Bloodborne HIV: Don't Get Stuck!

Protect yourself from bloodborne HIV during healthcare and cosmetic services

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Could Singaporean Transfusion Service Have Infected HIV Positive Man?


Man who donated HIV tainted blood jailed“, says a headline on asiaone health website. According to the article, the man “failed to declare on his donor health assessment form that he had recently slept with prostitutes”. The discovery was made after the man donated blood in November 2009. He had previously donated blood between July 2008 and August 2009 and was HIV negative. But his alleged unprotected sex with sex workers was said to have taken place in December 2007, so that particular event was not responsible for his change of status.

Anyhow, the false declarations he is said to have made were for earlier donations, not the one found to be contaminated. But the blood transfusion service would do well to investigate its own services. Because, if the man in question did not have any further possible sexual exposures to HIV after the one in 2007, he might have been infected through the use of contaminated equipment by the transfusion services. This phenomenon has been common in the past in China and is still likely to be a considerable risk.

According to a statement from the Health Science Authority, it “takes its responsibility to safeguard the national blood supply very seriously”. Therefore, they might also like to taken into account the very low prevalence of HIV among Chinese sex workers (the incident was said to have involved Chinese sex workers), estimated to be about 0.6% (which is the same as national prevalence for the US). Indeed, a number of countries have found that sex workers are not very likely to be HIV positive unless they also face non-sexual risks, such as intravenous drug use. A true assessment of risk for HIV and other blood borne viruses can not be made without taking into account both sexual and non-sexual risks.

Resolved: We Must Stop Ignoring Bloodborne HIV in Africa


Why do so many HIV-positive children in Africa have HIV-negative mothers? For example, approximately 30% of HIV-positive kids aged 0-11 years have HIV-negative mothers in Mozambique (see pp. 177-181 in: http://www.measuredhs.com/pubs/pdf/AIS8/AIS8.pdf).

Why are so many virgin men and women found with HIV? In the Republic of Congo, for example, virgin women aged 15-49 years have higher HIV prevalence than all women, 4.2% vs 4.1% (see p. 101 in: http://www.measuredhs.com/pubs/pdf/AIS7/AIS7.pdf).

The personal stories behind these statistics are hard to fit with the common view that almost all infections are from sex. Why has there been so little attention and response to Africans with unexplained infections?

THE PURPOSE OF THIS NOTE IS TO INITIATE DEBATE ABOUT WHETHER TO CONTINUE TO IGNORE NON-SEXUAL HIV INFECTIONS IN AFRICA. To do so, this note presents four arguments for AIDS activists, both in Africa and elsewhere, to recognize and respond to HIV from skin-piercing procedures in African health care and cosmetic services.

1. DE-STIGMATIZING HIV/AIDS: Programs for HIV prevention in Africa – including especially foreign-funded programs — focus almost exclusively on sex. With all attention on sex, the emotions, prejudices, and controversies around sex naturally spill over into HIV programs. Thus, it is not only wrong to think that all African HIV comes from sex (see points 3 and 4, below), but also confusing and distracting. Currently, stigma against HIV is so great that most people with unexplained infections keep silent, so as not to be accused of sexual behaviors that some people don’t like. When the public discourse is corrected to recognize blood-borne as well as sexual HIV (see: https://dontgetstuck.wordpress.com), people with HIV from blood risks will be able to speak out without facing stigma compounded by charges they are lying. And they will then be able to contribute to public efforts to make health care and cosmetic services safe.

2. PREVENTING HIV INFECTIONS: Ensuring that medical facilities are safe will not only prevent HIV infection but also the transmission of other blood borne pathogens. Across Africa, HIV prevalence is lower in countries where more people are aware of blood-borne risks for HIV; see: https://dontgetstuck.wordpress.com/africans-aware-of/

3. SEX ALONE CAN’T EXPLAIN AFRICA’s HIV EPIDEMICS: All attempts to explain Africa’s epidemics as exclusively sexual have failed to find anything that is so different about sex in Africa that could account for Africa’s high rates of HIV prevalence. Studies find that Africans have fewer partners and use condoms more than Americans and Europeans.

Circumcision is less common in Europe than Africa. Sex can’t explain how HIV prevalence is lower after long term wars, and among people living further from health clinics. Sex is a risk for HIV because so many Africans are infected – but how are so many infected?  

4. EVIDENCE THAT AFRICANS GET HIV FROM SKIN-PIERCING EVENTS: A lot of evidence shows HIV transmission through skin-piercing procedures in Africa. Evidence is both old and new. For example:

(a) In 1985, Project SIDA in Kinshasa, Zaire (now the Democratic Republic of Congo), tested inpatient and outpatient children aged 1-24 months and their mothers for HIV. Seventeen (39%) of 44 HIV-positive children had HIV-negative mothers. Among children with HIV-negative mothers, “medical injections seemed to be the most important risk factor for HIV…” The study team noted, “Injections are often administered in dispensaries which reuse needles and syringes yet may not adequately sterilize them” (Mann et al, Risk factors for human immunodeficiency virus seropositivity among children 1-24 months old in Kinshasa, Zaire. Lancet 1986, ii: 654-7. p. 656.)

(b) Around 1990, WHO’s Global Programme on AIDS coordinated a study in Rwanda, Uganda, Tanzania, and Zambia to test in-patient children 6-59 months old and their mothers for HIV. Sixty-one (1.1%) of 5,593 children were HIV-positive with HIV-negative mothers; only three had been transfused. WHO experts concluded “the risk of non-perinatally acquired HIV and of patient-to-patient transmission of HIV among children in health care settings is low” (Global Programme on AIDS. 1992-1993 Progress Report. Geneva: WHO, 1993). A similar conclusion would be unthinkable if 1% of inpatient children in London, Boston, or Seoul were found with non-vertical HIV infections.

(c) A study among women in Malawi, 2003-05, found that women who had received hormone injections for birth control were 10.4 times more likely than other women to return with incident HIV infections, and 23 of 27 women with incident infections had received such injections; relative risk was adjusted for age, bacterial vaginosis, and number of sexual partners; reported condom use was uncommon for both women who acquired HIV infection (11.5%) as well as for those who remained HIV-negative (15.1%) (Kumwenda et al. Natural history and risk factors associated with early and established HIV type 1 infection among reproductive-age women in Malawi. Clin Infect Dis 2008; 46: 1913-1920).

(d) Many other studies in Africa link incident HIV to injections, report virgins with HIV, and report kids with HIV but HIV-negative mothers (see Chapters 7, 8, and 9 of Points to Consider, available for free download at: http://sites.google.com/site/davidgisselquist/pointstoconsider).

PROPOSAL: Let’s dialogue about this at these websites – http://aidsperspective.net/blog/, http://hivinkenya.blogspot.com/, http://blogs.poz.com/sean/, https://dontgetstuck.wordpress.com/ http://signpostonline.info/about the evidence, what to do, anything else relevant to the issue

Simon Collery, David Gisselquist

Is Depo Provera Only Recommended for Poor and Non-White People?


The Florida Courier is far more blunt than other articles about the Depo Provera hormonal contraceptive drug that has been found to increase transmission of HIV from men to women and from women to men. Noting that the use of Depo has long been opposed by Black, Latina and Native American women’s health groups, it is apparent that the drug is disproportionately used by black and poor women, even though it was known there were serious side effects associated with its use.

For many years the drug has been actively promoted, in both its injectable and oral forms, in African countries. In the US, users are “33 percent under the age of 19, 84 percent Black women, and 74 percent low income”. Manufacturer Pfizer has acknowledged some of the side effects. But tens of millions of units of the drug have been supplied to developing countries, especially Mozambique, Tanzania and Nigeria.

While Pfizer claimed not have read the report some time after it had been published, and so refused to comment on it, the development community has been slow to issue guidelines on use of Depo Provera pills and injections. And none of the mainstream media appear to have mentioned the fact that injectable contraceptives may be administered using reused and unsterile equipment, or may have been so administered in the past.

Guidance is anxiously awaited by those who don’t wish to stop using birth control but must avoid any serious side effects that may result from Depo Provera.

Scarification and Male Circumcision Associated with HIV Infection in Children


Dr Devon Brewer has just published a paper on the role of scarification and male circumcision in transmitting HIV in Mozambican children and youth. The findings suggest that there is little difference in transmission whether the circumcision is performed by a traditional circumciser or a medically qualified professional. This may help shed light on the question of why “16-20% of HIV infected children had seronegative mothers” in surveys carried out in Swaziland and Uganda.

HIV transmission is not particularly closely correlated with sexual behavior in African countries but many children infected with HIV are not even sexually active (nor are quite a number of adolescents and adults). Considering the current popularity of mass male circumcision as a means of reducing HIV, and the millions of dollars being thrown at it, these findings deserve to be investigated, not just dismissed by UNAIDS and the HIV industry in general.

Scarification may be common in some countries, including countries with high prevalence of HIV and other blood borne diseases. So far, little research has been carried out into the possible contribution of scarification to HIV epidemics.

Brewer finds that “circumcised and scarified children and youth were two to three times more likely to be infected with HIV than children and youth who had not been circumcised or scarified, respectively”. He further remarks that these phenomena could only account for a relatively small fraction of horizontally acquired HIV infections in these groups. Therefore, other blood exposures, such as unsafe healthcare, probably account for the rest.

While standards of hygiene may be higher in clinical settings than in traditional settings, medical circumcision may involve more risky procedures, such as anesthetic injections and suturing. Also, health facilities may have a tendency to concentrate blood-borne and other pathogens, given that people who are sick attend these facilities, if possible.

There is plenty of research showing that medical facilities in African countries are ill-equipped to control infections that are spread as a result of medical procedures. Kenya, Uganda, Tanzania and other countries already carrying out mass male circumcision campaigns, along with those planning to do so, would do well to ensure that they don’t risk doing more harm than good.

It would have been preferable to carry out a thorough investigation before rolling out such campaigns because it’s difficult to interrupt something that has already gone so far and attracted and spent so much money. Perhaps this finding about male circumcision could be compared to the even longer running and far more widespread contraception campaigns, which may also have exposed people to risks of HIV transmission.

As Brewer concludes, “To determine modes of HIV transmission with confidence, researchers must employ more rigorous research designs than have been used to date in sub-Saharan Africa. Such designs involve assessing blood and sexual exposures comprehensively in incident HIV cases and controls, tracing their contacts corresponding to these exposures, and sequencing infected person’s HIV isolates. In the meantime, Mozambicans and other Africans should be warned about all risks of blood-borne HIV transmission, including scarification and medical and traditional circumcision, and informed about how these risks can be avoided”.

Hormonal Contraception and Increased HIV Transmission Risk


All the mainstream media have been running the story about recent research which shows that hormonal contraception commonly used in African countries substantially increases the risk of HIV infection, for both women and men.

There is now an urgent need to give people advice that will protect them from harm, while also offering them the most effective and acceptable forms of birth control, without risking infection with sexually transmitted infections (STI).

Something that is not mentioned by the copious media articles on the issue is that, because the most popular means of administering hormonal contraception in African countries is by injection, this may point to an additional factor in the rapid spread of HIV; injection safety may have improved in the last ten years or so, but during periods when HIV transmission rates were highest, it is possible that injecting equipment was used in ways that did not protect against HIV transmission.

Sexual and reproductive health programs have had a poor record in emphasizing the dual use of family planning methods, for preventing unplanned pregnancies and for protecting against STIs. The programs may not have adequately convinced people of the need for protection against STIs.

After all, many of the people who have been infected with HIV would not consider themselves to be particularly promiscuous or careless, and rightly so. The majority of people infected in countries such as Kenya, Tanzania and Uganda were not at high risk on account of their sexual behavior.

The thrust of this blog and website is to emphasize that HIV can be transmitted through unsafe sex and through unsafe healthcare and cosmetic services. The need to investigate the role of unsafe injections in the administration of hormonal contraceptives is as urgent as that of the role of these contraceptives in increasing HIV transmission.

The manufacturer of a popular version of injectible contraceptive, Depo-Provera, is Pfizer. Instead of declining to comment on the grounds that they haven’t read the study (it’s not that long) they could break new ground in HIV prevention by leading the investigation.

One commentator suggested greater use of “intrauterine devices, implants and other methods” on the grounds that if use of injectible contraception is to decrease, there needs to be a viable alternative. But some of these methods may also carry HIV transmission risks, something that should be explored thoroughly by those thinking of changing contraception method.

Copenhagen Consensus Centre and HIV: Think Before You Rethink


You might expect research into prevention of non-sexually transmitted HIV to start with the available literature. But when the research is carried out by Bjorn Lomborg’s RethinkHIV, you’d be mistaken. They have already produced three papers that ignore entirely the substantial literature which shows that non-sexually transmitted HIV, especially that transmitted through unsafe healthcare and cosmetic services, could be very high in many African countries.

The RethinkHIV researchers do list a few authors who dismiss non-sexual HIV transmission or claim that it is insignificant. But they don’t mention the research which recommends that non-sexual modes of transmission are in serious need of investigation. Adequate investigation into the relative role of non-sexual HIV transmission modes in the worst epidemics in the world has never been carried out; and funders and research institutions seem uninterested in addressing these and related issues.

However, out of the three papers published by RethinkHIV, one concludes that not enough is known about non-sexually transmitted HIV to evaluate prevention strategies in terms of cost, benefit, effectiveness, acceptability or anything else. Without alluding to the wealth of research already available, the short paper by Rob Baltussen and Jan Hontelez dismiss the rather lengthy claims made by Lori Bollinger in another paper as being without foundation.

Bollinger looked at issues such as autodisable syringes (ones that automatically break after one use and so can’t be reused), healthcare staff training in the proper use of syringes, safe disposal of medical waste and information for the public about non-sexual HIV transmission. The problem with her economic evaluation of these is that she availed of UNAIDS’ data on the different modes of transmission, which is woefully inadequate, being based more on assumption and guesswork than genuine research.

Baltussen and Hontelez’s questioning of UNAIDS’ data is brief and devastating and should be read by everyone interested in questioning the absense of funding for HIV prevention strategies that address non-sexual modes of transmission. It will be interesting to see whether this (inadvertently?) adversarial approach to what could be the biggest contributors to HIV transmission in African countries pays off.

This site provides information about non-sexually transmitted HIV and there are also links to various other related resources available on the web. In addition, you will find links to papers and sources of data used to create the site, throughout.

[I have have also covered these issues on my HIV in Kenya blog.]

HIV Concurrency: Another UNAIDS Sacred Cow Slaughtered


Because we believe that health care and cosmetic services may contribute more to HIV epidemics than is admitted by UNAIDS and the HIV industry in general, we are always concerned when a new slogan or buzzword (or even an old one) dominates the entire global HIV agenda. Examples of these terms are ABC, abstinence, multiple partnerships, polygyny, dry sex, treatment is prevention, test and treat, circumcision, early sexual initiation, and the list goes on.

Our argument is not that we know how significant the contribution of hospital acquired and other non-sexual modes of transmission are to HIV epidemics. Rather, we are calling for the issues to be investigated, with an open mind. And an open mind is something you rarely find in the HIV/AIDS literature. Many papers start with the assumption that heterosexual sex contributes 80, even 90% of all new infections in African countries.

The concurrency theory is the view that many sexual relationships in Africa overlap and that this is an efficient means of spreading HIV. This was one of several possibilities considered by the HIV industry to explain why people all over the world can engage in large amounts of ‘unsafe’ heterosexual sex without that resulting in massive HIV epidemics. Yet, far lower levels of sexual behavior, often far ‘safer’ sexual behavior, in African countries results in rates of HIV transmission that can not be explained by the data we have about transmission probabilities for heterosexual sex.

In another blog, I have collected together and commented on some of the best recent scientific research into concurrency and, as a theory, it has been found wanting. Proponents of the theory are all required to hold, often without stating, a very strong, highly racist and sexist theory about African sexuality, one that has no empirical support whatsoever:

HIV Concurrency Theory is Dead; Can’t You Smell it Yet?

The Sound of a One Legged Argument Kicking Itself

Concurrency Regurgitated: Dubious Evidence Found Increasingly Credible by Experts

Global HIV Policy: Blame, Stigma and Finger-Wagging

Concurrency: the Favorite Plaything of the Sex-Obsessed HIV Industry

Concurrent Relationships: the Latest Stick for Beating Africans

In its entry for ‘sacred cow’, Wikipedia has a particularly apposite citation: “V. S. Naipaul … has the ability to distinguish the death of an ordinary ox, which, being of concern to no one, may be put quickly out of its agony, from that of a sacred cow, which must be solicitously guarded so that it can die its agonizing death without any interference.”

But our concern is not for the theory or the academic hubris that lies behind it; it is for the millions of people who have been infected with HIV when a bit of honesty might have protected them; for those who have already died or transmitted the virus to others because they don’t know how it is spread; and for those who will continue to be infected with or transmit the virus because the HIV industry refuses to investigate the role of health care and cosmetic HIV transmission in high prevalence African countries.

Circumcision is a Joke to Some Researchers, but Do they Know the Risks Involved?


Although it’s reported as good news, nearly one fifth of South African men surveyed thought that circumcision would fully protect them from HIV. The report concluded that “communication and counseling should emphasize what clinical AMC is and its effect on HIV acquisition“. But communication around male circumcision always appears to be lacking. The dangers of being circumcised in countries where safety in health facilities cannot be guaranteed doesn’t seem to be discussed. Apparently, those pushing for more circumcision are satisfied with their own research, though they don’t appear to have looked into the risks involved.

Aside from problems with botched operations, and they do occur, there is a high risk of exposure to contaminated blood through unsterilized medical instruments in many African countries. You may end up in a showcase circumcision program or you may end up being operated on in conditions that most Africans have to face when they attend health facilities for far more urgent operations and care.

However, despite all the enthusiasm for circumcising 20 million men, and the vast claims of numbers circumcised in Kenya (where most men are already circumcised), only 600,000 in 14 countries are said to have undergone the operation during the current program. One commentator says “it’s really, really difficult to bring this to scale“, which is a delicate way of saying that you can’t expect a massive health program to be carried out in a group of countries where health facilities are scarce, underfunded, underequipped, understaffed and in atrocious conditions. Just have a look at a few Service Provision Assessment reports for African countries.

It’s worth bearing in mind that the 60% protection claimed for circumcision refers to sex without a condom; if circumcised and uncircumcised men use condoms properly and all the time, they will both have the same risk of being infected with HIV. It is also worth remembering that while circumcision may give some protection to men (though the evidence is not strong enough to justify the costs and risks), it can increase HIV transmission to women. It is women who are already infected in far greater numbers than men in most high HIV prevalence areas. As many as 5 women can be infected for every 1 man; mass male circumcision may end up increasing overall HIV transmission.

One of the most ardent fans of circumcision for others is Robert Bailey, who has done much of the promoting in Kenya. He said “We’re hacking away at it every month…those foreskins are flying.” This attempt at humor may come back to bite him, because many clinical trials carried out in East Africa have involved practices that are highly questionable, ethically and clinically. It’s not people like Bailey who suffer the numerous but less media friendly health problems that Africans face. But obsession with HIV, African sexuality, circumcision and the like distracts attention and funding from the real issues. Bailey wants 2 billion for circumcision programs while millions of people are infected with and die from cheaply preventable and curable diseases.

Perhaps Bailey himself might enjoy the experience of having an operation in some of the facilities that the UN cannot guarantee the safety of? Perhaps he’d like his family to sample the delights of badly trained clinical officers (like a nurse, but do the work of doctors because there are too few properly trained personnel)? Like all skin piercing procedures in African health facilities, male circumcision can be very dangerous.

Because there is a lot of money involved, no one wants to stand up to this heavy handed approach to the issue. Uganda’s Museveni has said the operation is not scientifically proven to prevent HIV, which is good, but he has also said that ” only premarital abstinence and marital monogamy are sure to work”, which is not true. Most new HIV transmissions occur in long term relationships, that’s been the case for some time, and not just in Uganda either. And that’s the problem with circumcision: lying behind it is the incorrect assumption that most HIV transmission occurs through heterosexual sex. Countries with high HIV rates need to investigate the relative roles of health and cosmetic facility HIV transmission.

Denial is Not Refutation: HIV Industry Needs to Investigate Medical Transmission


An article about “the role of blood-borne HIV infections from unsanitary healthcare procedures” is a couple of years old now, but it’s so rare to read anything about non-sexually transmitted HIV written by an institution connected with the UN, it’s still worth reading. It could be years before they cover the subject again.

This article responds to research published in the International Journal of STDs and AIDS which shows that risks of hospital acquired HIV infection are very high in many developing countries, particularly those in Africa which have the highest prevalence rates in the world.

The authors of the research try to understand why non-sexual HIV transmission, through unsafe medical procedures, is so understudied. In fact, UNAIDS and other well funded bodies even deny that such risks play a part in serious HIV epidemics, though they have never succeeded in explaining how serious epidemics arise in the first place.

The usual explanation is that individual sexual behavior is responsible for about 80% (or even 90%) of HIV and most of the other 20% is transmitted from by mothers to their children. But no one has ever found people who engage in high enough levels of sexual behavior to explain the 80% figure. And some countries have found that up to 20% of HIV positive infants have HIV negative mothers.

While the well funded HIV institutions either imply or state that infants must have been infected sexually, perhaps by their father or another relative, such levels of sexual assault have never been identified anywhere, nor would very high levels of these kinds of behavior be enough to give rise to HIV prevalence rates found in Swaziland, Botswana, South Africa and other sub-Saharan African countries.

Enough research has been carried out to show that medically acquired HIV transmission certainly occurs, and that it might even occur a lot. And while sexual transmission of HIV is very inefficient, medical transmission is many times more efficient, with some procedures carrying up to 100% probability of transmission, for example, contaminated blood transfusions.

The only thing missing is proper investigation. Those who fund HIV research and carry it out seem unwilling to do research that would either confirm their contention that medical transmission hardly ever occurs, or indicate that HIV prevention efforts need to concentrate a bit less on individual sexual behavior and more on what goes on in hospitals and other health facilities.

The debate goes on. One might expect scientists, or anyone with at least some small acquaintance with scientific research, to give greater credence to those who have carried out and published research. But this doesn’t appear to be the case, not yet anyhow. Those opposed to the view that non-sexual HIV transmission could be more common than currently estimated are also strongly opposed to investigating or researching the issue.

In addition to suggestions that non-sexual transmission is ‘kept off the international agenda’, others have pointed to double standards in research ethics, healthcare safety and scientific studies; evidence showing that hospital acquired HIV transmission is common has been knowingly withheld in African countries, evidence that would be made public in Western countries, even in the countries who have funded the research in question.

An ‘expert’ called Francois Venter took the usual option chosen by defenders of the HIV industry status quo: he branded those who disagreed as conspiracy theorists. Yet he accepted that too little work has been carried out in this area. However, there is no hint of conspiracy in the published work of those who are calling for further investigation. This kind of ad hominem response does nothing to strengthen the case for the HIV industry.

The same expert even claims that unsafe needle practices in health facilities does not explain why relatively wealthy countries like Botswana and South Africa have more severe HIV epidemics than less wealthy countries in Africa. This shows that he really doesn’t understand the claim that is being made. Far more people in high HIV prevalence countries like Botswana and South Africa have access to health facilities, and therefore face more risks than those in countries where the majority of people hardly ever get near a health facility.

The idea that most people in countries like Uganda, Tanzania and Kenya are protected from HIV infection because their health services are so poor is a terrible indictment on the understanding that Venter and his colleagues have of HIV transmission in Africa. But a number of studies have shown that proximity to urban areas, roads and health facilities is associated with higher HIV prevalence. Those in rural areas, away from roads, health facilities and other services, are far less likely to be infected.

Lying about non-sexually transmitted HIV, or keeping people from researching and publishing about it, is not going to protect people who are currently being infected. Nor is it going to reduce the levels of stigma that build up around a disease that is said to be mainly transmitted sexually. UNAIDS and the rest of the industry needs to come clean and do some convincing investigative work.

Let Us Give Up Our Anti-Gay Prejudice, But Not Just Yet


What chills me most about the UK’s lifting of the ban on gay men donating blood is not the prejudice that lies behind such a ban, though that is shocking enough; it’s the fact that the UK does not appear to have much confidence in its health services. Their ’12 month deferral period’ instead of an outright ban does little to assuage any fear people may have.

If the blood transfusion services are not able to screen blood that may be contaminated with HIV and other blood-borne viruses, why just ban gay men from donating blood? What about people who face other sexual risks? And what about people who face non-sexual risks, for example, those who receive health care or cosmetic services that may not be 100% safe?

Another question that this issue raises is about how well the blood transfusion service can assess risk if they will not allow a donor to donate blood even if they are practicing safe sex. Are these health professionals telling us that safe sex is not really safe, or that it’s not safe enough? Or are they just telling us that they can’t really guarantee the safety of the blood? Are the donors even safe?

I raise these questions because there is always lot of dithering about blood-borne risks for HIV transmission, especially relative to sexual risks. During the Football World Cup in South Africa last year, the media drooled over estimations of how many sex workers would be operating in the various cities where matches were being played, how many customers they would have and various other salacious irrelevance.

But nothing was mentioned about the risks people could face if they went to a dental clinic, a hospital, a tattoo parlor or even a hairdressing salon. Half a million people descended on a few South African cities, the country with the highest number of HIV positive people in the world, and no mention was made of the most serious HIV risks that exist.

Of course, many people from Western countries travelling to African countries get advice from guide books, embassies, travel shops and travel agencies. But these don’t usually extend to cosmetic services. Should the UK also ban blood donations from foreigners, travellers, migrant workers and others suspected of falling into one of these groups? Or perhaps they would settle for a 12 month deferral period for them, too?

One commentator points out that HIV is not purely transmitted by men having sex with men. This is true, a small percentage of people infected in the UK are not gay and/or not male. And a large percentage are infected through intravenous drug use. But more importantly, HIV is not purely transmitted through sex; it is not just a sexually transmitted disease.

HIV risk is not confined to sexual risk. And while health and cosmetic services in Western countries are far less likely to use contaminated instruments now, compared to in the 1980s, the very fact that people still see HIV as an STD is worrying. It means that they will not recognize serious risks when faced with them, nor will they know how to avoid them.

Health providers have a duty to inform people fully about sexual and non-sexual risks and how to avoid them. A selective ban, partial or otherwise, on those felt to be ‘most at risk’ represents a failure to give people comprehensive advice about all types of risk and leads to a piecemeal and, as it happens, stigmatizing health policy.