Despite the monstrous quantities of 'unsafe' sex that Africans are claimed to engage in by UNAIDS and other HIV institutions, HIV is not at all distributed evenly. Prevalence ranges from less than 1% in some African countries, a lot less than in some US cities, to more than 25% of the adult population in others (and even 50% in some demographic groups). Even within high prevalence countries HIV is not distributed evenly. In many African countries the virus tends to be far more common in cities, close to main roads, close to health facilities, among wealthier and better educated people, etc. It is also generally far more common among women than among men.
Other research has found HIV prevalence to be higher in areas where diseases such as schistosomiasis (bilharzia) and malaria are higher. However, as these both tend to be higher among less wealthy people with lower levels of education and in rural, as opposed to urban areas, there is more than a suggestion that HIV transmission may have widely varying risk factors. Yet UNAIDS and friends tend not to dwell on most forms of non-sexual risk in Africa.
As David Gisselquist writes in the Don't Get Stuck With HIV website: "Unlike Western countries, where almost all HIV transmission occurs outside families, a lot of HIV transmission in Africa happens within families – mother-to-child and spouse-to-spouse transmission together account for an estimated 45% of new infections." Not only is a lot of HIV not transmitted sexually, but a lot is not transmitted through 'unsafe' sex. Many of these couples where at least one partner is infected have no sexual risks. Hundreds of thousands of new infections every year occur through these two routes.
In Africa, then, the main groups are those at risk of mother to child transmission and married couples, especially couples where one partner has been infected. It's as likely to be the female as the male partner, but how does the index partner become infected, the first in the couple? Sex, says UNAIDS, but sex with whom, how much sex and what kind of sex? Heterosexual sex is not an efficient means of transmitting HIV. Gisselquist is suggesting that the focus of international HIV reduction efforts in African countries should address these and other risk groups, where sexual risk is very likely to be low but HIV prevalence is high; this could cut as many as 700,000 transmissions annually.
A serious set of risk factors could arise from unsafe healthcare and perhaps even unsafe cosmetic services. It's not just that conditions in healthcare and cosmetic facilities in African countries are primitive but also that many people are not aware that such risks exist; if they are not aware of the risks, they will not know that they need to avoid them, nor how to avoid them. But if they are aware, they will also realize that a person's HIV status is not a reliable indication of their sexual behavior. This should reassure some who have been brainwashed to associate HIV with 'immoral' behavior; many women, especially, have been beaten by their partners, ostracized by their communities and even killed because of the incorrect association of HIV with sexual behavior.
The HIV industry does talk a lot about the importance of HIV testing. But they also put people off testing where being positive has such terrible consequences. If people were to know that there were other, non-sexual risks, the stigma associated with testing and with having (or being thought to have) HIV should reduce. People who know their status don't tend to take risks, neither sexual nor non-sexual; but they must also be advised of the non-sexual risks. Those who are infected non-sexually can be involved in sexual transmission just as easily as those who are infected sexually. But in the current climate of sex-obsessed HIV policies, they are unlikely to know about non-sexual risk.
Prevention of mother to child HIV transmission is vital if the mother is already infec read more..
Thursday, 14 June 2012
Child Hiv Transmission-African Countries-Sexual Behavior-Hiv Prevalence
Saturday, 19 May 2012
Pre-Exposure Prophylaxis-African Countries-Hiv Negative-HIV
Apologies for the lack of posting this year but I have had enough work keeping my other blog going. The subject of PrEP and related issues do also crop up there, though.
Daily use of Truvada has been backed for pre-exposure prophylaxis use by a panel of 'experts', which generally refers to people who are so well paid to say the right thing that no one else will disagree with them. It's likely that this use of the drug will soon be approved by the FDA. I wasn't able to find a register of the 'experts'' interests but I'm sure it would make interesting reading.
If approved, the drug will be prescribed for HIV negative people who are thought to be at high risk of being infected sexually, which generally refers to men who have sex with men in Western countries. The drug is not being considered for use by intravenous drug users. It is also unlikely to be of much value for commercial sex workers in wealthy countries as they are rarely infected unless they are also intravenous drug users or face other serious risks.
This suggests that PrEP is unlikely to be effective in high HIV prevalence developing countries, where high risk groups are not easy to identify. In many African countries, the bulk of infections among adults occur in married people and those in long term relationships, who don't face very high sexual risks. In other words, the drug is of little use as PrEP where it is most needed. But I'm sure that won't stop Big Pharma from lobbying the right people so that the potential tens or hundreds of millions of Africans can be exploited.
The process of palming off useless but extremely expensive drugs with potentially dangerous side-effects on Africans has been eased by years of publicity for the dominant HIV transmission paradigm, which says that almost all HIV in African countries is transmitted through heterosexual behavior. The fact that the paradigm is seriously challenged by empirical data has done little to influence policy, which concentrates on the politician, religious leader and media friendly process of wagging fingers, pointing fingers and poking fingers into the many HIV fuding pies.
Opposition from groups who claim to represent the interests of HIV positive people has almost all been taken care of in the time honored fashion of paying off anyone who speaks out of turn (or rubbishing anyone who won't take payment). A rare voice of dissent comes from the Aids Healthcare Foundation, which has consistently opposed the current trend of rushing into practices which have little empirical backing, but which mysteriously receive full backing from 'experts'.
Pharmaceutical front group Aids Vaccine Advocacy Coalition (AVAC), predictably, blow the trumpet for PrEP; pharmaceutical products ostensibly produced to treat illness would never have become as profitable if they were only used by sick people. But the UK's Nick Partridge puts his finger on the problem, probably inadvertently: "But we need to know if people at highest risk of infection are prepared to take a pill every day and whether there would be an increase in risk-taking behaviour which could outweigh the prevention effectiveness of Truvada."
The truth is, we don't know who is at highest risk in high prevalence countries, we know that most will not take the pill every day and it's very likely there will be an increase in risk-taking behavior, especially where people opt for PrEP because they know (or even think) they are at risk.
[For more about non-sexual HIV transmission and male circumcision, see the Don't Get Stuck With HIV site.]Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. read more..
Wednesday, 29 February 2012
Pharmaceutical Industry-African Countries-Hiv Infection-Avac-HIV
Pharmaceutical industry front group AVAC is blowing the usual trumpet for PrEP because some recent trial results have been encouraging. They said predictably little about results which were not so encouraging.The problem with PrEP still remains: no high prevalence country has managed to put all HIV positive people on antiretrovirals, not even all those who are at the stage of disease progression where it is a serious threat to their health. Why does anyone think they can roll out a drug for people who are not infected with HIV on the grounds that it might give them 'up to' 73% protection?If 20% of sexually active people are infected with HIV and most of the other 80% are considered to be at risk of infection, will they all be given PrEP? Think of the cost, the logistics, the high levels of resistance, the side effects, things instititutions like AVAC and UNAIDS don't seem to be willing to discuss sensibly.It also seems like a humiliating climbdown for UNAIDS and all the others who maintained that HIV is almost always spread through unsafe heterosexual sex in African countries (though hardly ever in non-African countries, however unintuitive that may sound). Are all 'risk reduction' strategies now to cease?Will we instead just give out drugs and ignore the things we appeared to deplore for the last thirty years, promiscuous men, survival sex, commercial sex work, exploitation, early and unplanned pregnancies, early marriage, concurrent relationships, large numbers of partners, low use of condoms, lack of family planning and whatever other issues we have spent so long bemoaning?Warren Mitchell from AVAC remembered to thank the trial volunteers, presumably mostly guinea pigs who, if they are African, will never be able to afford the drugs and for whom the money to pay for them may never be raised. I don't suppose he was being ironic, either.Another move which looks suspiciously like a way to vastly increase the volume of ARV drug sales, and thereby increase dependency on drugs and funding, is a strategy called test and treat (or various other names). This involves testing the whole population of a country regularly, perhaps every year, and putting everyone found positive on treatment.Testing even a reasonable percentage of people in a population once has remained elusive, let alone the whole population or the whole population every year. But even testing once a year is not thought to be enough, so test and treat is still just a theory. And it is well known that early treatment carries a lot of risks that have not yet been adequately explored.It is to be wondered if people will be obliged to take the drugs by law or if they will face stigma if they refuse. UNAIDS has many years of experience in the use of stigma as a weapon with which to threaten people and punish them for being African so perhaps they have some plans in this area. No disease has ever been beaten by drugs alone so it seems hard to believe that HIV will be the first. But it is great news for the pharmaceutical industry.[For more about PrEP and HIV issues in Africa, see my other blog, HIV in Kenya.]Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from Hiv Infection. read more..