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UNAIDS, Beckham and Sidibe: Right Words; Wrong Oriface


Every year, more than 1.5 million people are newly infected with HIV, the vast majority of them black Africans, with a lot more women than men being infected. Meanwhile, UNAIDS continues to insist that the virus is spread almost entirely through ‘unsafe’ sexual behavior in African countries, though nowhere else in the world. HIV via unsafe healthcare, they insist, almost never happens in countries with the worst healthcare systems in the world.

The institutional racism and sexism exemplified by UNAIDS, the broader UN, the World Bank, charitable foundations and other parties results in huge levels of transmission of a virus that is difficult to transmit through heterosexual sex; transmission through unsafe healthcare remains completely ignored, even denied, by what has become a massive HIV industry.

These institutionally racist and sexist stances also result in the implication that most of the people infected with HIV are highly ‘promiscuous’, careless, uncaring, stupid, and whatever other negative qualities the media happens to have been fed about HIV positive Africans at any given time.

There is no mainstream media coverage of these instances of institutional racism and sexism, no online campaigns to have UNAIDS abolished, no celebrity photo shoots with publicity obsessed naifs being paraded before an adoring (or despising) public, no newspaper articles, neither tabloid nor broadsheet.

Where are the academic articles by those whose entire time is spent, allegedly, examining and analyzing such phenomena and advising those putting together policies that should go towards reducing the transmission of serious diseases like HIV? Which academics are condemning the institutional racism and sexism that has continued, unabated, since HIV became a lucrative headline-grabbing disease in the late 1980s?

There’s plenty of media coverage of some ex-singer that UNAIDS hoped could belt out a few well rehearsed lines in front of a camera (and a sneering Michel Sidibe). A child actress did a better job of memorizing and spewing out the right lines and buzzwords, with the right facial expressions and body language, so she got some publicity too.

An exhibition that sounded (to some) like it would ‘insult’ black people, even though most of the people taking part in it were black South Africans, was banned because a few people managed to drum up a crowd of ‘insulted’ people who had never seen the exhibition. Though insulted by something they had never seen, they remain uninsulted by the continued treatment of black Africans as sex obsessed disease vectors; protestors scream about ‘objectification’, but fail to recognize it in the flesh.

Ultimately, what Victoria Beckham was saying was no more ridiculous than what UNAIDS and other institutions repeat endlessly. She’s just not very good at UN-speak; her mentors haven’t worked on her hard enough; give it time and she too will be able to trott out the same bullshit as the smirking head of UNAIDS does.

No one was infected with HIV by Beckham’s speech and, unlike the usual UNAIDS blather, it wasn’t even articulate enough to be considered racist or sexist. No black people were injured by an exhibition that never happened at the Barbican. The only ones insulted will be the ones who were told that the event was far too shocking for their poor delicate little selves. The truth, clearly, is far too dangerous for ordinary people to handle. Nice to know that the notion of a ‘protectorate’ has not died out completely.

Millennium Development Goals For All, But At All Costs?


A survey was carried out in one district each in Kenya, Tanzania and Zambia to establish which factors are associated with health facility childbirth (thus shedding light on which factors are associated with the decision to give birth elsewhere, perhaps at home). Health seeking behavior is strongly associated with wealth, education, and urban residence; wealthier, better educated women living in urban areas, in general, are more likely to give birth in a health facility.

These factors are of especial interest because of their association with HIV. Wealthier, employed, better educated, urban dwelling women in African countries are often more, rather than less likely, to be infected with HIV. The tables below are for Kenya, Tanzania and Zambia, but these trends can also be found in other countries. The first table shows HIV prevalence by wealth quintile, with prevalence being lower among poorer people and higher among wealthier people.

Wealth quintile tableThe next table shows HIV prevalence in males and females, by employment and by urban/rural residence. Males are far less likely to be infected than females, unemployed people are less likely to be infected than employed people and rural dwelling people are less likely to be infected than urban dwelling people.

Employment residence

The third table shows that HIV prevalence is sometimes lower among those who have less education and higher among those with primary education in Kenya and Tanzania and those with secondary education and beyond in Zambia. (Note, figures for education are for attendance, not attainment, so they don’t tell you that much. But MDG 2 is about ‘achieving universal primary education’, not about academic attainment.)

education

Receiving antenatal care at a health facility is part of the Millennium Development Goal (MDG) number 5, to improve maternal health. Therefore, it is not surprising that all 14 African countries I have looked at have a very high score for this goal, all ready for 2015. But the goal does not consider matters such as conditions in health facilities, skills of providers, facility practices, equipment, supplies, etc. So the percentage of women delivering in health facilities and the percentage of deliveries attended by a skilled health provider are far lower, being out of the MDG limelight.

ANC tableFor information on health facility conditions, equipment and supplies, there are Service Provision Assessments for each of the three countries, showing that there are many serious lapses. But questions about whether skilled providers are skilled, and of how skilled they are, are less often asked (particularly in relation to the MDGs). Another paper, entitled “Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward“, addresses this issue.

Skill levels overall are not impressive and are low in some areas in the countries involved (Nicaragua, Benin, Ecuador, Jamaica and Rwanda). The researchers note that “knowledge of a procedure is no guarantee that it can be performed correctly”, but also that problems are not solely due to a lack of skills or training, that some are due to lack of equipment, supplies and other things.

The first article estimates that skilled birth attendance could substantially reduce maternal deaths “presuming that facilities meet standards of quality care.” Quite. But various sources of data show that health facilities often don’t meet standards of quality care. The possibility that health facilities may be the source of a considerable proportion of HIV infections in high prevalence countries must be considered urgently if healthcare transmitted HIV, and other diseases, are to be averted.

Reducing maternal deaths is a laudable goal, but it is nothing short of unethical to encourage women to attend health facilities where the conditions are likely to be unsafe. Right now, failing to achieve MDG 5 may even be preferable to achieving it. Of course deaths from hemorrhage, obstructed labor, puerperal sepsis and pre-eclampsia must be reduced, but not at the cost of increasing incidence of HIV, hepatitis and other bloodborne diseases.

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


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

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

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

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

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

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

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

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

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

HIV Eradication May Require Regime Change in HIV Industry


Having collected the data in 2012, the Kenya Aids Indicator Survey (KAIS) was released last week. Prevalence has fallen in most provinces. The exceptions are Northeastern Province, where data was not collected due to civil unrest, and Nyanza, where prevalence has increased from almost 14% in 2008 to 15% in 2012. 37% of Kenya’s HIV positive people reside in Nyanza. So the news is not so bad if you don’t come from Nyanza, especially if you don’t come from any of the exceptionally high prevalence towns on the shores of Lake Victoria.

Prevalence is now 5.6%, closer to Tanzania’s 5.1% than Uganda’s 7.2%. As usual, HIV prevalence is generally higher among women (6.9%) than among men (4.4%), higher among urban dwelling people than rural dwelling people and higher among employed people than unemployed people. Prevalence is lowest among females and males who have less education and higher among those who have completed primary or reached secondary or beyond. Prevalence tends to be higher among wealthier quintiles in rural areas and among poorer quintiles in urban areas, which may represent a change in HIV prevalence by wealth quintiles in earlier surveys.

With about 100,000 people being newly infected each year, incidence is said to be 0.5% and the highest number of new infections occurred among people aged between 25 and 34 years, with incidence estimated at 1.2%. Incidence has barely changed between 2007 and 2012, what the report refers to as ‘stable’. The entire epidemic could be described as stable, rather than declining, as prevalence has remained much the same for more than ten years.

Predictably, there are quite a few figures relating to the mass male circumcision program. You don’t put tens of millions of dollars into a program without making sure that you collect data showing that the program was successful. Clearly the program is not successful yet, with the bulk of circumcisions claimed for Nyanza province, which has a prevalence figure nearly three times the national figure. But there is a lot of triumphalist stuff about how high HIV prevalence is among uncircumcised people. Of course, none of the data throws any light on why HIV prevalence is so high among people in this province, so high among Luo people especially, yet not among Kisii or Kuria people.

The level of bullying and manipulation by those running mass male circumcision programs (which the HIV industry likes to refer to as voluntary medical male circumcision or VMMC) becomes apparent when you read some of the literature. Although the invasive operation’s claimed protective value against HIV (and goodness knows what else) has never been very convincing, people are systematically browbeaten over a period of years about hygiene benefits, which have never been demonstrated at all, ‘modernity’ of circumcision, ease of using condoms, increased sexual pleasure and a host of other things for which there is no evidence whatsoever.

According to the abstract “older men should adopt the practice to serve as role models to younger men”, as if there is some moral value in circumcision being provided by a benevolent dictator. UNAIDS addsn a commonly heard claim about “queues of young men and boys awaiting” mass male circumcision, which is clearly drawn from publicity materials rather than from any kind of independent research.

Talking of invasive operations, there is a chapter on blood and injection safety, ironically appearing straight after the mass male circumcision chapter. The figures for blood safety do not sound very encouraging, especially remarks about ‘misclassifications’ in donor records. UNAIDS’ ‘all men are bastards, all women are victims’ theory of HIV transmission gets a bit of a knock as well since nearly four times as many men as women said they donated blood in the 12 months before the survey. The findings about injection safety have been mentioned already on this site  when a full paper was published on the subject in May.

The question now is ‘what next’? Mounds of data have been collected over many years, mostly high level data that gives few clues about how people are becoming infected. Data about ‘attitudes’, sexual behavior, economic circumstances, education, etc, have not allowed any useful ‘targeting’ because the usual conclusion is that ‘it is all about sex’ and other kinds of victim blaming. So it’s heartening to hear that data is being collected about blood and injection safety, albeit a very small amount.

The next step needs to involve comprehensive contact tracing, finding out about people’s non-sexual as well as their sexual contacts, visits to health facilities, traditional practitioners, cosmetic providers and anywhere skin-piercing procedures are carried out. If someone is HIV positive it must be asked who, or what did they come into contact with, whether as a result of sexual or any other kind of behavior. Will the deep prejudices of the HIV industry allow them to take these investigations where they need to go, or will the eradication of HIV have to wait until there’s a regime change in the HIV industry?

Why Contact Tracing is Vital in High HIV Prevalence African Countries


A recent blog post I wrote received some comments from ‘Brad’, at The Mosaic Initiative, a grassroots organization based in the US. Although Brad seems to think that what I wrote accords in some way with what he believes, it is quite clear to me that we both think very different things about HIV.

For a start, I believe that HIV epidemics in African countries are NOT like HIV epidemics in the US and other Western countries. The bulk of HIV transmission in Western countries is a result of either male to male sex or injected drug use. The bulk of HIV transmission in African countries is not a result of either of these, in any country.

The very point of the Don’t Get Stuck With HIV website and blog is that no African country has made a convincing estimate of the proportion of HIV transmission that is a result of sexual, as opposed to non-sexual transmission. It is just assumed that about 80% is a result of heterosexual sex and most of the remaining 20% is accounted for by mother to child transmission; these assumptions have been held for more than 20 years and emanate from WHO, the World Bank, UNAIDS and other institutions that control HIV funding, globally and in African countries.

I also disagree with Brad that it is merely “important to know how HIV is spreading”; it is vital to know whether someone was infected through sex, through unsafe healthcare, through some traditional practice or in a tattoo studio. There is no “generalized pandemic” that Brad speaks of. In Western countries, the vast majority of people are not at risk of being infected with HIV. Even in African countries some people are more likely to be infected than others; in Burundi HIV prevalence is low, but in Botswana it is high. In cities, even Bujumbura, prevalence tends to be high.

Prevalence is almost always higher among women than men in high prevalence African countries, higher among employed people than unemployed people, higher among wealthier people than poor people, etc. There is a huge level of heterogeneity, between and within countries. This heterogeneity does not seem to correlate very much with sexual behavior, though you may believe otherwise if you have immersed yourself in HIV industry literature.

For example, birth rates are high in Kenya’s Northeastern Province, condom use is low, education is low, poverty is high, intergenerational marriage and sex rates are high, all things thought to relate to high HIV transmission; but HIV prevalence is the lowest in the country, lower than in some US cities.

The problem with the approach of UNAIDS and others is not that they employ ‘targeting’, as Brad suggests, but that their assumption implies that all sexually active people who engage in heterosexual sex are equally at risk in African countries. You can’t ‘target’ everyone in a population, or even half or a quarter of hundreds of millions of people.

Although UNAIDS and others claim that the bulk of HIV transmission is a result of heterosexual sex between people in long term monogamous relationships, with the implication that one or both partners must have had ‘unsafe’ sex outside of their relationships, they do not carry out contact tracing, that is, investigating ALL the possibilities for how each person was infected.

Most of the emphasis is on sexual transmission, and even then, sexual partners are usually not tested; when they are tested the HIV types are usually not matched. Therefore, it is almost always unknown how each person was infected, even though it is almost always assumed, in the absence of data to prove it, that each infection was a result of ‘unsafe’ heterosexual sex.

Effectively, UNAIDS and others in the HIV industry are not targeting any group because they don’t have a clue where to look. They assume that almost everyone who is HIV positive engages in ‘unsafe’ sex; they also assume that anyone who engages in any kind of sexual activity they consider to be ‘unsafe’ is a ‘risk group’, and that IS every sexually active heterosexual (or heterosexual who has sex with heterosexuals, or whatever nomenclature you care to adopt).

HIV status is not an indication of sexual activity, ‘safe’ or ‘unsafe’; and sexual activity is not an indication of HIV status or HIV ‘risk’. People in the US and other Western countries may object to contact tracing but in African countries it is vital. It has been avoided in African countries precisely because some have decided that it is a ‘bad thing’, that it ‘stigmatizes’ people, but as a result ALL African people in high prevalence countries have been stigmatized. The situation in Africa is not like the situation in Western countries and the sooner the HIV industry realizes that, the better.

Borborygmus: Recent Contributions to HIV Epidemiology


David Gisselquist has already written a critical reaction to Jacques Pepin’s latest attempt to rewrite the history of HIV and unsafe injections. But AidsMap has gone in the opposite direction, by writing a completely uncritical, triumphalist regurgitation of Pepin’s paper, without finding anything strange about this ‘study’.

It’s odd enough that Pepin’s findings happen to match earlier claims from him and others, some made quite a number of years ago, as if simply wishing away HIV transmission through syringe and needle reuse were enough to almost eradicate it completely.

But in the ten year period Pepin is dealing with, sexual transmission has received almost all the attention and funding; yet the contribution of sexual transmission must have increased if Pepin is correct. At the same time, non-sexual transmission, which has yet to be addressed, even acknowledged by the HIV hierarchy, has dropped by almost 90%, a truly etymological decimation.

Pepin’s estimations, the provenance of which are very unclear, fly in the face of data collected by the Kenya Aids Indicator Survey. A paper using data from this survey finds that men who have had one or more injection in the previous 12 months were three times more likely to be HIV positive and women were two and a half times more likely.

The minute number of HIV transmissions that Pepin estimates were a result of unsafe medical injections in a year globally, 17,000-34,000, could be closer to the number of HIV transmissions in Kenya alone that were transmitted through various non-sexual routes.

Vague proportions of HIV transmission through sexual and non-sexual modes are estimated using the thoroughly flawed Modes of Transmission Model, which is well criticized on this site. So it remains a mystery what Pepin is talking about. Kenya is unlikely to be the only country where unsafe healthcare contributes a substantial proportion of HIV transmissions; but it is one of the few countries in Africa that has carried out any research into this phenomenon.

UNAIDS’ Garbage In Garbage Out Strategy Found Fit For Purpose


Although a Journal of the International AIDS Society (JIAS) paper, which ostensibly analyses Modes of Transmission (MoT) data and reports, has been through some kind of peer review process, the term ‘systematic’ in the title is misleading. In fact the review is highly selective. The phenomena of HIV infection through unsafe healthcare, traditional and cosmetic practices have been left out completely. This is despite the ready availability of relevant and up to date papers about these phenomena.

The Don’t Get Stuck With HIV website is a repository for many relevant materials. David Gisselquist also made a paper available last year that they have completely ignored, entitled ‘UNAIDS’ Modes of Transmission Model Misinforms HIV Prevention Efforts in Africa’s Generalized Epidemics‘. The bibliography therein should be very useful for anyone who wishes to carry out a systematic review in the future.

The JIAS study mentions recommendations from a 2012 set of guidelines produced by an MoT ‘study group’ and one of them recommends to “Adopt a bottom-up approach, that is, an approach that ensures that sufficient data is available to parameterize the model before making changes to tailor the MOT to more finely represent the local setting”.

The fact that no data has ever been collected by MoT studies for non-sexual HIV transmission may explain why such modes of transmission are ignored by the JIAS study. But it doesn’t explain why non-sexual transmission receives so little attention in the HIV literature as a whole, aside from peremptory denial of its existence.

Gisselquist recently pointed out some of the most glaring flaws in the MoT methodology in a brief blog post. But even the JIAS paper itself unearths some remaining flaws that make one wonder why such a weak and fragile tool should still be used after about a decade of demonstrations of its uselessness.

Ironically, MoT tools were supposed to contribute to UNAIDS’ ‘Know Your Epidemic, Know Your Response’ strategy. This strategy, like all UNAIDS strategies, is based on the assumption that almost all HIV transmission in African countries is a result of heterosexual transmission. That means that the majority of people in high prevalence countries are said to be ‘at risk’, either of becoming infected or of infecting others. So every African HIV epidemic looks pretty much the same to UNAIDS because of the built in assumptions of their various ‘tools’.

Therefore, a strategy for ‘targeting’ those most at risk ends up not targeting anyone; HIV interventions must aim to cover entire populations. Aside from being a waste of money and time, as well as stigmatizing the most affected populations, UNAIDS have failed to account for the bulk of transmissions in high prevalence countries. The two decade old, phenomenally expensive institution throws up its hands and says that the majority of people at risk of being infected are people who fall into ‘low risk’ categories.

Despite scratching the surface of the Modes of Transmission Model and finding that that’s all there is to it, the JIAS paper concludes that some aspects of it need to be ‘revised’. Which is even more misleading than calling the paper a ‘systematic’ review. But if UNAIDS have achieved anything in the last two decades it is in showing that a garbage in garbage out strategy really does work, and may continue to attract funding for another 20 years, at least. I wonder how many of the authors of the paper will end up working for UNAIDS, if they haven’t already done so.

Prejudice Continues to Blind UNAIDS to Non-Sexual HIV Transmission


Perhaps the author means well by speculating about how much ‘sodomy’ there is in Zambian prisons. But articles like this miss a great opportunity to look at possible non-sexual HIV risks in prisons. For example, what are safety standards like in prison health facilities? Do prisoners engage in cosmetic practices, such as tattooing, piercing, even shaving and hairdressing? Do any of them engage in traditional practices that may involve skin piercing or cutting? Do any engage in blood oaths or anything else that could result in a HIV negative person coming into contact with the blood of a HIV positive person?

The article says that “homosexuality is among the six key drivers of the transmission of HIV in” Zambia. One source lists these drivers as: multiple and concurrent sexual partners, mother to child transmission, low and inconsistent condom use, vulnerable and marginalized groups, low rates of male circumcision and mobility and labour migration. Let’s look at each of them in turn.

No non-sexual ‘drivers’ are clearly identified there. But the list is a very weak tool for identifying the risks that many people face, given that prevalence reaches over 20% in the capital, Lusaka, and close to that figure in two other provinces. For example, several articles have shown that having multiple partners does not account for extremely high rates of HIV transmission; concurrent partnerships are no higher in high prevalence areas than in low prevelence areas, but they can not account for very high rates of transmission either, despite the frequent, triumphalist literature spewed out on the subject.

Many women are infected fairly late in their pregnancy or just after giving birth, when they are unlikely to have engaged in any kind of sexual behavior, let alone unsafe sexual behavior; and the partners of many women who seroconvert are HIV negative. In addition, some women are infected by their infant, who could only have been infected by some kind of non-sexual route, such as unsafe healthcare. We have no idea how common this phenomenon is.

HIV prevalence in many countries is higher among those who sometimes use condoms and lower among those who say they never do. Condom use only protects against sexual transmission of HIV, not against non-sexual transmission. The issue of circumcision is highly controversial and it has never been shown that the mass male circumcision programs currently being carried out in high HIV prevalence African countries will have any impact on HIV transmission, except by the use of dubious figures conjured up by those who believe that circumcision is superior to the alternative, which involves not slicing off a healthy piece of genital flesh.

Mobility and labor migration are perhaps more closely related to ‘vulnerable and marginalized groups’ in Zambia because HIV prevalence is exceptionally high among those involved in mining, for example. Many miners are mobile, many are immigrants, and high levels of HIV prevalence means that they are singled out for stigmatization by the HIV industry, which insists that HIV is almost always transmitted through unsafe sex. Therefore these high prevalence groups must be promiscuous, also careless, selfish, predatory and a whole lot of other pejorative things.

The HIV industry continues to stigmatize people who are often already marginalized, blame people who are infected and alienate people who are most vulnerable to suffering from poor health, facing many other hazards relating to health, poverty, education and employment. There are two ‘drivers’ of HIV epidemics, sexual and non-sexual. The industry concentrates on sexual transmission to the almost total exclusion of non-sexual transmission. This needs to be addressed if countries like Zambia are to reduce HIV transmission, especially in prisons and mining areas, and eventually eradicate it altogether.

[For more about non-sexually transmitted HIV through unsafe healthcare, cosmetic and traditional practices and how to protect yourself, visit the Don’t Get Stuck With HIV site.]

More junk science underestimating HIV from medical injections


AIDS experts still haven’t figured out what is different about Africa that can explain why HIV epidemics there are so much worse than elsewhere. The continuing failure to find what is different exposes persistent (intentional or natural) incompetence on the part of respected researchers.

Specifically, scores of studies that have tested, followed, and retested hundreds of thousands of HIV-negative Africans to find when and how they get HIV have failed to trace the source of observed new infections.[1] Without tracing the source, there is no way to say infections came from sex – but “HIV from sex” is nevertheless the conclusion (and racist slur) from decades of incompetent, incomplete research. When such studies find people with new HIV infections who report no possible sexual exposure to HIV, researchers characteristically reject the evidence: “hmmmm, an African with HIV…must have lied about sexual behavior….”

With that “scientific” method, the US National Institutes of Health and UK’s Medical Research Council could save money by paying researchers sitting in offices in Baltimore, US, or Oxford, UK, to make up data to fit pre-determined conclusions. That would be more efficient than paying them to go to Africa, collect data, and then reject what doesn’t fit desired conclusions.

While funders have avoided funding good science to explain Africa’s HIV epidemics – for 30 years and counting – they have been all too happy to fund junk science that will get the desired results. One popular junk-science strategy to get desired results has been to model Africa’s HIV epidemic with unreliable parameters and weak, selected, or made-up data.

The latest paper by Pepin and colleagues[2] falls into that category of junk science – presenting a model with unreliable parameters and data, and using results from the model to claim that unsafe medical injections accounted for less than 1% of new HIV infections in Africa in 2010 (8,000-16,000 from injections vs. 1.9 million total new infections[3]).

Several obvious problems with the estimate are as follows:

1. Pepin’s assumed rate of HIV transmission through a contaminated syringe or needle – 1 in 150-300 injections – is far too low to allow observed HIV outbreaks through health care in Russia, Romania, Libya, and elsewhere. If those outbreaks occurred – they did! – then Pepin’s proposed rate of HIV transmission through injections is misleadingly low. For example, in Russia in 1988-89 hospital procedures passed from HIV from 1 child to more than 260 children in 15 months. Most transmissions in this outbreak came from children who had been infected less than 6 weeks earlier – enough time for infected children to get dozens but not 150-300 skin-piercing procedures followed by reuse of unsterilized instruments.[4]

2. Pepin’s same model estimates 4,300-8,500 new hepatitis C virus (HCV) infections in Africa from unsafe injections in 2010, less than 1% of estimated new HCV infections (cf: an estimated 18 million Africans were living with HCV in 2005[5], which corresponds to approximately 1 million new infections per year). Because virtually all new HCV infections come from blood, not sex, it’s likely that unsafe injections account for a lot more than 1% of new HCV infections – and by extension, more than 1% of new HIV infections as well. Furthermore, other skin-piercing procedures aside from injections likely account for a lot of new HCV infections – and by extension a lot of new HIV infections as well.

3. Pepin’s estimates distract from facts that need answers. Why do 16%-31% of HIV-positive children in Mozambique, Swaziland, and Uganda, have HIV-negative mothers (among children with tested mothers)?[6] Why do so many mutually monogamous couples find that one or both partners are HIV-positive?

In his conclusion, Pepin commendably recognizes “other modes of iatrogenic transmission” including[2]: “use of multi-dose medication vials, phlebotomies with re-used needles, dental care with improper sterilisation of instruments, unscreened transfusions, ritual scarifications and circumcisions performed by traditional practitioners… Better measurement of such exposures and of their impact on viral dynamics is an essential first step…”

Even so, Pepin does not hit the nail on the head. What is required to measure the “impact [of such procedures] on viral dynamics” is to trace HIV infections to their source. When infections are traced a hospital, dental clinic, tattooist, etc, then continue with outbreak investigations to determine the extent of the damage from unsafe health care or other skin-piercing procedure.

References

1. Gisselquist. Randomized controlled trials for HIV/AIDS prevention in Africa: Untraced infections, unasked questions, and unreported data. Available at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1940999 (accessed 14 June 2014).

2. Pepin et al. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010. PLOS one 2014; 9: 1-8. Available at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0099677 (accessed 14 June 2014).

3. Annex table 9 in: UNAIDS. Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, progress report 2011. Available at: http://whqlibdoc.who.int/publications/2011/9789241502986_eng.pdf?ua=1 (accessed 15 June 2014).

4. See: https://dontgetstuck.org/russia-cases-and-investigations/

5. Hanafiah et al. Global epidemiology of hepatitis C virus infection. Hepatitis 2013. Available at: http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/pdf (accessed 14 June 2014).

6. See pages for Mozambique, Swaziland, and Uganda at: https://dontgetstuck.org/cases-unexpected-hiv-infections/; see also: https://dontgetstuck.wordpress.com/cases-unexpected-hiv-infections/).

Namibia: Lack of Healthcare or Lack of Healthcare Safety?


An online Namibian newspaper article reports that “Women who experience violence in volatile abusive relationships face four times higher risk of contracting HIV“, following a study of the links between gender based violence and HIV.

HIV prevalence is currently estimated at 13.4% in Namibia, an upper middle income country with a GDP per capita of $8,191, but also a high level of economic inequality. Population density is one of the lowest in sub-Saharan Africa.

However, when it comes to antenatal care, 81% of deliveries take place in a health facility. The only country I found in the region that was higher than that was South Africa, at 91.4%, which has the highest number of people living with HIV in the world.

81.5% of deliveries are performed by a skilled provider in Namibia. What is probably the highest figure in Africa is that for Botswana, at 99%. But Botswana has the second highest HIV prevalence in the world, at 25%, compared to swaziland’s 26%.

HIV prevalence is higher among women than men in Namibia, at 58% of all infections, and this phenomenon is common to every African country. While domestic and gender based violence need to be addressed regardless of how high or low HIV prevalence is, these are just as abhorrent in rich countries with low HIV prevalence as they are in an upper middle income country with high HIV prevalence.

According to the latest Service Provision Assessment, there are some very serious lapses in infection control in Namibian health facilities, including shortages or unavailability of syringes and needles, soap and water, latex gloves and disinfectant.

So what about addressing safety in health facilities? The number of physicians, nurses and midwives per 10,000 is higher than in other countries in Africa. Some of the biggest differences between Namibia and other much lower prevalence countries is its wealth and it’s far higher levels of access to health services. It is unlikely to be lack of healthcare that results in such high HIV prevalence, but rather lack of safe healthcare.

There is simply no evidence that HIV is ‘mainly driven by heterosexual sex’, the mantra that UNAIDS and the HIV industry have stuck to for so long. Prevalence in Namibia has increased from 1.2% in 1990 to reach a peak of at least 15.3% in 2007, but it has barely fallen since then. It’s time to abandon the sexual behavior fallacy and investigate non-sexual HIV transmission through unsafe healthcare, traditional and cosmetic practices.

[To read more about HIV transmission through unsafe healthcare, have a look at the Don’t Get Stuck With HIV site’s Healthcare Risks for HIV pages.]