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

Comments Off on Charging HIV-positive husbands and wives with adultry — and lying about it Posted by on December 31, 2015

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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).

behavioral paradigm, blood, HIV, iatrogenic, institutional racism, media racism, nosocomial, unsafe healthcare ,

Depo Provera and Circumcision: Violence Against Women Masquerading as Research

1 Comment Posted by on July 1, 2015

Although there are plenty of instances of institutionally sanctioned violence against women, this blog post is about two very prominent instances: mass male circumcision programs [*Greg Boyle, cited below; one of the most up to date publications on the subject, which cites many of the seminal works] and the aggressive promotion of the dangerous injectible contraceptive, Depo Provera (DMPA).

Why are mass male circumcision (MMC) programs instances of violence against women? Well, three trials of MMC were carried out to show that it reduced female to male transmission of HIV. They were show trials, with the entire process monitored to ensure that it gave the results that the researchers wanted. These trials have been cited countless times by popular and academic publications.

Less frequently cited was a single trial of MMC that was intended to show that it reduced male to female transmission of HIV. None of these four trials were independent of each other and the female to male trials produced suspiciously similar results, despite taking place in different countries, with ostensibly different teams. But the single male to female trial showed the opposite to what the researchers wanted: circumcision increased HIV transmission, considerably.

During all four of the trials, male participants were not required to inform their partner if they were found to be HIV positive, or if they became infected during the trial. If there had been any ethical oversight, those refusing to inform their partner would have been excluded from the trial. This is what would have happened in western countries, including the one that funded the research, the US.

Given that many women and men believe that circumcision protects a man from HIV, these MMC programs are giving HIV positive men the means to have possibly unprotected sex with HIV negative women. Many women and men were infected with HIV during the four show trials and almost all of those infections could have been avoided. How participants became infected during the trials has never been investigated, which is not only unethical, but also renders the trials useless.

Despite Depo Provera use substantially increasing the risk of HIV positive women infecting their sexual partners, and the risk of HIV positive men infecting women using the deadly contraceptive, this is the favored contraceptive method for many of the biggest NGOs (many of the biggest NGOs are engaged in population control of some kind). Therefore, its use is far more common in poor countries (especially among sex workers) and among non-white populations in rich countries.

These two instances of violence against women (and men) are funded by the likes of CDC, UNAIDS and the Gates Foundation. Many research papers extolling the virtues of MMC and Depo Provera are paid for by such institutions, copiously cited by them in publications, and constantly wheeled out as examples of successful global health programs. Yet, they are both responsible for countless numbers of avoidable HIV infections.

There is currently a lot of institutional maundering about violence against women and certain instances of it, but some of these same institutions are taking part in the perpetration of it; they are funding it, making money and careers out of it, promoting themselves and their activities on the back of what is entirely unethical. Why do Institutional Review Boards, peer reviewers and academics, donors and others seem happy to ignore these travesties? Who is it that decides that this is all OK, when it clearly is not?

Why are these not considered to be unethical: aggressively promoting the use of a dangerous medication, and an invasive operation that will neither protect men nor women? Is it because those promoting them are making a lot of money out of them, because the victims are mostly poor, non-white people, because the research and programs take place in poor countries, because ethics is nice in principle but too expensive in practice…? Or all of the above and more?

* Boyle, G. J. (2013). Critique of African RCTs into male circumcision and HIV sexual transmission. In G. C. Denniston et al. (Eds.), Genital cutting: Protecting children from medical, cultural, and religious infringements. Dordrecht, The Netherlands: Springer Science+Business Media doi: 10.1007/978-94-007-6407-1_15

behavioral paradigm, blood, circumcision, HIV, iatrogenic, male genital mutilation, mass male circumcision, VMMC , ,