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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?

Take a look at: Seeking the positives, by John Potterat


In an important contribution to the history of medical research, John Potterat’s new book, Seeking the Positives, recounts his involvement in research on sexually transmitted disease and HIV. Chapter 7 recounts researchers’ failure to explain how so many Africans get HIV (chapter 7 is available for download at http://home.earthlink.net/~jjpotterat/book.html).

The AIDS epidemic has been a disaster for tens of millions of Africans. What has not been widely recognized is the damage to medical research – epidemiologists have not done what is required to show how so many Africans get HIV. In a closed-door meeting at WHO in 2003, John described HIV epidemiological research in Africa as: “First World researchers doing second class science in Third World countries.”

How will the medical research community rebuild competence after its deliberate incompetence in not explaining and thereby containing Africa’s AIDS epidemic?

John’s book offers much more than a history of HIV research failures. He and his staff at the Colorado Springs public health department reduced STD in the community. Working with researchers from CDC and elsewhere, they tested new control strategies and documented what works – demonstrating the importance of contact tracing and network analyses to understand and limit STD transmission. Research in Colorado Springs has had an impact on STD prevention programs around the world.

But this is not only history – the human costs of research failures are continuing. According to the latest UNAIDS’ estimate, 1.4 million Africans got HIV in 2014 (see:http://www.unaids.org/sites/default/files/media_asset/AIDS_by_the_numbers_2015_en.pdf). If someone could tell Africans how they are getting HIV, they might be able to protect themselves and collectively to wind down their epidemic.

I recommend the book for reading in epidemiology classes – to foster truthniks and doubters, so we will have the experts we need in future health crises. When you get the book, I recommend you start with a brief look at Appendix 3, which lists individual and STD/HIV program awards.

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).

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


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Suppose a neighborhood gossip spread rumors a married woman was seeing lovers when her husband was at work, or that a married man had lovers? Suppose the gossip had no evidence, but was well paid to spread such rumors?

This situation threatens many HIV-positive married men and women in Africa. HIV prevention programs pay health care professionals to say most adults — including most HIV-positive married men and women with an HIV-negative partner — got it from lovers, even if there is no evidence they had lovers, and even if they deny it. Most health care professionals seem only too happy to play the role of malicious gossip.

For example, a UNAIDS-funded study in Zimbabwe followed adults to see who got HIV and what were their risks. The authors reported: “Thirteen of 67 individuals seroconverting in this study reported no sexual partners in the inter-survey period… This leads us to suspect that…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 HIV-positive women, the % of  husbands 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 to the chapter that reports HIV prevalence).

Seeing such data, a World Bank economist, opines: “Sexual intercourse among women outside the marriage (or cohabiting union) may be more common than reported… [T]he contradiction between self-reported female behavior and the proportion of discordant female couples…suggests that self-reported behaviors are likely to be biased…”[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 health care professionals (behaving like paid gossips) who propose his wife lied about outside lovers? It is relevant, as well, that health care professionals have a conflict of interest – the alternative to blaming the wife for adultery is to acknowledge her infection could well have come from unsafe health care.

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 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. http://econ.worldbank.org/external/default/main?theSitePK=469382&contentMDK=21077340&menuPK=574960&pagePK=64165401&piPK=64165026

Cambodia: Partially reported outbreak in Roka Commune, but lots of other risks and unexplained infections


Roka Commune outbreak

According to newspaper reports, residents of Roka Commune in Cambodia began to suspect something was wrong in November 2014 when a 74-year old man tested HIV-positive. He sent his granddaughter and son-in-law for tests. They also tested positive. More residents went for tests; many were HIV-positive.

The next month, 24 December 2014, Cambodia’s Ministry of Health announced: “The Ministry of Health (MOH) of the Kingdom of Cambodia, with the support of the World Health Organization (WHO), US Centres for Disease Control and Prevention [CDC], UNAIDS, UNICEF and Pasteur Institute in Cambodia is investigating a number of HIV cases which have occurred among villagers from Roka village in Roka commune in Sangke district, Battambang province.”[1]

Strategy to avoid facing the problem: blame a scapegoat

What happened in Roka? The Government of Cambodia seems to have settled on a scapegoat. On 3 December 2015, a Cambodian court sentenced an unlicensed healthcare provider, Yem Chrin, to 25 years in jail for infecting more than 100 people with HIV.[2]

Strategy to avoid facing the problem: Incomplete investigation, incomplete report

Chrin’s sentencing left unanswered questions. For one thing, the numbers didn’t fit. Local newspapers put the total infected around 300. For another, the court did not wait for and use evidence from the joint Government-WHO-CDC-Institute Pasteur investigation[3].

The first substantial (but still partial) report from that investigation appeared two months later, in February 2016, in the US CDC’s Morbidity and Mortality Weekly Report[4].

  • As a part of that investigation, a case-control study “identified medical injections and infusions as the most likely modes of transmission.”
  • A test that can identify how long people have been infected [preliminary incidence assay] “suggested that 30% of infections in this outbreak could be classified as having occurred within the 130 days preceding specimen collection.” This points not only to rapid spread but also to high risk to transmit – effectively demolishing WHO’s oft-repeated estimated risk of 0.3% to transmit through reused syringes and needles.
  • As in many other nosocomial HIV outbreaks, children were on the front lines: 22% of cases were in children <14 years old.
  • More than 70% of HIV-positive samples tested for hepatitis C antibodies were found to have antibodies – similar to what one would expect to find in injection drug users who routinely reuse syringes and needles to inject illegal drugs.

The joint investigation and CDC’s February 2016 report are big improvements compared to the usual silence about patients’ risks, but still fall short of telling what happened so that an informed public and experts could work together to prevent and stop similar events in Cambodia and elsewhere — eg, Africa. The report:

  • does not discuss the specific procedures and errors that led to infections,
  • does not estimate rates of transmission through various procedures.
  • does not trace infections to specific healthcare settings, implicitly accepting what is likely a cover-up — blaming one unlicensed practitioner for the outbreak.
  • does not discuss infections in neighbouring communities, even ignoring infections that showed up in testing during the year.

Risks continue

A December 2015 BBC article – one year after Roka broke into public view – reports continued and common unsafe practices.[5]

A Westerner, who has worked in Cambodia’s health sector for many years says there is a general lack of knowledge about infection control throughout the country’s healthcare system. “I would say there are many more Rokas in Cambodia…The practices are so poor that it’s inevitable. I don’t think there’s a difference between licensed and unlicensed doctors. I think what we saw in this case was a breach of infection control practices [and] doctors working in the government sector get very little training – if any – in infection control.…People blame this HIV outbreak [in Roka] on an unlicensed practitioner. But it could be many practitioners, licensed or unlicensed, working for the government or not, who have bad practices which can end up with Hepatitis B, or Hep C, or HIV. If you aren’t aware of the problems then it’s harder to fix them.

Unexplained and uninvestigated infections continue

In mid-February 2016, an NGO reported 14 patients testing HIV-positive – 10 from Peam village in Kandal Province, a village of 1,000, and 4 from neighboring villages[6]. The article reported 32 previously known infections in Peam village, for a total of 42 or 4.2% of 1,000 villagers. In interviews, persons newly identified with HIV denied sexual risks and suspected infection from injections by a specified local doctor.  Cambodia’s Ministry of Health responded by testing 279 residents of Peam village; tests found 4 new infections. That would bring the total in Peam village to 46 or 4.6%. The number of Peam residents found with HIV is much greater than what could be expected from a 2005 national survey[7] reporting 0.6% of Cambodian adults to be HIV-positive; in Peam, that would be 3 infections only (0.6% of an estimated 500 adults out of a total population of 1,000).

The information I have been able to find does not report any effort to trace and test persons who visited suspected clinics, the ages of those tested, or the ages of those testing HIV-positive. Nevertheless, by early March 2016, Cambodia’s Ministry of Health and the World Health Organization (WHO) issued a joint statement denying an outbreak in Kandal Province[8].

 

 

See also these dontgetstuck.org blogs posts

References

1. Eng Sarath. Ministry of Health, Cambodia. 24 December 2014. HIV cases in Sangke district, Battambang. Available at: http://www.cdcmoh.gov.kh/97-hiv-cases-in-sangke-district-battambang

2. Kehumile Mazibuko. News Tonight Africa, 4 December 2015. Cambodia: unlicensed medical practitioner sentenced for infecting more than 100 people with HIV. Available at: http://newstonight.co.za/content/cambodia-unlicensed-medical-practitioner-sentenced-infecting-more-100-people-hiv

3. Khy Sovuthy, Anthony Jensen. Cambodia Daily, 8 December 2015. In HIV case, key evidence trails behind guilty verdict. Available at: https://www.cambodiadaily.com/news/in-hiv-case-key-evidence-trails-behind-guilty-verdict-102320/

4. Mean Chhi Vun et al. Cluster of HIV infections attributed to unsafe injections  – Cambodia December 1, 2014-February 28, 2015. Morbidity and Mortality Weekly Report 2016: 65:  142-145. Available at: http://www.cdc.gov/mmwr/volumes/65/wr/mm6506a2.htm (accessed 28 March 2016).

5. John Murphy. BBC, 17 December 2015. A country in love with injections and drips.
Available at: http://www.bbc.com/news/magazine-35111566

6. Aun Pheap, George Wright. Doctor denies spreading HIV in latest outbreak. Cambodia Daily News 22 February 2016. Available at: https://www.cambodiadaily.com/news/doctor-denies-spreading-hiv-in-latest-outbreak-108791/ (accessed 28 March 2016).

7. Cambodia Demographic and Health Survey 2005. Available at: http://www.dhsprogram.com/what-we-do/survey/survey-display-257.cfm (accessed 28 March 2016).

8. Hean Socheata. WHO, Phnom Penh: no regional outbreak. Voice of America 4 March 2016. Available at: http://www.voanews.com/content/no-regional-hiv-outbreak-in-cambodia-world-health-organization/3220134.html (accessed 28 March 2016).

 

Why do UNICEF, WHO, and UNAIDS choose to stigmatize rather than protect African youth?


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Beginning in early 2015, UNICEF with UNAIDS, WHO, and other organizations initiated the All In to #EndAdolescentAIDS program. The program has some good points – e.g, asking for better treatment for HIV-positive adolescents.

However, the program is off the mark on HIV prevention. It says nothing about risks adolescents in Africa face to get HIV from blood-contaminated instruments during health care (blood tests, dental care, injections, etc) and cosmetic services (tattooing, manicures, hair styling).

Ignoring such risks while focusing only on sex stigmatizes those who are already infected (aha! you had careless sex!) and misleads those who are HIV-negative to ignore blood-borne risks.

Sex? The best available evidence – from national surveys – suggests less than half of HIV infections in African adolescents came from sex. For example, in national surveys in Kenya, Lesotho, and Tanzania, majorities of HIV-positive youth aged 15-19 years reported being virgins (Table 1). Across these three countries, 57% (36 of 63) HIV-positive youth in the survey samples reported being virgins.[1]

table 1 adolescents

Some virgins may have acquired HIV as babies from their mothers – but without antiretroviral treatment (ART), which arrived late in Africa, few babies with HIV survive to adolescence. Thus most adolescent virgins with HIV likely got it from blood contacts. If virgins are getting HIV that way, some non-virgins are likely getting it the same way — just because an HIV-positive adolescent had sex with one or more partners does not mean sex was the source of his or her HIV.

Using data from national surveys in Lesotho, Swaziland, and Zimbabwe, and assuming no lying about sexual behavior, Deuchert in a 2011 paper estimates only 30% of HIV-positive never-married adolescent women aged 15-19 years got HIV through sex.[2]

What if some lied? National surveys in Lesotho, Swaziland, Zimbabwe, and Zambia included 5,570 never-married women aged 15-19 years. Three percent (250) were HIV-positive, of which 116 (46%) reported being virgins. Even supposing that some women lied, a recent PhD dissertation estimates only 50% of infections came from sex (the author assumed some HIV-positive girls lied about being virgins, but this was more than offset by some non-virgins getting HIV from non-sexual risks).[3]

But let’s cast the net wider: Over the last 15 years, 45 national surveys in Africa reported %s of virgin and non-virgins youth aged 15-24 years with HIV (Table 2). Among those who said they weren’t virgins, the % with HIV was often no or only moderately greater than for self-reported virgins.

For example, in Congo (Brazzaville), Rwanda, Guinea (2012), Democratic Republic of the Congo, and Gambia, the % of young women HIV-positive was equal or higher among self-reported virgins than among all young women. Among young men, the % with HIV was the same or higher among virgins than among all young men in Tanzania (2007-08), Congo (Brazzaville), Sierra Leone (2013), Guinea (2oo5), Mali, Sao Tome and Principe, Burundi, Benin, Burkina Faso, Niger, and Gambia.

Across all 45 surveys, the median ratio of the %s of self-reported virgin young men with HIV to all young men with HIV was o.75 (last line, Table 2). Across all 45 surveys, the median ratio of the %s of self-reported virgin young women with HIV to all young women with HIV was 0.33 (last line, Table 2). And, as noted above, many infections in non-virgins likely came from bloodborne risks.

The only way to say most HIV infections in adolescents in Africa come from sex is to throw away the best evidence we have – to assume survey data are wrong because self-reported HIV-positive virgins are lying.

That seems to be what bureaucrats and experts at UNICEF, WHO, UNAIDS, and other international organizations have done – ignoring evidence to accuse HIV-positive adolescents of unwise sex, and accusing them also of lying if they say they are virgins.

Stigmatizing HIV-positive African youth for unwise sexual behavior is a form of abuse – not sexual abuse, but abuse nonetheless. Because young women are more likely than young men to be exposed to HIV during more frequent health care and cosmetic procedures, not warning about bloodborne risks contributes to unrecognized violence and abuse targeting African women.

table 2d adolescentstable 2e adolescents

References

1. Brewer DD, Potterat JJ, Muth SQ, Brody S. Converging evidence suggests nonsexual HIV transmission among adolescents in sub-Saharan Africa. J Adolescent Health 2007; 40: 290-293. Partial draft available at: https://www.deepdyve.com/lp/elsevier/converging-evidence-suggests-nonsexual-hiv-transmission-among-105k5VXKQE (accessed 19 December 2015).

2. Deuchert E. The Virgin HIV Puzzle: Can Misreporting Account for the High Proportion of HIV Cases in Self-reported Virgins? Journal of African Economics, October 2011, pp 60-89. Abstract available at: http://jae.oxfordjournals.org/content/20/1/60.abstract (accessed 19 December 2015).

3. Tennekoon VSBW. Topics in health economics. PhD dissertation. Washington State U, 2012. Available at: http://research.wsulibs.wsu.edu:8080/xmlui/bitstream/handle/2376/4270/Tennekoon_wsu_0251E_10484.pdf?sequence=1 (accessed 18 December 2015). See also an earlier paper by

 

 

 

 

 

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.