Bloodborne HIV: Don't Get Stuck!

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Tag Archives: HAI

Millennium Development Goals For All, But At All Costs?

A survey was carried out in one district each in Kenya, Tanzania and Zambia to establish which factors are associated with health facility childbirth (thus shedding light on which factors are associated with the decision to give birth elsewhere, perhaps at home). Health seeking behavior is strongly associated with wealth, education, and urban residence; wealthier, better educated women living in urban areas, in general, are more likely to give birth in a health facility.

These factors are of especial interest because of their association with HIV. Wealthier, employed, better educated, urban dwelling women in African countries are often more, rather than less likely, to be infected with HIV. The tables below are for Kenya, Tanzania and Zambia, but these trends can also be found in other countries. The first table shows HIV prevalence by wealth quintile, with prevalence being lower among poorer people and higher among wealthier people.

Wealth quintile tableThe next table shows HIV prevalence in males and females, by employment and by urban/rural residence. Males are far less likely to be infected than females, unemployed people are less likely to be infected than employed people and rural dwelling people are less likely to be infected than urban dwelling people.

Employment residence

The third table shows that HIV prevalence is sometimes lower among those who have less education and higher among those with primary education in Kenya and Tanzania and those with secondary education and beyond in Zambia. (Note, figures for education are for attendance, not attainment, so they don’t tell you that much. But MDG 2 is about ‘achieving universal primary education’, not about academic attainment.)


Receiving antenatal care at a health facility is part of the Millennium Development Goal (MDG) number 5, to improve maternal health. Therefore, it is not surprising that all 14 African countries I have looked at have a very high score for this goal, all ready for 2015. But the goal does not consider matters such as conditions in health facilities, skills of providers, facility practices, equipment, supplies, etc. So the percentage of women delivering in health facilities and the percentage of deliveries attended by a skilled health provider are far lower, being out of the MDG limelight.

ANC tableFor information on health facility conditions, equipment and supplies, there are Service Provision Assessments for each of the three countries, showing that there are many serious lapses. But questions about whether skilled providers are skilled, and of how skilled they are, are less often asked (particularly in relation to the MDGs). Another paper, entitled “Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward“, addresses this issue.

Skill levels overall are not impressive and are low in some areas in the countries involved (Nicaragua, Benin, Ecuador, Jamaica and Rwanda). The researchers note that “knowledge of a procedure is no guarantee that it can be performed correctly”, but also that problems are not solely due to a lack of skills or training, that some are due to lack of equipment, supplies and other things.

The first article estimates that skilled birth attendance could substantially reduce maternal deaths “presuming that facilities meet standards of quality care.” Quite. But various sources of data show that health facilities often don’t meet standards of quality care. The possibility that health facilities may be the source of a considerable proportion of HIV infections in high prevalence countries must be considered urgently if healthcare transmitted HIV, and other diseases, are to be averted.

Reducing maternal deaths is a laudable goal, but it is nothing short of unethical to encourage women to attend health facilities where the conditions are likely to be unsafe. Right now, failing to achieve MDG 5 may even be preferable to achieving it. Of course deaths from hemorrhage, obstructed labor, puerperal sepsis and pre-eclampsia must be reduced, but not at the cost of increasing incidence of HIV, hepatitis and other bloodborne diseases.

Kenya: Needle Exchange Programs Could Save Lives

Despite the success of needle exchange and other harm reduction programs around the world, there people and institutions who still reject them. Even though injection drug use is said to contribute a relatively small proportion of HIV infections in Kenya, apparently some community and religious groups don’t always wish to support them. Perhaps they do not understand harm reduction?

Canada has been particularly open to needle exchange and other programs, and the view that “Drug users shouldn’t be given clean needles…it only encourages them” is a minority view now, thankfully. If needle exchange reduces transmission of HIV and hepatitis, it must be encouraged. While it may not cut injection drug use directly, it provides a means of reaching out to users in a meaningful way.

Persecuting durg users and suspected drug users, searching and questioning them, using possession of syringes as a reason for arresting them and confiscating their injecting equipment, do not ultimately result in a reduction in injecting drug use. Worse still, these actions result in users facing potentially more dangerous conditions, as well as increasing syringes and needle reuse.

Community and religious groups may be influenced by a hangover from the Bush era. Bush had a sort of ‘victorian’ influence; if he believed something, no matter how stupid, his supporters (sort of hard to believe he had them, but he must have) would believe the same thing. This is especially true of his supporters who were in receipt of US funding for their activities.

The contribution of prison populations to the HIV epidemic in Kenya is also said to be high. Even Canada, the US and Australia don’t have a needle exchange program in prisons, but it would be wise for Kenya to establish where infections are coming from among prisoners.

Aside from the copious innuendo about what men do in prisons, male to male sex is likely to be an issue in a country where it can land you in prison. Prisoners must face other risks, too. Injection drug use is one possibility, but also perhaps tattoos, body percing, blood oaths, traditional practices occur in prisons? Even sharing razors and other sharp objects carries some risk.

Kenya’s Modes of Transmission Survey is not a reliable means of estimating the combined contribution of several groups, such as injection drug users and prison populations. People who fall into these groups may face a high risk of being infected, yet few intervention programs are currently aimed at them.

Needle exchange programs would be a good start and may help to launch other programs, such as opioid replacement therapy, in the long run. But other programs addressing prisoners, men who have sex with men, sex workers and others could address between 20 and 30% of HIV transmission, which is a very substantial figure.

Too many African countries have been swayed by Western prudishness about sexual behavior in their approach to HIV. They have adopted some of the homophobia, xenophobia and other prejudices on which various wars on ‘terror’, ‘drugs’ and the like have been based. This has not led to rapid reductions in HIV transmission; so it’s time for a change.

The Only Certainty About Unsafe Healthcare and HIV is Ignorance About It

An article by Ndebele, Ruzario and Gutsire-Zinyama, who work for the Medical Research Council of Zimbabwe, claims to dismiss the ‘wait and wipe’ finding, which came from circumcision studies carried out in Africa. This refers to the finding that men who waited at least 10 minutes after coitus and used a dry cloth to wipe their genitals were far less likely to be infected with HIV than both circumcised and uncircumcised men who did not follow this procedure.

What is most extraordinary about this finding is that it has been feebly denied by some, but ignored by far more; in contrast, the findings about a rather weak association between circumcision and HIV transmission was used to push an extremely aggressive, well funded and loudly publicized program to circumcise as many African males, both teenagers and children, as possible.

One should no longer be surprised when researchers embrace the results they expected, while at the same time distancing themselves from those they don’t expect, and certainly don’t want. The ‘wait and wipe’ finding was presented at a conference some time back and was covered by US media. But it never received the attention, or subsequent funding, that mass male circumcision programs received.

So, seven years after those hyped mass male circumcision programs started, and a claimed several million men and boys circumcised under the programs, no further research appears to have been done into this interesting finding. Ndebele et al, who don’t seem aware that HIV prevalence in Zimbabwe is higher among circumcised men, rebuke several commentators, including myself, for suggesting that ‘wait and wipe’ could become an alternative strategy to circumcision.

What I said was that appropriate penile hygiene is a lot simpler, cheaper, safer and less invasive than mass male circumcision. The circumcision enthusiasts have encouraged people to associate circumcision with hygiene, but they have never shown that HIV transmission has anything to do with penile (or vaginal) hygiene. It simply suits their purposes that people seem ready to believe in such a connection.

So how can Ndebele et al question the findings about penile hygiene without also questioning those about mass male circumcision? And how can they not call for further research to be carried out? They accuse myself and other commentators of engaging in ‘pure speculation’, which we do engage in. But we are not the ones who collected the original data, some of which we now wish to selectively dismiss, and the rest of which we wish to use to aggressively promote circumcision programs.

So they proceed to engage in pure speculation of their own, and they seem to believe they are ‘dismissing’ arguments about the possible role of unsafe healthcare with a rhetorical question: they ask “With all the campaigns on safe needles that have been going on, where on earth can one still find health professionals using unsafe needles?” The answer is that syringe reuse is likely to occur in every high HIV prevalence African country.

Merely running a campaign about unsafe healthcare and syringe reuse does not reveal the extent of HIV transmission through these routes. Nor does running a campaign ensure that unsafe healthcare simply ceases to be an issue after a few years. No number of strategies, position papers, frameworks, roadmaps, multi-page reports, toolboxes or other pen-pushing exercises so beloved by the HIV industry will tell us the extent of non-sexual transmission of HIV through unsafe healthcare.

Nor will ‘putting unsafe healthcare on the agenda’ (no matter for how long) ensure that any meaningful changes will come about. Most people know little about non-sexually transmitted HIV and are constantly told that 80% of transmission or higher in Africa is a result of unsafe sex. Researchers rarely even mention HIV transmitted through unsafe healthcare, except to dismiss it, without evidence.

The authors argue that the results they wish to embrace are correct and that the results they wish to deny are merely a “coincidental finding”, and conclude that “there is no need to conduct further research” into the ‘wait and wipe’ finding.

This just about sums up the HIV industry’s approach to mass male circumcision. This has been a process of scrabbling about for data, any data which appears to support the program, and denying or ignoring any data which shows the program to be a hoax; all cobbled together by greedy (and probably somewhat pathological) ‘experts’, who will do anything to promote circumcision, ably supported by an institutionally racist HIV industry.

HIV Risks For Women Who Have Sex With Women

Given the flaws in UNAIDS’ Modes of Transmission model, the bulk of HIV transmissions in African countries are unexplained. They are not almost all, as UNAIDS claims, a result of heterosexual sex. Many must result from other modes of transmission, but UNAIDS has failed to take the necessary steps to investigate non-sexual transmission, through unsafe healthcare, cosmetic or traditional practices.

Another possible set of unexplained transmissions comes from research into women who have sex with women (WSW). A paper by Sandfort et al finds that “based on the available data [they] could not identify a transmission route for 13 of the infected women”, about a third of all infected women. The authors do admit that they “cannot rule out that these women were infected at birth or through medical procedures”, but they didn’t collect data that would allow them to rule out infection through medical procedures, for some reason.

A paper by Matebeni et al note that there are “some cultural practices in Southern Africa [which] render women’s bodies vulnerable and thus contribute to the spread HIV and AIDS” but they don’t say which ones, perhaps they are referring to female genital mutilation. This paper also mentions the possibility of expusure to medical transmissions, but they don’t make it clear what kind they are referring to.

Both papers give credence to the possibility that some of the women were infected with HIV through sex with their female partners. But if they haven’t tested the female sexual partners of the women they found to be HIV positive, we are as much in the dark about the risks of transmission through sex between women, particularly women who have sex exclusively with other women.

Both papers conclude that further research is needed and the authors are to be applauded for starting to address this highly sensitive subject. But it is to be hoped that they will consider non-sexual transmission if they do further research. Contact tracing would need to include, not just sexual contacts, but also contacts where the HIV positive person could have come into contact with someone else’s blood, such as various healthcare, cosmetic or traditional procedures.

UNAIDS and Uganda: Prejudice Begets Prejudice

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

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

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

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

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

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

Denial Reigns Supreme in the HIV Industry

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Institutional Barebacking: HIV, Colonials and Neocolonials

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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