Borborygmus: Recent Contributions to HIV Epidemiology
June 25, 2014
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David Gisselquist has already written a critical reaction to Jacques Pepin’s latest attempt to rewrite the history of HIV and unsafe injections. But AidsMap has gone in the opposite direction, by writing a completely uncritical, triumphalist regurgitation of Pepin’s paper, without finding anything strange about this ‘study’.
It’s odd enough that Pepin’s findings happen to match earlier claims from him and others, some made quite a number of years ago, as if simply wishing away HIV transmission through syringe and needle reuse were enough to almost eradicate it completely.
But in the ten year period Pepin is dealing with, sexual transmission has received almost all the attention and funding; yet the contribution of sexual transmission must have increased if Pepin is correct. At the same time, non-sexual transmission, which has yet to be addressed, even acknowledged by the HIV hierarchy, has dropped by almost 90%, a truly etymological decimation.
Pepin’s estimations, the provenance of which are very unclear, fly in the face of data collected by the Kenya Aids Indicator Survey. A paper using data from this survey finds that men who have had one or more injection in the previous 12 months were three times more likely to be HIV positive and women were two and a half times more likely.
The minute number of HIV transmissions that Pepin estimates were a result of unsafe medical injections in a year globally, 17,000-34,000, could be closer to the number of HIV transmissions in Kenya alone that were transmitted through various non-sexual routes.
Vague proportions of HIV transmission through sexual and non-sexual modes are estimated using the thoroughly flawed Modes of Transmission Model, which is well criticized on this site. So it remains a mystery what Pepin is talking about. Kenya is unlikely to be the only country where unsafe healthcare contributes a substantial proportion of HIV transmissions; but it is one of the few countries in Africa that has carried out any research into this phenomenon.