Bloodborne HIV: Don't Get Stuck!

Protect yourself from bloodborne HIV during healthcare and cosmetic services

Tag Archives: Voluntary Medical Male Circumcision

Hepatitis B Virus and Kenya’s Mass Male Circumcision Programs – Why the Secrecy?

With all the posturing in the recently released Kenya Aids Indicator Survey (2012) about mass male circumcision, whether performed in completely unsterile conditions found in traditional settings or the (hopefully) more sterile settings of health facilities, nothing was mentioned about hepatitis B or C. But an article in the East African describes a piece of research carried out by the Kenya Medical Research Institute into hepatitis B (HBV) which finds that prevalence is increasing.

Amazingly, the article admits that the “modes of transmission [for HBV] are similar to HIV — sexual transmission, contaminated blood products and mother to child transmission”; it is “passed from person to person through bodily fluids such as blood, semen or vaginal fluids”. Following a recent paper on HIV transmission through medical injections, it is very important to stress that HIV, like HBV, can be transmitted through non-sexual routes, such as unsafe healthcare, cosmetic and traditional practices.

The article is equally frank about the lack of research into HBV in Kenya: “scientists say the reason for the rise in HBV in Kenya is still unknown since no scientific study has been done to explain the phenomenon”. In contrast, the HIV industry is a lot less frank about non-sexual HIV transmission, even though the country’s Infection Control Policy admits that “Epidemiological data on HAIs [Healthcare Associated Infection] in Kenya is currently lacking, but the risk for HAIs is high”. Slowly, some of these glaring gaps in research are being filled in, though the HIV industry displays a confidence that seems entirely unjustified.

Importantly, HBV among blood donors in Kenya is rising. Are those donating their blood being exposed to contaminated medical instruments through the blood transfusion services? The Kenyan Blood Transfusion Service is not able to supply enough blood to keep up with current demand, so they would need to make sure that people who donate are not being put at risk of infection with HBV or other blood borne viruses. While no one would want to scare people away from health facilities or from blood donation, keeping risks a secret would surely be a lot worse, wouldn’t it?

The article suggests that the counties finding high rates of HBV are in the Northern parts of Kenya (which often have the lowest HIV rates). It is suggested that “The likely causes of HBV in the region are cultural practices like tattooing, circumcising without using sterilised implements and because the regions are dry and people may not be able to get proper nutrition that ensures strong immunity.” As usual, there is a reluctance to ask if health facilities might also be somewhat responsible; does that mean these facilities will not be investigated, and that conditions, if unsafe, will not be improved?

There are various hepatitis related campaigns, but are WHO and other international health institutions going to ensure that all the people involved in the country’s mass male circumcision programs, will be protected from infection with HBV and hepatitis C virus (HCV) as well? WHO makes vague claims about huge proportions of HBV and HCV being transmitted as a result of unsafe healthcare. But what exactly are the figures for ‘priority’ mass male circumcision countries? Again, it’s likely that healthcare safety is more of a risk in these ‘priority’ countries, some of the poorest countries, with amongst the lowest levels of healthcare spending in the world, than it is in Western countries; why are we only given one, generalized figure, when the viruses must be much more prevalent in some countries than others?

Egypt, as (just one) example of a country with a serious hepatitis problem, has seen the figure for years of life lost (YLL) through HBV increase by 3,930% in the 20 years from 1990 to 2010. Liver cancer has increased by 361% in the same period. Cirrhosis has increased by 40% to become the number three cause of YLL, accounting for 1,127,000 YLLs, or 7.1% of all YLLs. Whether the almost 100% prevalence of circumcision in the country contributes to these figures is another question, but it shows what can happen in a country where there is a very high level of access to healthcare, yet where healthcare safety is not adequately addressed. One of the main reasons HCV prevalence is higher in Egypt than anywhere else in the world is because of schistosomiasis vaccination programs, which were carried out using inadequately sterilized glass syringes.

Reusable syringes and needles are no longer commonly used, but the WHO data shows that there is still a problem with unsafe injection practices. So the last thing high HIV prevalence African countries need is a vastly increased risk of bloodborne virus transmission through unsafe healthcare, whether this involves reuse of injecting equipment or other items that are used to pierce the skin during healthcare procedures. Mass male circumcision programs will likely increase the incidence of unsafe healthcare practices, including injections, and the WHO’s claimed benefits in terms of averted infections may not be enough to outweigh the risks involved.

Even if levels of protection against sexually transmitted HIV outweigh the risks, and this is highly debatable (and debated, outside of the HIV industry), what about the risks of infection with HBV, HCV or other bloodborne pathogens, including HIV, during the circumcision procedure itself? Some recent research has questioned the safety of Kenya’s health facilities. There are clearly more risks than those pushing the circumcision programs would like to admit; so will those who succumb to HIV industry pressure be advised of those risks? I suspect they will not.

Mass Male Circumcision: Cultural Imperialism and ‘Public Health’

Three-quarters of women interviewed in Kenya’s highest prevalence province say they prefer circumcised partners” screams the headline. Except that only 30 women were interviewed.

There’s a whole rash of articles in praise of circumcision on the PLOS ONE site (Public Library of Science) that I simply don’t have the time or energy to read. Articles about how wonderful the operation is in reducing HIV transmission from females to males (not the other way, though) don’t appear to have found anything new in all the years they have been coming out. That is, aside from different ways of exaggerating the very small level of protection circumcision may afford men, other things being equal.

Women interviewed also believed, incorrectly, that circumcised men are ‘more hygienic and cleaner’. I wonder what would lead to them believing such a thing? Many people believe that a woman must wash herself after (and sometimes before) sex to be ‘more hygienic’, yet it has been known for some time that this is not only untrue, but that ‘vaginal douching’ increases the risk of infection with HIV. The same is true of male genital douching, but it was circumcision enthusiasts who established this, so they are not in a hurry to disabuse people of this dangerous myth.

It is hard not to see the push for circumcision, which comes almost entirely from the US, as highly stigmatizing and culturally imperialistic. It sounds as if men (and women), who in this instance belong to a non-circumcising tribe, are being told that Luo men are dirty because they are uncircumcised and that, since HIV is almost always transmitted through unsafe sexual behavior in Africa (a popular HIV industry myth), this ‘lack of hygiene’ is caused by not being circumcised. All they have to do is submit to circumcision and everything will be fine.

The branding of Luos as unclean and unhygienic by Western health practitioners is no less despicable than the views of other Kenyan tribes, who do practice circumcision, about Luos being ‘mere children’ and their leaders being ‘unfit to govern’ the country because they are uncircumcised. It is beliefs like this that have contributed to a lot of the ‘tribal’ violence Kenya has experienced, especially around election time. It seems the Western funded efforts to circumcise hundreds of thousands of Luos, perhaps millions, are not above using ‘tribalism’ to achieve their own ends.

Despite the small numbers, it is alarming that most of the women are said to express a ‘preference’ for circumcised men on the basis of beliefs that even the author accept are unproven: that circumcised men are ‘cleaner’ or ‘more hygienic’, that it takes them longer for them to ejaculate and that they ‘perform better’. Especially as the number who have ‘true’ beliefs, ones propagated by those promoting circumcision, is a lot smaller.

Is this kind of ‘demand creation’, based on complete lies, acceptable just because those doing the highly aggressive promotion claim that circumcision is effective at reducing HIV transmission from women to men (the absolute reduction being about 1.3%)? Or is it completely unacceptable, not because the reduction is very small, or because the randomized trials constantly referred to are highly suspect, but because this is a crude piece of cultural imperialism dressed up as a public health program?

GlaxoSmithKline: “How Modern Clinical Trials are Carried Out”

We would need further details to investigate what actually took place, but the practices outlined certainly don’t reflect how modern clinical trials are carried out. We conduct our trials to the same high scientific and ethical standards, no matter where in the world they are run.

That’s a comment from a GlaxoSmithKline spokesperson following the discovery of mass graves of an estimated 800 children in Ireland, who are thought to have died while taking part in ‘secret’ clinical trials, for which there is no evidence informed consent was ever given. That’s a huge number of deaths, by any standards. It is to be wondered how many deaths (and injuries) it took before the trials were stopped.

It would be nice to think that the GSK spokesperson is right, that such things could never happen today. But there’s a whole list of unethical practices in Wikipedia that GSK have been involved in, and those are just the more recent cases. And what about their current collaboration with the Gates Foundation to develop a malaria vaccine? Such a vaccine would be a godsend, but who is keeping an eye on them, given their record?

I don’t doubt that such things no longer happen in Ireland, nor in other Western countries. But unethical practices in African countries are certainly not a thing of the past.

The Don’t Get Stuck With HIV site has a section on DepoProvera (DMPA) hormonal contraceptive, which evidence suggests may increase infection with HIV among those using, and onward transmission by those using the method. Also on this site David Gisselquist has written about the unethical behavior of health professionals who have failed to investigate or act in any way on evidence that infants and adults may have been infected with HIV through unsafe healthcare.

WHO have been dragging their feet over unsafe healthcare, especially unsafe injections through reuse of injecting equipment, use of DepoProvera in HIV endemic countries and various non-sexual modes of HIV transmission. There are also the mass male circumcision campaigns, which are based on lies about research that was carried out in Kenya, South Africa and Uganda. It has never been explained how people who seroconverted during these trials were infected with HIV, it was just claimed that they must have had unsafe sex. Though many of the men did not have any obvious sexual risks, non-sexual risks were not considered, including the circumcision operation itself.

The list of serious ethical breeches goes on. Some participants taking part in the circumcision trials were not told they were infected with HIV, and were followed to see how long it would take for them to infect their partners, who also weren’t told they were at risk. This resembles the Tuskegee and Guatemala Syphilis ‘Experiments‘, which also ended in the 1960s. Yet mass male circumcision campaigns are ongoing and extremely well funded, despite not having anything like the rate of takeup anticipated by those making a lot of money from carrying out the operations.

There has been some secrecy surrounding DepoProvera, and a lot of data about mass male circumcision may have been collected but never released, but much of the data about these issues is readily available to anyone with an internet connection. Like the results of the Irish trials, much of the research was published in “prestigious medical journals”. But I assume this is not what GSK is referring to when they talk about ‘modern clinical trials’?