estimated dates of transmission from earlier to later infections.

Figure 1: Cluster of 198 infections in Roka, Cambodia, linked by transmissions during 2011-14[5]

env_timetree_baltic (1)

Using information from these reports, one of the managers of this website (DG) estimated the transmission efficiency of HIV through contaminated injection equipment at 4.6%-9.2% (this is the risk that an injection administered to an HIV-positive person during the outbreak transmitted HIV to a subsequent patient).[6]

Other information related to the Roka outbreak

In early 2017, a newspaper article reported 292 infections in the outbreak.[7]

As in many other nosocomial HIV outbreaks, children were on the front lines: 22% of cases were in children <14 years old.[2]

Alerted by the investigation, people looked for unexpected infections and unsafe practices elsewhere in Cambodia. A December 2015 BBC article – one year after Roka broke into public view – reports continued and common unsafe practices.[8] In mid-February 2016, an NGO reported 14 patients testing HIV-positive – 10 from Peam village in Kandal Province, a village of 1,000, and 4 from neighboring villages[9]. The article reported 32 previously known infections in Peam village, for a total of 42 or 4.2% of 1,000 villagers. In interviews, persons newly identified with HIV denied sexual risks and suspected infection from injections by a specified local doctor.

See also these dontgetstuck.org blogs posts

References

1. Eng Sarath. Ministry of Health, Cambodia. 24 December 2014. HIV cases in Sangke district, Battambang. Available at: http://www.cdcmoh.gov.kh/97-hiv-cases-in-sangke-district-battambang

2. Mean Chhi Vun et al. Cluster of HIV infections attributed to unsafe injections  – Cambodia December 1, 2014-February 28, 2015. Morbidity and Mortality Weekly Report 2016: 65:  142-145. Available at: http://www.cdc.gov/mmwr/volumes/65/wr/mm6506a2.htm (accessed 28 March 2016).

3. Saphonn V, Fujita M, Samreth S, et al. Cluster of HIV infections associated with unsafe injection practices in a rural village in Cambodia. J Acquir Immune Defic Syndr 2017; 75: 285-e86. Available at: https://journals.lww.com/jaids/Citation/2017/07010/Cluster_of_HIV_Infections_Associated_With_Unsafe.19.aspx (accessed 12 February 2018).

4. Rouet F, Nouhin J, Zheng D-P, et al. Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014-2015. Clin Infect Dis 2018; 66: 1733-1741. Available at: https://pubmed.ncbi.nlm.nih.gov/29211835/ (accessed 24 February 2021).

5. Roka/HIV/bayesian_timetree. Evolutionary and epidemiological analysis of the Roka HIV outbreak. Bedford Lab. Available at: https://bedford.io/projects/roka/HIV/bayesian_timetree/ (accessed 15 November 2018). This figure has been copied by permission from Bedford Lab.

6. Gisselquist D. HIV transmission efficiency through contaminated injections in Roka, Cambodia. biorxiv 2017. Available at: https://www.biorxiv.org/content/biorxiv/early/2017/05/15/136135.full.pdf (accessed 12 February 2018).

7. Millar P. How the residents of Cambodia’s “HIV village” are coping more than two years on. Southeast Asia Globe, 15 March 2017. Available at: http://sea-globe.com/how-the-residents-of-cambodias-hiv-village-are-coping-more-than-two-years-on/ (accessed 14 August 2017.

8. John Murphy. BBC, 17 December 2015. A country in love with injections and drips.
Available at: http://www.bbc.com/news/magazine-35111566

9. Aun Pheap, George Wright. Doctor denies spreading HIV in latest outbreak. Cambodia Daily News 22 February 2016. Available at: https://www.cambodiadaily.com/news/doctor-denies-spreading-hiv-in-latest-outbreak-108791/ (accessed 28 March 2016).

See also:

Kehumile Mazibuko. News Tonight Africa, 4 December 2015. Cambodia: unlicensed medical practitioner sentenced for infecting more than 100 people with HIV. Available at: http://newstonight.co.za/content/cambodia-unlicensed-medical-practitioner-sentenced-infecting-more-100-people-hiv

Khy Sovuthy, Anthony Jensen. Cambodia Daily, 8 December 2015. In HIV case, key evidence trails behind guilty verdict. Available at: https://www.cambodiadaily.com/news/in-hiv-case-key-evidence-trails-behind-guilty-verdict-102320/

Why do UNICEF, WHO, and UNAIDS choose to stigmatize rather than protect African youth?


(return to first research page)

Beginning in early 2015, UNICEF with UNAIDS, WHO, and other organizations initiated the All In to #EndAdolescentAIDS program. The program has some good points – e.g, promoting more HIV testing and better treatment for HIV-positive adolescents.

However, the program is off the mark on prevention. It says nothing about risks adolescents in Africa face to get HIV from blood-contaminated instruments during health care (blood tests, dental care, injections, etc) and cosmetic services (tattooing, manicures, hair styling).

Ignoring such risks while focusing only on sex stigmatizes those who are already infected (aha! you had careless sex!) and misleads those who are HIV-negative to ignore blood-borne risks.

Evidence HIV-positive adolescents did NOT get HIV from sex

The best available evidence – from national surveys – suggests less than half of HIV infections in African adolescents came from sex. For example, in national surveys in Kenya, Lesotho, and Tanzania, majorities of HIV-positive youth aged 15-19 years reported being virgins (Table 1). Across these three countries, 57% (36 of 63) HIV-positive youth in the survey samples reported being virgins.[1]

table 1 adolescents

Some HIV-positive teens may have gotten HIV from their mothers when they were babies; but without antiretroviral treatment (ART), which arrived late in Africa, survival to adolescence would be unusual. Thus most adolescent virgins with HIV likely got it from blood contacts. If virgins are getting HIV that way, some non-virgins are likely getting it the same way.

Using data from national surveys in Lesotho, Swaziland, and Zimbabwe, and assuming no lying about sexual behavior, Deuchert estimates only 30% of HIV-positive never-married adolescent women aged 15-19 years got infected through sex.[2] What if some lied? Deuchart does the math: “The assumption that HIV is predominantly sexually transmitted is valid only if more than 55% of unmarried adolescent women who are sexually active have misreported sexual activity status.” (Tennekoon makes a similar analysis.[3])

But let’s cast the net wider: During 2003-15, 45 national surveys in Africa reported the %s of (self-reported) virgin and non-virgin youth aged 15-24 years with HIV (see Table 2 at the end of this blog post). Young men and women got HIV whether or not they virgins.

For example, in Congo (Brazzaville), Rwanda, Guinea (2012), Democratic Republic of the Congo, and Gambia, the %s of young women that were HIV-positive was greater among virgins than among all young women. Among young men, the % with HIV was the same or greater among virgins vs. all young men in Tanzania (2007-08), Congo (Brazzaville), Sierra Leone (2013), Guinea (2005), Mali, Sao Tome and Principe, Burundi, Benin, Burkina Faso, Niger, and Gambia.

Across all 45 surveys, the median ratio of the %s of self-reported virgin young men with HIV to all young men with HIV was 0.75 (last line, Table 2). Across all 45 surveys, the median ratio of the %s of self-reported virgin young women with HIV to all young women with HIV was 0.33 (last line, Table 2). And, as noted above, many infections in non-virgins likely came from blood-borne risks.

The only way to say most HIV infections in adolescents in Africa come from sex is to throw away the best evidence we have – to assume survey data are wrong because self-reported HIV-positive virgins are lying. That seems to be what experts at UNICEF, WHO, and UNAIDS have done – ignoring evidence to accuse HIV-positive adolescents of unwise sex, and accusing them also of lying if they say they are virgins.

Stigmatizing HIV-positive African youth for unwise sexual behavior is a form of abuse. Because young women are more likely than young men to be exposed to HIV during more frequent health care and cosmetic procedures, not warning about bloodborne risks contributes to unrecognized violence and abuse targeting African women.

table 2d adolescentstable 2e adolescents

References

1. Brewer DD, Potterat JJ, Muth SQ, Brody S. Converging evidence suggests nonsexual HIV transmission among adolescents in sub-Saharan Africa. J Adolescent Health 2007; 40: 290-293. Partial draft available at: https://www.deepdyve.com/lp/elsevier/converging-evidence-suggests-nonsexual-hiv-transmission-among-105k5VXKQE (accessed 19 December 2015).

2. Deuchert E. The Virgin HIV Puzzle: Can Misreporting Account for the High Proportion of HIV Cases in Self-reported Virgins? Journal of African Economics, October 2011, pp 60-89. Abstract available at: http://jae.oxfordjournals.org/content/20/1/60.abstract (accessed 19 December 2015).

3. Tennekoon VSBW. Topics in health economics. PhD dissertation. Washington State U, 2012. Available at: http://research.wsulibs.wsu.edu:8080/xmlui/bitstream/handle/2376/4270/Tennekoon_wsu_0251E_10484.pdf?sequence=1 (accessed 18 December 2015). See also an earlier paper by

 

 

 

 

 

HIV and the Real(ly Lucrative) Risks


In an article entitled the ‘real’ risks of sex with someone who has HIV, the authors concentrate on a handful of considerations, but don’t mention some of the most important risks. They seem intent on advertising (or advertorialing) HIV drugs, like a lot of these media articles. Also, the article is about a HIV positive American celebrity, so there may be no real intention of informing people about HIV.

Anyhow, the gender of the HIV positive person is not mentioned. In Western countries, very few males are infected through heterosexual sex. The majority are either infected through male to male sex or through injected drug use. Of course, many may claim to have been infected through heterosexual sex, and even believe they were. But the chances of a man being infected by a HIV positive woman through penile-vaginal sex are so low that there are few documented instances, where there is no possible doubt about the source of the infection.

The position is completely different for women. It is perfectly possible for a HIV positive man to infect a HIV negative woman through penile-vaginal sex, although the risk is not especially high. There are many other factors that can increase the risk, and they are too numerous to list, but the overall health of both parties may be an important one. This is not just about sexual health, but rather the state of each person’s immune system at the time.

Anal sex is also a significant risk for men and for women. But the risk for a man who never engages in receptive anal sex, only insertive anal sex, remains far lower, and this is the case for anal sex with men and with women. The receptive partner, whether male or female is at very high risk. A lot of people wouldn’t admit to engaging in anal sex of any kind, and they may not always remember what they did and didn’t do.

There are even highly complex reasons why someone may be more susceptible or more infectious at a given time, or under certain circumstances. Too little is known about these matters and they will probably remain little understood until someone finds out how to make money out of such knowledge. Concentrating on therapies is a lot easier, because they are already the source of incredible amounts of money, even by pharmaceutical industry standards.

If you don’t know the most significant risks of being infected with HIV, or of infecting others, you can’t protect yourself from them. So this Yahoo! article is very dangerous. But it is merely a function of the relationship between Big Pharma and big media. In the end, such sources of dis/information are not the best way of protecting yourself or others from HIV and other diseases. Broaden your research base, open your eyes, and think.

Zimbabwe: Thought Embargo at HIV Inc to Continue Indefinitely


The Zimbabwean health minister, David Parirenyatwa, has exposed his complete ignorance about the country’s HIV epidemic by claiming that there is ‘rampant homosexuality’ in prisons, and that this is making an especially large contribution to high rates of HIV transmission in these institutions.

Naturally, there are some men who have sex with men in prisons, and not just in Zimbabwe. But that is not just because men are more likely to have sex with men when incarcerated for lengthy periods with men, denied conjugal visits and other rights. It’s also because having sex with someone of the same gender can itself attract a prison sentence.

However, what the health minister fails to realize is that there tend to be very poor health services in prisons. If he had inspected health services in prisons he would have come to a very different conclusion. Indeed, had he inspected health services outside of prisons he would also have come to a different conclusion about Zimbabwe’s massive HIV epidemic.

Prevalence in Zimbabwe had already reached about 15% in the early 1990s (compared to about 1% in South Africa). But it shot up to almost 30% before the end of the decade, then dropped back to early 1990s levels in less than 10 years. The figure has remained at roughly half its peak for the last decade or so.

The death rates required to bring prevalence from 30% to 15% in less than 10 years must have been phenomenal. Did the esteemed (and I’m sure astute) Parirenyatwa notice a sudden rise in prison populations during the 1990s, followed by a profound drop, with a subsequent flatlining thereafter? Or a sudden rise in male to male sex? Or a sudden rise in ‘unsafe’ sex among heterosexuals?

I don’t think so. But I also doubt if the health minister has a clue what was going on in the country’s health services then, or perhaps now. Massive increases in HIV transmission during the 1990s was very likely a result of a decrease in levels of safety in health facilities, along with a probable increase in usage of health facilities.

Minister, HIV is most efficiently transmitted through unsafe skin piercing procedures, such as injections with reused injecting equipment, surgical instruments, etc, also through unsafe body piercing and tattooing, and even through unsafe traditional practices, such as scarification, blood oaths and others.

Just how unsafe would cosmetic and traditional practices be in a prison? We can only guess. How safe would they be elsewhere? It’s unlikely anyone has checked. If they have, they would have found it difficult to publish the findings.

It’s easy to blame high HIV prevalence on ‘promiscuity’, male to male sex, carelessness, stupidity, malice and other phenomena, so beloved by journalists and others milking the HIV cow, far too easy. But ministers, journalists, academics, and even those who have reached lofty heights in international NGOs and the like, are still permitted to consider the roles of unsafe healthcare, cosmetic and traditional practices. I invite them to do so.

‘African’ Sexuality: Consensus or Prejudice?


An article by Damien de Walque, entitled ‘Is male promiscuity the main route of HIV/AIDS transmission in Africa?‘, seems curiously behind the times. He refers to the “pervasive if unstated belief in the HIV/AIDS community…that males are primarily responsible for spreading the infection among married and cohabiting couples”.

Disturbingly, de Walque goes on to conclude that, because women are as likely as men to be the infected partner in discordant relationships (where only one partner is HIV positive), both male and female promiscuity must be the main route of transmission. This is by no means the only possible conclusion; far more women than men are infected with HIV in high prevalence African countries, but this could be a result of other risks, particularly non-sexual risks.

However, women being almost as likely as men to be the infected partner in discordant relationships was not a new discovery when de Walque was writing in 2011. Gisselquist, Potterat, Brody and Vachon published an article in 2003 entitled ‘Let it be sexual: how health care transmission of AIDS in Africa was ignored‘, which presents evidence from the 1980s showing that women are almost as likely as men to be the positive partner in discordant relationships. They also show that neither is promiscuity the main route.

The article by Gisselquist et al looks back at papers from the 1980s demonstrating clearly that the bulk of HIV transmission in African countries is not sexually transmitted. Data collected about sexual behavior does not support the view that Africa is exceptional. Rather, data about other risks, such as unsafe healthcare, cosmetic and traditional practices was either not collected, or was ignored.

Even the abstract gives a good sense of what was going on in the 1980s (and is still going on). I’ll cite it in full, adding italics for emphasis:

“The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988.We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.”

Consensus among influential experts should be based on available data; not only did these experts ignore a lot of available data, they failed to collect a lot of data that could have led to a very different consensus. But several long-held preconceptions, for example, about ‘African’ sexual behavior, may have had undue influence on the consensus of these experts. It is these preconceptions that I am interested in.

By claiming that UNAIDS is going to change its name to UNAZI (as far as I know, they are not going to), I wished to draw attention to the fact that the still current claim that HIV is almost always transmitted via heterosexual contact in African countries (but nowhere else) is based on the preconceived views of some very prejudiced ‘experts’. UNAIDS acquired a consensus of experts who had decided, before the institution was established, that they were going to concentrate almost exclusively on heterosexual transmission, and diminish the role of unsafe healthcare and other non-sexual transmission routes.

The big lie about HIV in ‘Africa’ is that 80% (sometimes 90%) of prevalence is from ‘unsafe’ heterosexual sex, and most of the remaining 20% (or 10%) is from mother to child transmission. This lie emerged in the 1980s, from ‘experts’ who knew that it was a lie. The entire HIV industry is still based on this lie three decades later. As a result, most African people are unaware that unsafe healthcare, cosmetic and traditional practices may be a far bigger HIV risk than sexual behavior.

UNAIDS Becomes UNAZI – Focus At Last?


UNAIDS reached 20 and became 21 without anyone really noticing. HIV prevalence had peaked in some of the worst affected countries by the time the institution was established, but many epidemics had only just begun.

For example, HIV prevalence in South Africa was very low in 1990, probably less than 1%. Along with several other southern African countries, prevalence rocketed for much of the following 10 to 15 years, eventually making this zone the worst affected in the world.

HIV epidemics tend to concentrate in certain zones, rather than in certain countries. A large area in southern Africa constitutes one of these zones, taking in much of South Africa, Zimbabwe, Zambia, Botswana, Swaziland, Lesotho, Namibia and parts of Mozambique and Malawi.

But some zones are not best described by national boundaries. The areas surrounding Lake Victoria, for example, make up another zone, bringing together a large proportion of the HIV positive population of Kenya and Uganda (and, formerly, Tanzania).

Many HIV zones are cities, such as Bujumbura and Nairobi, hotspots, surrounded by relatively low prevalence areas. But some zones are more rural and isolated from big cities, such as the Njombe region of southern Tanzania, where prevalence is higher than anywhere else in the country.

All the northern African countries make up a very low prevalence zone, with most western African countries making up a higher prevalence zone. Central Africa and the western Equatorial area are fairly low prevalence, but eastern Africa used to be the highest prevalence zone, and there are still several million people living with HIV there.

So the United Nations Aids Zones Initiative is, presumably, going to make distinctions between ‘Africans’, who have all been lumped together by UNAIDS. Rather than referring to, say, Kenya’s epidemic, there will be the Lake Victoria Zone, the Mombasa Zone, and so on. After all, prevalence in some parts of the country is lower than in many rich countries, such as Canada.

A country like Tanzania, where 95% of the population is HIV negative (and only about 2% of the population are receiving treatment), will now be able to spend health funding on diseases that affect many people, diseases that have long been ignored. Health services there and in other countries should benefit considerably from the creation of UNAZI.

But the most important change will be in the received view of HIV, the view that it is almost always transmitted through heterosexual sex in ‘African’ countries (though nowhere else in the world). UNAZI will not be able to claim, as UNAIDS did, that there are certain zones on the continent where heterosexual practices are somehow exceptional!

We can look forward to an immediate reduction in the stigma that goes with branding anyone infected with HIV as promiscuous (or as a helpless victim of promiscuity). Whatever explains the concentration of HIV in these zones will be unrelated to sexual behavior; the explanation is far more likely to relate to unsafe healthcare, even unsafe cosmetic and traditional practices (although the first is the main suspect).

UNAZI will be much more than a change in name, or a change in focus. It will also be an exit strategy, a way of attending (belatedly) to the main causes of HIV epidemics, without admitting that UNAIDS and their chums have been lying for so long, of course. UNAZI will probably only last long enough to ‘turn off the tap’ that UNAIDS never acknowledged, and then quietly re-merge with WHO.

Paying for Sex and Paying for Chastity: All the Same?


Offering money to young girls in return for an undertaking by them to have less sex, or to take precautions against infection with sexually transmitted infections and unplanned pregnancy, strikes me as inherently contradictory. If you want to make money out of your body, what difference does it make whether you achieve that by agreeing to have sex, or by agreeing not to have sex?

Imagine you wish to make money in these ways: you have clients who pay you to have sex; and you have clients who pay you not to. The two types of client are perfectly compatible. Instead of making eight dollars a day (100 Rand), week or month, you can make sixteen, or you can use the payment as leverage to charge some clients more, or as a subsidy to charge some less.

These ‘conditional cash transfers’ seem to be based on a number of assumptions. For a start, they seem to assume that HIV is almost always a result of sex, generally extra-marital sex, and generally ‘unsafe’ sex. They also seem to assume that protecting themselves against being infected with HIV is within the control of the recipient of the money.

What about non-sexually transmitted HIV, through unsafe healthcare, cosmetic or traditional practices? Don’t people infected in that way need money too? Shouldn’t they be encouraged to avoid health facilities where conditions are dangerous, also practitioners who have a poor record for safety?

By the way, the recipient of money is always female. Therefore, it is further assumed that the male with whom the female has sexual intercourse is usually the ‘index case’, the one more likely to be HIV positive. (All men are sexual predators and all women are sexual victims, at least in the world of HIV.)

But, as it turns out, most young males in South Africa and other sub-Saharan African countries tend to be HIV negative. Far more females than males become infected, some in their teens, but far more in their twenties, and many in their thirties. So who is doing all this infecting?

This requires another assumption: the girls/women are having sex with men who are older than them, often much older. There are several problems with this attempt at rescuing current HIV ‘policy’ and thinking: many females do not have sex with men who are much older than themselves; many ‘older’ men are not HIV positive; and many females are infected even though their sexual partners are roughly the same age as themselves.

Worse still, some girls/women are infected even though they either have not had sex, or they have always taken precautions. In fact, using condoms is more strongly associated with higher HIV prevalence than not using condoms. Those trying to dig themselves out of this hole claim that people who know they are HIV positive are more likely to use condoms. But this claim is not well supported by evidence.

‘Intergenerational’ marriage and sex, where one partner (usually the male) is older than the other, used to be the darling of the anti-sex brigade. But very little research was carried out into whether it really resulted in higher rates of HIV transmission. When some research was carried out it was found that it may be associated with lower rates of transmission.

Back to the drawing board? Well, no, actually. As well as persuading girls/women not to have sex (or the wrong kind of sex, or sex with the wrong kind of person, etc), there are conditional cash transfers for men who agree to be circumcised. It works, too. Not very well. Not many men will agree to be circumcised for a few dollars.

Unsurprisingly, more men will agree to be circumcised if they are paid more money, and fewer if they are paid less. But most of the men who agree to the operation would have already agreed to it without the payment; they were already convinced that circumcision would be the answer to their prayers (or what they thought were their prayers).

There is cash to stay in school, even though this is not associated with lower HIV incidence. The payments may continue because school is a good thing. But didn’t we know that already? Didn’t we already know that all children should go to school and that there should be equal access for all children, regardless of their gender, tribe, religion, etc?

There is cash to support prevention of transmission of HIV from mother to child. What about reducing infection in mothers? Many are infected when they are already pregnant, even late in their pregnancy, or just after giving birth. Many infected have husbands who are negative. These women are unlikely to have been infected through sexual intercourse, despite the constant pompous and racist prognostications of the HIV industry.

Sometimes the payment, or some of it, goes to the family. Great, so poverty is a bad thing; and another thing we just wouldn’t have known if it hadn’t been for this research? The World Bank made a big hoo hah recently about how wonderful eradicating human parasites is, how much better off children are, with improvements in health, academic achievement, etc.

But human parasites are debilitating and result from appalling living conditions. They are also easily and cheaply treated. Aside from the clever medications, provision of water and food of a quality appropriate for human consumption can also significantly reduce the problem. Why so much research to tell us what we already know? Why so much research telling us that a lot of what we are doing is wrong, yet the research, and much of what we are doing, both continue.

Something all of the above failed approaches have in common is that they show that HIV is not very closely related to sexual behavior. It is not just that attempting to influence someone’s sexual behavior often fails; successfully influencing someone’s sexual behavior also fails to reduce HIV transmission.

Conditional cash transfers that assume HIV is almost always a result of sexual behavior don’t just frequently fail to influence sexual behavior, they fail to prevent HIV transmission. Mass male circumcision has been shown to reduce HIV transmission from females to males, only slightly, and only under certain conditions; but it increases transmission from males to females.

These same researchers have been working on the same unpromising initiatives for many years, even decades: Karim, Pettifor, Jukes, Thirumurthy, etc. However, their racist bilge doesn’t fail because it is racist, it fails because it is based on assumptions that are not borne out by their own findings. Except in the minds of journalists, there is no ‘money, sex, HIV’ triad in Africa; HIV is also transmitted through non-sexual routes, such as unsafe healthcare, cosmetic and traditional practices. Let’s try dealing with that.