Don't Get Stuck With HIV

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Drugs for All Deemed More Profitable than Circumcision


Demands to roll out mass male circumcision programs, claimed to reduce HIV transmission, date back at least 20 years. Other claims about the ‘benefits’ of circumcision go back centuries. But by the time the programs had started several other interventions had been identified that have a far better claim to reduce HIV transmission.

For example, ‘test and treat’, the practice of putting everyone who tests positive for HIV on ARVs immediately, is claimed to reduce transmission to a HIV negative sexual partner by 96% or higher. (Note, 90 is something of a magic number in UNAIDSland at the moment, with their 90-90-90 strategy replacing various other magic numbers conjured up in the past.)

PrEP, the practice of giving ARVs to HIV negative people who are thought to be at risk of infection with the virus, is also claimed to reduce transmission to a HIV negative partner by 96%.

If the number of HIV positive people in the world is something around 30 million, depending on which estimates you use, and about half of them are claimed to be on ARVs already, there are still around 15 million who can benefit from ARVs. That’s worth, say, a few billion dollars.

Although a lot of those opposed to mass male circumcision don’t seem to realize this, many of those promoting circumcision are the same people who promoted behavior based programs, particularly those with an emphasis on ‘abstinence’. Those programs, although they never completely died out, were a disaster. Even the people formerly pushing them now admit that they probably had no impact on HIV transmission. But they wanted to find another source of funding to replace the vast amounts that used to go into ‘prevention’, a lot of which was spent on behavior based rubbish.

Circumcision seemed like the answer because the number of people who could be targeted for circumcision could run into hundreds of millions. Every year millions more male children would be available to keep the programs profitable.

At first the promoters claimed they were only targeting sexually active adults, but they quickly found that most of them didn’t want to be circumcised. It was much easier to recruit children and now they can turn their attention to infants.

But with test and treat, coupled with PrEP, how can the circumcision enthusiasts still claim that there is any benefit to the operation? They need to target almost the entire male population in countries where circumcision is not widely practiced. They must carry out the operation on about 75 men for every one claimed reduction in HIV transmission.

The other interventions, test and treat and PrEP, are claimed to be targeted at those most at risk. Let’s take a look at who is thought to be most at risk, and see just how many hundreds of millions of people that involves, who would need to be taking these drugs for the rest of their lives in the case of test and treat, and for as long as they are thought to be at risk for PrEP.

In western countries there are few groups who are thought to be at risk. The biggest group is men who have sex with men. The second biggest group is injecting drug users. But aside from commercial sex workers, who are given some choice in prevention options in many rich countries, there are not many others.

The picture is completely different in southern and eastern African countries, with high prevalence and/or large numbers of people infected with HIV. This article about a PrEP program in Kenya says the groups of people claimed to face the highest risk of being infected include:

  1. Discordant couples (where one partner is HIV positive and one is HIV negative)
  2. People who frequently contract sexually transmitted infections
  3. People who are said to be unable to ‘negotiate’ condom use
  4. People who frequently use post-exposure prophylaxis (a short course of ARVs for people who suspect they may have been infected, taken within 72 hours of contact)
  5. People who share injecting equipment

Out of the estimated 77,600 new infections in Kenya it is not clear how many arose among any of the listed ‘risk’ groups. High prevalence countries tend not to trace contacts, assuming that the bulk of transmissions (about 90% if you exclude infants said to have been infected by their mothers) were a result of heterosexual intercourse.

You could easily add other risks to the above list, for example (most of the following are a risk in developing countries although 7, 10 and 12 are likely to be more common in rich countries):

  1. People who have given birth in a health center/clinic
  2. People who have given birth at home, or anywhere other than in a health center/clinic
  3. People who have received birth control injections
  4. People who have had injections, blood tests, transfusions, dental care, infusions, etc
  5. People who have had operations that involved piercing the skin, major or minor (including circumcision)
  6. People who have received some forms of traditional healthcare that involved skin piercing
  7. People who use injected appearance or performance enhancers (eg botox, steroids, etc)
  8. People who get their head shaved or where skin is pierced and/or weakened by processes
  9. People who receive manicures, pedicures, etc
  10. People who have body piercings
  11. People who practice scarification and other practices
  12. People who get tattoos

Of course, with the second list, you could warn people about the risks and clean up health centers, cosmetic establishments and anywhere skin piercing occurs (the list is surprisingly long). This would seem preferable to putting almost everyone in a population on expensive drugs for many years.

But UNAIDS, CDC, WHO and other establishments object to calls to warn people about the risks they face in health and cosmetic facilities in developing countries. They warn some people from rich countries about the risks in poor countries but they refuse to warn people in poor countries.

Even concentrating on the risks listed in the Kenya article it is easy to identify many millions of people who could be said to need the $775 per annum PrEP, which is the estimated cost of the drugs alone (I don’t know what other costs there may be).

So you can see the attraction for the HIV industry. If there were only 5 million people requiring years of ARVs, for some, a lifetime of ARVs, that’s several billion dollars for Kenya alone. There are countries with higher prevalence and others with higher numbers of people infected than Kenya.

With only a few billion dollars for mass male circumcision, with its 1.3% absolute risk reduction, or even the claimed 60% relative risk reduction, drugs for the sick and the well seems like a far more lucrative strategy. Even if the benefits realized for mass male circumcision far exceed those unlikely claims, they can’t come close to the claimed benefits of test and treat and those of PrEP.

One problem is that you can’t roll out PrEP for many of the groups claimed to benefit. For example, in discordant couples the positive partner should already be receiving ARVs. People who share injecting equipment could be better served by a clean syringe and needle program. There may be other examples, where overlapping PrEP and test and treat might raise eyebrows among the more scrupulous in the industry.

And it would be perverse to give PrEP to people while they still attend clinics and other places where skin piercing procedures take place without warning them about the risks and also ensuring that those places start to abide by strict infection control regulations that people in rich countries (and rich people in poor countries) enjoy.

If PrEP and test and treat strategies are as wonderful as we are told, let’s hope they do as well in the field as they did in trials. But let’s also get rid of these silly mass male circumcision programs. We no longer have to pretend that they will reduce HIV transmission, or even pretend that that’s why they were rolled out in the first place. Worse still, the profits are orders of magnitude lower than the drug based strategies.

HIV: Cuba’s Success and Uganda’s Failure


Uganda is frequently mentioned in glowing terms in articles about HIV, especially in relation to the late 80s, 90s and early on in the 2000s. In contrast, Cuba is rarely mentioned in glowing terms, although the percentage of 15-49 year olds infected with HIV (prevalence), at 0.3%, is 23 times smaller than the same figure for Uganda, which stood at 7.1% in 2015 (all HIV figures from UNAIDS).

In fact, one could suggest that Uganda never got to grips with the epidemic. They still can’t explain why so many people, said to face a low risk of being infected with HIV, have seroconverted over the past several decades. Despite huge amounts of research, money and other resources being thrown at the country, the bulk of published research on HIV in Uganda seems to be focused on assumed sexual behavior and assumed sexually transmitted HIV.

Little or no international funding went into the HIV epidemic in Cuba. The country worked hard to research the epidemic, even before the first HIV positive person was identified there, several years before. Luckily, the country had a well developed health service, with more doctors per patient than any other high prevalence country (including the US). Indeed, the US (where an estimated 1.2 million were living with HIV in 2013) seemed intent on ridiculing Cuba’s approach to the virus.

Some of the criticisms were directed at claimed human rights aspects of Cuba’s achievements. It was often stated or implied that men who have sex with men were especially targeted by, for example, Cuba’s imposed ‘quarantine’. The quarantining started when little was known about the course of the illness, but it was relaxed once more was known. A number of personal accounts, some from men who have sex with men, now make it clear that many of the people quarantined are grateful to have received the care they got at the ‘sanitaria’ (there are links to other similar articles from this article).

An article by Tim Anderson finds that the quarantine did not target men who have sex with men; it also finds that other procedures were carried out in accordance with international guidelines. Anderson notes that Cuba was ‘more thorough’ in their testing and tracing procedures. Cuba has continued to make improvements in how they deal with the epidemic, which is a low level one, with men who have sex with men being the most affected group.

Sarah Z Hoffman refers to Cuba’s HIV program as ‘the most successful in the world’. Cuba approached HIV with the aim of reducing the likelihood of those infected going on to infect other people. That may sound like an obvious aim, but the greater thoroughness of Cuba identified by Anderson can be contrasted with a reduction in contact tracing in many countries, where it was claimed that certain groups were being unfairly targeted by such measures.

Cuba also started providing all HIV positive people with antiretrovirals in 2001, which they produced themselves as generic versions. Other countries had to wait a long time before they could provide more than a small fraction of HIV positive people with ARVs, and they had to pay astronomical amounts of money for them for years (although the costs are far lower now).

Hoffman writes “HIV infected people must provide the names of all sexual partners in the past six months, and those individuals must be tested for HIV. People found to have any sexually transmitted disease must undergo an HIV test as well. Voluntary HIV screening is encouraged.”

This is one of the places where practices in Cuba differ from practices in most other countries. This is called ‘contact tracing’ and it’s a vital tool of infection control. But in most countries people can claim anything they wish to about their sexual partners, that they have never had sex, that they have only engaged in heterosexual sex, that they have never injected drugs, etc. If people can withhold such information then contact tracing is impossible.

(My previous post is about a rare and valuable contribution to the history of HIV in Africa from John Potterat’s book ‘Seeking the Positives’, much of which concentrates on his work on HIV and STI epidemiology in the US. There’s a link to the chapter here. The approach the US adopted towards HIV could hardly have been more different from that of Cuba. Unfortunately, most other countries, certainly most poor countries, wedded themselves to the US, till death…etc.)

As a result of not tracing contacts, or of not doing so very assiduously, countries like the US, with extremely high transmission rates in certain groups, have never got their epidemic under control. In common with Cuba, the largest proportion of new HIV infections now is among men who have sex with men. Unlike Cuba, there is also a large injecting drug population in the US. But where contacts are not traced, they can not be offered the same opportunity to avoid infection if they are negative, or avoid infecting others if they are positive. Nor can they be ‘connected to care’ as quickly as possible.

In fact, many of the things western countries write copiously about, such as early testing and treatment, universal testing, elimination of mother to child transmission, universal access to treatment, were achieved in Cuba years ago, but have never been fully achieved even in some western countries. Where HIV prevalence is highest, in southern and eastern African countries, some of those achievements may not be realized in our lifetime.

Unfortunately for the worst affected countries, the rights of individuals are claimed to be foremost. Their contacts, past and future, are not treated as individuals. If the individual has multiple partners and chooses not to reveal that they engage in high risk practices, that’s considered to be the individual’s business. If the individual has had no sexual partners, or no HIV positive sexual partners, then the source of their infection needs to be identified. But in high prevalence African countries tracing of non-sexual contacts is rare. What you do find a lot of in research is findings referred to as ‘biased’, because the researcher expected every HIV transmission to be a case of sexual transmission.

(Despite the apparent desire of most countries to protect people’s individual rights in relation to HIV, this approach seemed to go out the window when the virus involved was ebola. Some ‘infection control’ measures seemed to involve groups breaking into people’s houses, forcing them into shabby health facilities, burning their property in public, spraying their houses, breaking up families and communities, etc. Who knows what approach will be taken to the next headline grabbing epidemic.)

So why all the attention and resources for a country that appears to have lost control of HIV a long time ago, and why all the rhetorical questions about Uganda, how their ‘success’ can be replicated, etc? More importantly, why so little attention for Cuba, and why is it so belated? We can learn a lot from both countries. Instead, we should be asking what Cuba did right, and continues to do right, but what Uganda did wrong, and continues to do wrong.

Cuba’s approach to HIV may have been the most successful anywhere. Some would go further and claim that Cuba may be the only country that was seriously threatened by the virus, but gained complete control over the epidemic early on, and retained that control. In the sphere of human rights, also, Cuba has made a lot of progress. Uganda, on the other hand, continues to move in the opposite direction in the fields of public health, human rights, HIV, political stability, economy, etc.

Long Standing De Facto Gag Rule on HIV in ‘Africa’


The gag rule about abortion is not the only gag rule, and even the ‘global gag rule’ never went away in developing countries. Organizations running sexuality, HIV, reproductive health and other programs have long had to cover up anything that might appear to show a pro choice attitude of any kind.

They knew that funding, especially from the US, would be threatened by even appearing to be pro choice in any way.

But there is a much more pervasive gag rule relating to HIV in high prevalence countries, all of which are in Africa. The history of HIV has some very shocking aspects that you won’t hear much about through reading some of the better known literature.

A chapter from John Potterat’s Seeking the Positives, entitled ‘Why Africa?: The Puzzle of Intense HIV Transmission in Heterosexuals‘ is available free of charge on ResearchGate.net. Potterat delves into a long list of the things that those researching into and writing about HIV are not allowed to speak of openly, even when they are reporting findings from scientific research.

For example, many researchers and other professionals believe in African ‘hypersexuality’ as an explanation of hyperendemic HIV (which is only found in African countries). This is just a prejudice, but it informs the bulk of HIV writings in scientific journals. Here’s a quote from Catherine Hankins, who was an epidemiologist at UNAIDS, that would make a Trumpite redneck proud.

Many assume that HIV really is a threat to all, regardless of sexuality, location, circumstances, etc, and don’t realize that there was a decision made to present the virus that way to appease those who felt they were being stigmatized as being most at risk; Potterat refers to the ‘consensus’ emanating from the WHO and CDC in 1988, and elsewhere to ‘consensus epidemiology’. Facts have never had as high a status as consensus where HIV in high prevalence countries is concerned.

People who have never been to a high HIV prevalence country could be forgiven for accepting that the risks of HIV transmission from unsafe healthcare and other skin-piercing practices are extremely low. But this is also claimed by people who live and work in high prevalence countries.

In fact, foreigners working for big institutions such as UN bodies, are issued with a specially written booklet warning them to avoid healthcare facilities that haven’t been approved by them. Yet people living in these countries, who must avail of unsafe facilities are not warned.

Potterat notes that he and his colleagues were told by a high ranking official ‘not to tell African people’ that their healthcare facilities are so dangerous that foreigners are warned not to use them.

In reality, Potterat’s recommendation that people in high HIV prevalence African countries be warned about the risks they face, and that conditions in health facilities be improved, is a very modest one. People have a right to such information, and to safe facilities; so why the reluctance to inform them?

People have a right to accurate, accessible, appropriate health information under international human rights law. Politically motivate agreements about what to tell the public and, more importantly, what to tell people in high HIV prevalence countries, do not constitute such health information.

Reluctance, apparently, partly stems from the fact that CDC, WHO, UNAIDS and the like think it will ‘water down’ their ‘messages’ about ‘safe’ sex. In other words they want to continue lying about ‘African’ sexuality, as well as about unsafe healthcare. They don’t want to be exposed as having spent three decades not addressing the main drivers of HIV, and instead lying about sexual behavior in high HIV prevalence countries. Hankins uses that argument in the BBC article linked above.

These revelations from Potterat’s book are all shocking because we are left with the question of how many people would be alive today if they had known what these international health institutions all knew so long ago. Such questions were asked about the inaccurate information spread by Mbeki’s regime in South Africa, so why not ask the same of international health institutions, universities, donor countries and others?

Tens of millions of people have been infected with HIV in high prevalence countries since the 80s; how many of them would be HIV negative now if they had known the risks of unsafe healthcare? Half of them? More than half? Perhaps we’ll never know. But the lies are well documented in Potterat’s writings and must be followed up by the scientific community.

Dear Researcher, What Kind of Whore am I?


My last blog post was about a researcher who seems to have found what she was looking for (young girls who claim to have had sex for money to buy sanitary towels) and now uses the finding to get publicity and, presumably, funding, or justification for funding if she has already received some.

Ten percent of the 15 year olds, allegedly, made this claim, which amounts to fewer than 20 people from a survey of 3000. But the researcher took what they said at face value because they were saying the right thing. The researcher is selling menstrual cups (specifically, mooncups) in a high HIV prevalence area.

Another piece of research looked at serodiscordance, where each partner in a couple has a different HIV status, one positive and one negative (or they are each infected with a recognizably distinct viral type). It was found that more women than men are in discordant relationships, which is taken to indicate that women are more ‘promiscuous’ than men, or more ‘promiscuous’ than previously assumed.

The researchers concluded that “due to social desirability bias, women in stable relationships practice concurrent partnerships more than reported”. In other words, the women whose partner was HIV negative but who were themselves HIV positive ‘lied’ about their sexual behavior.

The researchers, following the received view of HIV, believe that the virus is almost always transmitted through heterosexual sexual intercourse in high prevalence countries in ‘Africa’, but not in most countries outside of ‘Africa’. Therefore, HIV positive women in a discordant relationship must have been lying.

In the mooncup research, the researcher believed what was heard, and reported it as she heard it. But in the serodiscordance research the researcher did not believe what was heard, so it was classed as a ‘bias’, no different from saying that those women were lying.

Although there are all kinds of names for various different biases that plague certain kinds of research, it’s a bit harder to find names for the biases of researchers, who go into the field armed with their prejudices and the findings that they (and probably their funders and institutions, etc) seek, and proceed to grab what fits their preconceptions, discard what doesn’t, and put a spin on anything else that can be salvaged.

A very disturbing paper claims to identify three paradigms of ‘transactional sex’, for those who thought it only referred to sex for money. They identify:

Sex for basic needs
Sex for improved social status
Sex and material expressions of love

So there you have it! Since the study is not about people who are seen as straightforward sex workers and people who are married, it’s difficult to imagine what proportion of females could not be associated with any of these categories. Some authors on the subject conclude that females who don’t receive anything for sex (and, I guess, some who do), are coerced into having sex.

This is about sex in ‘African’ countries, by the way, so you don’t need to start thinking about any time you may have had sex that some zealous researcher could fit into one of their little boxes, unless you are ‘African’. Of course, if you are male (and ‘African’) then you are likely to be a John or a sexual abuser.

So how can you tell if you have had sex for reasons that the researcher can not classify as transactional or forced, how to tell if you are a prostitute, a victim, a John or a sexual abuser? Or, looking at it another way, if you are not from an ‘African’ country, neither are you married, nor a sex worker, have all your sexual experiences been of a kind that these researchers might approve?

Those writing on the subject often talk of females lacking power, and of the intervention they are researching, such as marketing mooncups and the like, as ’empowering’. Indeed, the subject of power often arises in discussions of HIV in ‘Africa’. As if we (the reseachers, NGOs, etc) have power and we are looking for downtrodden victims upon whom we may bestow it, if they just give the right answers to our questions (we can also tread down those awful men, too).

Shockingly, these well funded researchers really do wield great power in developing countries. They define what kind of person you are, a victim, an abuser, a prostitute, a john, and they tell others how to use these definitions, giving them a small share of their funding if they allocate people to the correct boxes.

The same researchers decide what they will accept as a valid response, on the one hand, and what they will put down to bias on the other, effectively calling the respondent a liar, unable or unwilling to accurately describe how they see themselves and their place in their own environment.

There are some who seem to go to the field with a blinkered view of HIV in high prevalence African countries, where they refuse to accept evidence that doesn’t fit their preconceived notions of ‘African’ sexuality, where sex is generally paid for (somehow) or forced, always ‘unsafe’, rarely (if ever) for pleasure and certainly not for love. If you are a HIV positive ‘African’, heck, even if you just have sex, you are (probably) a whore or a john.

Questionable Research: Are Menstrual Cups A Hard Sell?


In May of 2016, the English Guardian gushed:

“‘Girls are literally selling their bodies to get sanitary pads,’ says Dr Penelope Phillips-Howard. ‘When we did our study in Kenya, one in ten of the 15 year old girls told us that they had engaged in sex in order to get money to buy pads.'”

The 2015 study that they carried out is more careful in some ways. “Caution is suggested in interpreting the data provided, and particularly for analyses on low prevalence behaviors such as sex for money for sanitary products.” The study also reveals that the number of 15 year olds who claimed to have had sex to get money, specifically to get sanitary pads, was fewer than 20.

Another Guardian article appeared in the last few days on the same subject. The articles are both promoting a menstrual cup as an alternative to expensive, disposable sanitary pads, or similar ware.

Access to sanitary ware is vital for the health and welfare of girls and women, and making devices like the menstrual cup available is an excellent alternative to the ridiculously expensive disposable sanitary ware available in most places.

But if it’s a right, and vital for health, why dress this up as an attempt to ‘rescue’ 15 year olds who are said to be resorting to ‘transactional sex’ just to purchase sanitary pads? One of the researchers also claims the girls are often coerced into having sex.

Back in sensationalist mode, the recent Guardian article cites the same author and study:

The situation is so dire that in a 2015 study of 3000 Kenyan women, Dr Penelope Phillips-Howard found 1 in 10 15-year-old girls were having sex to get money to pay for sanitary ware.”

Note, 3000 women, but fewer than 200 15 year olds. Both Guardian articles are about having sex for money to buy pads, rather than having sex in return for pads. But the abstract of the 2015 article seems to blur this distinction, which I would argue is an important one if we are to judge whether this research is useful, however abused, or highly questionable.

There is also an article from a 2013 study, for which Phillips-Howard is a contributor, which clearly talks about both, having sex for money to buy sanitary ware and having sex for sanitary ware.

However, the 2013 article is quite different because it states that “Girls reported [my emphasis] ‘other girls’ but not themselves participated in transactional sex to buy pads, and received pads from boyfriends.” Claiming that other people do this may indicate that the respondent has simply heard such things, perhaps from peers, teachers, various sources of information about sanitary matters, or even presentations about HIV.

Going back to the two possible phenomena, sex to get pads (from sexual partners) and sex to get money to buy pads, do either of these stand up to scrutiny? The first seems unlikely on the basis of other claims and findings made in the literature cited, such as that few people want to talk about menstruation; males don’t at all, even many females generally don’t.

Do men buy sanitary pads as gifts for their sexual partners? I imagine this is rare. I have bought sanitary pads in East African shops and people don’t hide their reactions. Perhaps it happens.

Claims about girls engaging in ‘transactional’ sex can be found throughout the HIV, health, development and anthropological literature, all over the place. Sex in Africa is a common obsession among academics, journalists, policy makers, civil servants, Guardian readers, etc. There are claims that some girls have sex for status, food, mobile phones, phone credit, just about anything that a girl may want (or that they may be said to want).

Is it credible that lots of girls have ‘transactional’ sex for money, which they then use to buy sanitary pads? Well, again the articles state several reasons to think that they don’t, or don’t do so very much. After all, they have families with small incomes, they need to buy food, to pay bills, including school fees. Would they prioritize sanitary pads, having gone as far as to engage in ‘transactional’ sex?

The literature goes from claiming that girls say other girls have sex for sanitary pads or sex for money to buy sanitary pads, to claiming that 10% of 15 year old girls claim that they have had sex for money to buy sanitary pads.

By my reading, the causal link between engaging in ‘transactional’ sex and purchasing sanitary pads is lost if the girls don’t have sex in return for the pads. But if the claim is that they have sex for the pads then the literature itself undermines the claim that some men are happy to purchase them as gifts in return for sex.

We can’t rule out the possibility that someone has engaged in ‘transactional’ sex for money to buy sanitary pads, nor the possibility that someone has done so in return for sanitary pads. But Phillips-Howard’s claim that girls are literally selling their bodies to get sanitary pads looks more like a desperate attempt to shore up poor quality research than a genuine argument for the benefits of providing girls in developing countries with the most appropriate means to ensure menstrual hygiene.

Gag at the Stench of Bullshit: Durban HIV Conference


After decades of insisting that HIV in sub-Saharan African countries is almost always a result of ‘unsafe’ sex, and that infections can be averted by ‘abstaining’ from sex, being ‘faithful’ to one partner and using condoms, the massive HIV industry may now be admitting that these ‘behavioral’ approaches don’t work, and never have:

Dube believes that early access to ART (antiretroviral therapy) is the way forward after a decade of trying to change behaviour barely dented the transmission rate.

But the industry still insists that HIV is mostly transmitted via heterosexual (penile-vaginal) sex, in sub-Saharan African countries. Curiously outside of sub-Saharan Africa, the bulk of HIV transmissions are due to receptive anal sex and intravenous drug use.

The reasoning for this is not so complex: the vast majority of people engage in sexual intercourse at some time in their life. Just as the HIV industry really (really, REALLY) wanted behavioral programs to work, because few viable alternatives were acknowledged, now they really want antiretroviral drugs to work.

Instead of identifying people infected with HIV as early as possible, monitoring their health, and putting them on ARVs when they clearly need them, the HIV industry has come up with ‘treatment as prevention’, which means anyone testing positive for HIV will be put on ARVs, for the rest of their life.

Not content with getting as many HIV positive people on ARVs as possible, the industry has also come up with PrEP (pre-exposure prophylaxis). This means that people can go on ARVs before they are infected. The industry can then ‘target’ the people they say are in need of PrEP. After all, who wants to prevent infection with such a lucrative virus?

Hey presto! If almost everyone engages in sexual intercourse at some time, then almost everyone is at risk! The number of people infected with HIV globally is between 30 and 40 million (depending on whose figures you use), which might seem like a very large market for the bloodsucking HIV industry.

But in a few strategic moves, the market rockets to hundreds of millions, perhaps even a billion or so, as rubbish behavioral problems are dropped all over the developing world, to be replaced by the imposition of enormous drug programs. Sure, individuals don’t have to pay, but someone does; who, by the way, is going to pay?

Sex workers are an easy target, always have been. Even deciding who is a sex worker is a matter of debate among the HIV ‘experts’ (but certainly not among sex workers themselves). But how about the biggest HIV positive demographic in South Africa, which has the largest HIV positive population in the world? Teenage girls, many of whom are just becoming sexually active. What about giving PrEP to all of them, says the HIV industry?

Never mind prevention they say, treatment IS prevention they say, as they bank their billions and brand yet more sectors of the population as ‘at risk’. Meanwhile, young people are demanding things that they feel are important, such as sanitary pads and condoms (how much was spent on condoms over the last 20 years?)

Some people are even demanding cancer drugs. Why are some people not able to access these? Is it because cancer is old news? Not ‘sexy’ enough any more? Or is it because many of the patents on cancer drugs have long expired, and the number of people involved is only a fraction of the number of people who can have ARVs for life; cancer drug regimens are not life-long.

If HIV negative people are to be given ARVs to ‘protect them from infection’, what about people who are already HIV positive but still don’t have access to treatment? There are an estimated 20 million HIV positive people thought to be unable to access treatment (again, depending on who is counting, according to which methodology).

Poor Charlize Theron, who says it’s not an honor to host the Durban HIV conference because ‘we should have eliminated HIV by now’. So they didn’t tell her that this is the biggest opportunity in history that Big Pharma has had to put hundreds of millions of people on overpriced drugs that they will need for the rest of their lives?

Microcephaly: Zika or Pyriproxyfen?


The Ecologist runs an interesting article about the current media hype over Zika virus and its claimed connection with possibly high rates of babies born with microcephaly. According to The Ecologist, a much more likely possibility is the use of Pyriproxyfen to kill mosquito larvae by adding it to drinking water.

The fact that in most cases of microcephaly there is no evidence of Zika, and in most cases of Zika there is no evidence of microcephaly, makes the hypothesis sound a lot less convincing than newspaper reports would have us believe. Also, it is unclear how many children have actually been born with microcephaly; many suspected instances of causality have not been confirmed.

There’s a lot of money to be made from crop spraying and adding dangerous chemicals to drinking water, and a lot of support for it from international health institutions, such as the WHO, CDC and others. Names like Monsanto and Sumitomo Chemical (one of their strategic partners) also appear in The Ecologist’s article, but are absent from newspaper reports. Big industry has its interests to protect, and they can always depend on big media to help.

A report from Physicians in the Crop Sprayed Villages is summarized and brings up the thorny subject of diseases such as Zika and Dengue on the one hand, and poverty, environmental degradation, exploitation and marginalization on the other.

A British company called Oxitec is selling GM mosquitoes, which is a good way of persuading the public that GM is really a ‘good thing’, and won’t end up controlling the lives of small farmers and consumers, who make up the bulk of populations in Latin America and other developing regions.

Interfering with entire ecosystems is a favored method of pushing dangerous and unproven technologies, and the biggest players in the development industry will be jumping on the Zika bandwaggon over the coming months, if they haven’t already.

It remains to be seen whether Zika is or is not causally connected with microcephaly, and the question will be irrelevant to those who can smell a quick and healthy profit, as they all rally around to help (themselves).

HIV and the Real(ly Lucrative) Risks


In an article entitled the ‘real’ risks of sex with someone who has HIV, the authors concentrate on a handful of considerations, but don’t mention some of the most important risks. They seem intent on advertising (or advertorialing) HIV drugs, like a lot of these media articles. Also, the article is about a HIV positive American celebrity, so there may be no real intention of informing people about HIV.

Anyhow, the gender of the HIV positive person is not mentioned. In Western countries, very few males are infected through heterosexual sex. The majority are either infected through male to male sex or through injected drug use. Of course, many may claim to have been infected through heterosexual sex, and even believe they were. But the chances of a man being infected by a HIV positive woman through penile-vaginal sex are so low that there are few documented instances, where there is no possible doubt about the source of the infection.

The position is completely different for women. It is perfectly possible for a HIV positive man to infect a HIV negative woman through penile-vaginal sex, although the risk is not especially high. There are many other factors that can increase the risk, and they are too numerous to list, but the overall health of both parties may be an important one. This is not just about sexual health, but rather the state of each person’s immune system at the time.

Anal sex is also a significant risk for men and for women. But the risk for a man who never engages in receptive anal sex, only insertive anal sex, remains far lower, and this is the case for anal sex with men and with women. The receptive partner, whether male or female is at very high risk. A lot of people wouldn’t admit to engaging in anal sex of any kind, and they may not always remember what they did and didn’t do.

There are even highly complex reasons why someone may be more susceptible or more infectious at a given time, or under certain circumstances. Too little is known about these matters and they will probably remain little understood until someone finds out how to make money out of such knowledge. Concentrating on therapies is a lot easier, because they are already the source of incredible amounts of money, even by pharmaceutical industry standards.

If you don’t know the most significant risks of being infected with HIV, or of infecting others, you can’t protect yourself from them. So this Yahoo! article is very dangerous. But it is merely a function of the relationship between Big Pharma and big media. In the end, such sources of dis/information are not the best way of protecting yourself or others from HIV and other diseases. Broaden your research base, open your eyes, and think.

Zimbabwe: Thought Embargo at HIV Inc to Continue Indefinitely


The Zimbabwean health minister, David Parirenyatwa, has exposed his complete ignorance about the country’s HIV epidemic by claiming that there is ‘rampant homosexuality’ in prisons, and that this is making an especially large contribution to high rates of HIV transmission in these institutions.

Naturally, there are some men who have sex with men in prisons, and not just in Zimbabwe. But that is not just because men are more likely to have sex with men when incarcerated for lengthy periods with men, denied conjugal visits and other rights. It’s also because having sex with someone of the same gender can itself attract a prison sentence.

However, what the health minister fails to realize is that there tend to be very poor health services in prisons. If he had inspected health services in prisons he would have come to a very different conclusion. Indeed, had he inspected health services outside of prisons he would also have come to a different conclusion about Zimbabwe’s massive HIV epidemic.

Prevalence in Zimbabwe had already reached about 15% in the early 1990s (compared to about 1% in South Africa). But it shot up to almost 30% before the end of the decade, then dropped back to early 1990s levels in less than 10 years. The figure has remained at roughly half its peak for the last decade or so.

The death rates required to bring prevalence from 30% to 15% in less than 10 years must have been phenomenal. Did the esteemed (and I’m sure astute) Parirenyatwa notice a sudden rise in prison populations during the 1990s, followed by a profound drop, with a subsequent flatlining thereafter? Or a sudden rise in male to male sex? Or a sudden rise in ‘unsafe’ sex among heterosexuals?

I don’t think so. But I also doubt if the health minister has a clue what was going on in the country’s health services then, or perhaps now. Massive increases in HIV transmission during the 1990s was very likely a result of a decrease in levels of safety in health facilities, along with a probable increase in usage of health facilities.

Minister, HIV is most efficiently transmitted through unsafe skin piercing procedures, such as injections with reused injecting equipment, surgical instruments, etc, also through unsafe body piercing and tattooing, and even through unsafe traditional practices, such as scarification, blood oaths and others.

Just how unsafe would cosmetic and traditional practices be in a prison? We can only guess. How safe would they be elsewhere? It’s unlikely anyone has checked. If they have, they would have found it difficult to publish the findings.

It’s easy to blame high HIV prevalence on ‘promiscuity’, male to male sex, carelessness, stupidity, malice and other phenomena, so beloved by journalists and others milking the HIV cow, far too easy. But ministers, journalists, academics, and even those who have reached lofty heights in international NGOs and the like, are still permitted to consider the roles of unsafe healthcare, cosmetic and traditional practices. I invite them to do so.

‘African’ Sexuality: Consensus or Prejudice?


An article by Damien de Walque, entitled ‘Is male promiscuity the main route of HIV/AIDS transmission in Africa?‘, seems curiously behind the times. He refers to the “pervasive if unstated belief in the HIV/AIDS community…that males are primarily responsible for spreading the infection among married and cohabiting couples”.

Disturbingly, de Walque goes on to conclude that, because women are as likely as men to be the infected partner in discordant relationships (where only one partner is HIV positive), both male and female promiscuity must be the main route of transmission. This is by no means the only possible conclusion; far more women than men are infected with HIV in high prevalence African countries, but this could be a result of other risks, particularly non-sexual risks.

However, women being almost as likely as men to be the infected partner in discordant relationships was not a new discovery when de Walque was writing in 2011. Gisselquist, Potterat, Brody and Vachon published an article in 2003 entitled ‘Let it be sexual: how health care transmission of AIDS in Africa was ignored‘, which presents evidence from the 1980s showing that women are almost as likely as men to be the positive partner in discordant relationships. They also show that neither is promiscuity the main route.

The article by Gisselquist et al looks back at papers from the 1980s demonstrating clearly that the bulk of HIV transmission in African countries is not sexually transmitted. Data collected about sexual behavior does not support the view that Africa is exceptional. Rather, data about other risks, such as unsafe healthcare, cosmetic and traditional practices was either not collected, or was ignored.

Even the abstract gives a good sense of what was going on in the 1980s (and is still going on). I’ll cite it in full, adding italics for emphasis:

“The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988.We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.”

Consensus among influential experts should be based on available data; not only did these experts ignore a lot of available data, they failed to collect a lot of data that could have led to a very different consensus. But several long-held preconceptions, for example, about ‘African’ sexual behavior, may have had undue influence on the consensus of these experts. It is these preconceptions that I am interested in.

By claiming that UNAIDS is going to change its name to UNAZI (as far as I know, they are not going to), I wished to draw attention to the fact that the still current claim that HIV is almost always transmitted via heterosexual contact in African countries (but nowhere else) is based on the preconceived views of some very prejudiced ‘experts’. UNAIDS acquired a consensus of experts who had decided, before the institution was established, that they were going to concentrate almost exclusively on heterosexual transmission, and diminish the role of unsafe healthcare and other non-sexual transmission routes.

The big lie about HIV in ‘Africa’ is that 80% (sometimes 90%) of prevalence is from ‘unsafe’ heterosexual sex, and most of the remaining 20% (or 10%) is from mother to child transmission. This lie emerged in the 1980s, from ‘experts’ who knew that it was a lie. The entire HIV industry is still based on this lie three decades later. As a result, most African people are unaware that unsafe healthcare, cosmetic and traditional practices may be a far bigger HIV risk than sexual behavior.