Bloodborne HIV: Don't Get Stuck!

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Kenya’s HIV Prevention Revolution: Beating Swords into…Condoms

Kenya’s recently published ‘HIV Prevention Revolution Road Map – Count Down to 2030‘ presents various HIV data for each of the 47 counties, based on their new constitution. National prevalence is estimated at 6%, 1.6 million people (compared to 5% in the latest Aids Indicator Survey). But instead of getting rough data for each of the 8 provinces, it is now possible to see just how heterogeneous the country’s epidemic is.

Prevalence ranges from a very low .2% in Wajir to a massive 25.7% in Homa Bay, 128.5 times higher. The estimated number of people living with HIV in Wajir is 500, compared to 140,600 in Homa Bay, 281 times higher. Of course, people can work that out for themselves. But try working out how the situation in these counties can be so different if you also believe that HIV is almost always transmitted through sex.

Because that is the conclusion of the experts who put together this research. The contribution made by Homa Bay alone is said to be roughly the same as the contribution of sex workers plus their clients in the country. Over 60% of new infections are said to be a result of the sexual behavior of the populations of 9 counties, making up less than a quarter of the population. In contrast, the 10 lowest incidence counties are said to contribute 1% of all infections, through their sexual behavior, of course.

It is now claimed that 93.7% of all new cases of HIV are sexually transmitted. Only 20% of the hundreds of millions of dollars being pumped into the epidemic is to be spent on prevention, and most of that will be spent on condoms, finger wagging and a lot of other rubbish that has failed to have any influence on the epidemic so far. And yet it is expected to reduce transmission to about 1000 cases by 2030.

One of the most disturbing aspects of the report is a photograph that sums up the attitude of UNAIDS and other big players in the HIV industry (a lot of drugs are being sold through reports like this) towards Kenyans and other Africans. It depicts a crowned ‘King of Condoms’, with a paper crown on his head, demonstrating to the country’s first lady how to put a condom on a wooden dildo, while others look on.

Or perhaps others don’t see that as an instance of crass infantilization? Perhaps they don’t find anything questionable about the idea that HIV is transmitted almost entirely through sexual behavior in African countries? But the assumption is based on an entirely flawed ‘Modes of Transmission’ spreadsheet, rather than on research. Thirty years into the epidemic, with next to nothing to show for the billions that have been spent on prevention, shouldn’t we start collecting empirical data to guide future efforts?

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, 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; 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; about 3,000 were from 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!