A senior epidemiologist at UNAIDS once argued that if unsafe healthcare was common in some African countries, hepatitis C prevalence in South Africa would also be high; the largest HIV positive population in the world is found there, but hepatitis C is not common. She insisted that HIV was mainly spread by heterosexual sex in Africa.
However, the simple answer is that hepatitis C was not around in South Africa to a great enough extent. If it had been around to any great extent it would have been transmitted sexually among the people who were said to engage in high levels of unsafe sex, as well as being spread by unsafe healthcare.
To the question of why HIV prevalence is not high in Egypt and other countries where hepatitis C was spread by unsafe healthcare, the answer is the same; HIV was not around to any great extent in Egypt when hepatitis was being spread. HIV arrived some time in the 1980s, after the injected treatment for mass schistosomiasis had been replaced by an oral dose. Otherwise HIV prevalence would be high in Egypt.
Recently I came across estimates of the ‘sex worker’ population in three countries with very different histories, Morocco, Kenya and South Africa.
||People living with HIV
*This is an urban estimate, covering all towns of 5,000 or more people
The explanation that UNAIDS and others in the HIV industry give for differences in HIV epidemics always relates to sex. The typical argument about why prevalence is so low in Morocco and other northern African countries is that the populations are almost 100% Muslim, with some even claiming that male circumcision also protects men from HIV.
The sex worker population in Morocco is smaller than those in Kenya and South Africa (although the numbers for Kenya do seem pretty high, considering the urban population only includes about one quarter of people). But it is the figures for HIV prevalence and people living with HIV that are completely out of proportion.
Prevalence in Kenya is 61 times higher than prevalence in Morocco and prevalence in South Africa is 179 times higher. Are we expected to believe that the very different environments and histories found in these three countries, emerging over many decades and centuries, all result in an impact on sexual behavior alone, and that is as staggering as these figures suggest?
Surely there are some other important differences? For example, infrastructure is much better developed in South Africa than in Kenya. But much of Morocco is desert. More importantly, the Sahara may have protected countries around it from HIV. Health services are also better developed in South Africa.
HIV established itself in East Africa in the 1950s and had infected hundreds of thousands of people by the 1970s. The virus was not established in South Africa until the 1970s and by 1990 prevalence was still very low. So the majority of the six million infections occurred after 1990. But HIV only arrived in Morocco in the 1980s, from Europe, and it never really spread that widely.
Perhaps sexual behavior in Muslim countries is different from sexual behavior in non-Muslim countries. But numbers of sex workers, men who have sex with men and others suggest that it could not be differences in sexual behavior alone that accounts for huge differences in HIV prevalence and numbers of people infected.
The histories of countries where HIV failed to spread can be as enlightening as those of countries where the virus spread widely when it comes to understanding why a few countries have appalling epidemics, whereas others have relatively small ones. HIV spread most successfully in southern Africa, less successfully in eastern Africa and not very successfully in northern Africa.
Some have suggested that HIV was spread by unsafe healthcare several decades ago, but that sexual transmission took over in the 1970s or 1980s and that it now accounts for 80% or more of all transmission. But there is no evidence for this anomalous transition, with healthcare suddenly becoming safe and heterosexual sex becoming rampant, but only in some countries.
Even UNAIDS themselves don’t believe that healthcare is safe in African countries. They warn their own employees to avoid ‘non-UN approved’ health facilities and people are advised to carry their own syringes and needles. Tourists from wealthy countries are similarly warned when they are travelling in African countries. So why are African people not warned about the risks and how to avoid them?