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Category Archives: media racism

Microcephaly: Zika or Pyriproxyfen?


The Ecologist runs an interesting article about the current media hype over Zika virus and its claimed connection with possibly high rates of babies born with microcephaly. According to The Ecologist, a much more likely possibility is the use of Pyriproxyfen to kill mosquito larvae by adding it to drinking water.

The fact that in most cases of microcephaly there is no evidence of Zika, and in most cases of Zika there is no evidence of microcephaly, makes the hypothesis sound a lot less convincing than newspaper reports would have us believe. Also, it is unclear how many children have actually been born with microcephaly; many suspected instances of causality have not been confirmed.

There’s a lot of money to be made from crop spraying and adding dangerous chemicals to drinking water, and a lot of support for it from international health institutions, such as the WHO, CDC and others. Names like Monsanto and Sumitomo Chemical (one of their strategic partners) also appear in The Ecologist’s article, but are absent from newspaper reports. Big industry has its interests to protect, and they can always depend on big media to help.

A report from Physicians in the Crop Sprayed Villages is summarized and brings up the thorny subject of diseases such as Zika and Dengue on the one hand, and poverty, environmental degradation, exploitation and marginalization on the other.

A British company called Oxitec is selling GM mosquitoes, which is a good way of persuading the public that GM is really a ‘good thing’, and won’t end up controlling the lives of small farmers and consumers, who make up the bulk of populations in Latin America and other developing regions.

Interfering with entire ecosystems is a favored method of pushing dangerous and unproven technologies, and the biggest players in the development industry will be jumping on the Zika bandwaggon over the coming months, if they haven’t already.

It remains to be seen whether Zika is or is not causally connected with microcephaly, and the question will be irrelevant to those who can smell a quick and healthy profit, as they all rally around to help (themselves).

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


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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?


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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.

Africans Several Steps Ahead of ‘Global’ Health?


Many articles about ebola continue to mention a two year old boy who was probably infected with the virus some time in December of 2013. The articles refer to the boy as the ‘index case’, as if his being infected set off the recent epidemic in West Africa.

In fact, working back from confirmed cases, the trail goes cold before December 2013. There is no data about the virus and the investigation becomes pure speculation at this point. There is no evidence that the boy was infected by a bat, nor is there evidence that bats or other animals in the area carry ebola.

Articles mentioning this two year old boy, bats, ‘corpse touching’ at funerals and even sexually transmitted ebola (of which no cases have ever been confirmed), are commonplace. It is not just the media that revel in them, but also many scientific and medical articles.

But the people of West Africa seem oblivious to many of the warnings they have been receiving about ebola. And maybe they are right?

Apparently Liberians are completely unconvinced about the dangers of eating bush meat.

In Guinea, cases of malaria and deaths from malaria far exceed numbers of people infected with ebola and deaths from ebola. More importantly, the number of deaths from malaria has increased because people have been avoiding health facilities, fearing they might be infected with ebola.

Worse still, their condition may be mistaken for ebola and they could end up in an ebola treatment unit, with other suspected ebola cases, some of which turn out to have the virus.

To fear health facilities in Africa is perfectly logical. Healthcare conditions in most African countries are appalling. Not just ebola, but HIV, TB, hepatitis and other diseases have been spread by unsafe healthcare practices, such as reused injecting and other skin-piercing instruments.

CDC, UNAIDS, WHO and other health agencies may be convinced by their own propaganda, but people in Guinea, Sierra Leone and Liberia are not. And, it seems, they have entirely valid reasons for ignoring this ‘official’ advice. Unfortunately, that means many people will suffer from and die from easily treated conditions.

But ‘global’ health is in crisis because those most likely to suffer from ‘global’ health conditions are probably least likely to trust health facilities in their country. The interference of various international agencies (or local offices of international agencies) is only likely to increase this mistrust.

Nigeria has problems with ‘quack’ doctors. Nigerians escaped a serious ebola epidemic, but the second largest HIV positive population in the world resides in Nigeria. Nigeria has also swallowed the dubious claims of UNAIDS and others that HIV is almost always transmitted through heterosexual sex in Africa countries.

As a result, the country has passed punitive laws about ‘non-disclosure’, exposure and transmission, but only, it appears, when transmission is sexual.

The ebola epidemic has shown that people find it hard to trust ‘global’ health agencies. Warnings about various sexual practices and HIV have also fallen on deaf ears. But perhaps ordinary people are right to ignore ‘global’ health agencies. Perhaps bush meat and ‘corpse touching’ are either not as common or not as risky as we have been told. And perhaps the appalling conditions to be found in health facilities are much more risky than we have been told.

South Africa – Never Mind HIV, We’ve Got Penis Transplants


One ebola case, out of tens of thousands identified over nearly forty years, may have been sexually transmitted; the evidence is slim, but CDC and others really want this one case to be used to stress that people should be made aware of this highly remote possibility (if it is even remotely possible).

Strong evidence that a significant proportion of transmissions of ebola is a result of unsafe healthcare is quietly ignored; CDC and others don’t wish to warn people that the healthcare systems expected to deal with such outbreaks are far too weak to keep people alive, and are likely to be part of the problem in the cases of ebola and HIV.

South Africa has transplanted one penis on to a man who lost his through a botched circumcision. The US government is ploughing a few billion dollars into circumcising tens of millions of African adults (and an unknown number of children), so they will not be in a hurry to warn people about the hundreds of botched circumcisions reported every year (nor the uncounted thousands that remain unreported).

The English Guardian has a lengthy article about this single penis transplant, and has had a few, equally salacious articles, about botched circumcisions that occur in traditional, non-sterile settings. That same smug, self-satisfied newspaper has had next to nothing to say about appalling conditions in healthcare facilities in places where HIV prevalence is very high, or about the possible role of unsafe healthcare in transmitting HIV, hepatitis C and B, ebola, TB and various other diseases.

The craze for circumcising African men is based on the view that HIV is almost always ‘spread’ by men, through ‘unsafe’ sex, which almost every ‘African’ engages in, almost all the time (a view based entirely on prejudice). The press is completely unmoved by the fact that circumcision of men may increase HIV transmission from males to females, considerably.

The media goes crazy about the ‘possibly sexually transmitted’ ebola case, even exaggerating it into a dead certainty that it was sexually transmitted; and they are happy to promote the view that Africans engage in types and levels of sexual behavior that should be curbed by various (failed) measures, paid for by donor money. But this is just a continuation of what various colonizers began.

The racism behind the view that HIV is almost always transmitted through heterosexual contact in (some) African countries, but no non-African countries, has always remained unremarked by the press. The prejudice behind singling out uncircumcised African men and HIV positive women for intense vilification is rarely mentioned.

The fact that about 7% of HIV positive women in South Africa, the country with the largest HIV positive population in the world, report being sterilized forcibly, receives occasional mention. But readers seem to prefer articles about penis transplants and one possibly sexually transmitted case of ebola, it appears.

The Daily Maverick has an article about what the author dubs the ‘new denialism’; the health services in South Africa are failing, they are even failing HIV positive people, despite the huge amounts of money that the country is said to have received.

The health services are unable to cope with any illnesses and throwing money at HIV will not result in reasonable numbers of well trained and equipped staff, adequate supplies and, most of all, levels of cleanliness and hygiene that eliminate the possibility that many patients will end up being infected with something in hospital that is far worse than what they were admitted with.

There is nothing new about this denialism, but it needs to be recharacterized; health services are not just inadequate, they are dangerous. Aidsmap.com are certainly not alone in bemoaning the fact that many women in South Africa are infected with HIV relatively late in their pregnancy, sometimes after giving birth, even many months after.

Nor are Aidsmap alone in failing to consider the possibility that some of those women, perhaps most of those women, were infected with HIV through unsafe healthcare, reused syringes, needles, various types of equipment and various processes that require a far better level of hygiene than will be found in extremely high prevalence provinces, such as KwaZulu Natal and Mpumalanga.

The pharmaceutical industry does very well out of HIV and several other diseases that have hit the headlines in the mainstream press, and are deemed worthy of enormous funding. Many NGOs have been built by HIV money and will only thrive and prosper as long as a few diseases are considered worthy of massive funding.

The press loves a story about a penis transplant in a country too poor to prevent thousands of unnecessary deaths every year, of women giving birth, babies, children and adults with easily treated and prevented diseases. Appalling conditions in health services in most African countries does not merit the attention of the press, they are far too commonplace. If a story from ‘Africa’ has even the remotest connection with sex, publish it; if not, forget it.