Sunday, December 06, 2009

AIDS in Africa: Disturbing Evidence

In the U.S. and Europe, AIDS transmission via vaginal intercourse seems to be very low, with sexual transmission occurring mainly via anal intercourse—one reason why the infection rate is much higher among male homosexuals than in the general population. It is widely believed that this is not true in Africa, that, due perhaps to the prevalence of genital sores, vaginal transmission rates are high enough to provide much of the explanation of the very high rates of AIDS infection.

As a result of references in an online discussion, I recently came across two published articles which offer evidence that this explanation is wrong, that vaginal transmission rates in Africa are not substantially higher than elsewhere. They go on to suggest that what is really going on may be iatrogenic, doctor caused, disease, that much of the transmission may be due to sloppy medical procedures, in particular the reuse of needles for injections. The evidence is in part from the pattern of infection—rates are apparently much too high among young people who have not had sex and whose mothers are not HIV positive, suggesting a non-sexual transmission mechanism. In part it is from studies that try to measure the transmission rate via vaginal intercourse. In part it is from regional patterns that don't fit the patterns of the supposed causes.

The articles are:

Evidence of iatrogenic HIV transmission in children in South Africa


HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

My non-expert impression is that they represent serious scientific work, and that the evidence presented is pretty convincing. The implication is that this is a case of people trying to do good and doing harm instead, always disturbing. Does any reader know of later work either confirming or rebutting the argument?


Nick said...

Should remember that it might not just be traditional doctors that are responsible. Circumcision rituals and similar procedures might also play a role.

August said...

I vaguely remember hearing that the diagnosis is often applied without any actual testing for HIV, which would inflate the numbers. If you fit the profile and have certain symptoms, they say you have it. Some appear to be doing the same with swine flu.

I don't know how much of a negative effect this has, but it certainly didn't sound good. After listening to Elizabeth Pisani
talk about how proud she was of lying about the AIDs epidemic, I tend to be very skeptical of anything that comes out of that camp. They could be spreading it on purpose for all I know. If she's anything to go by, their agenda seems to be more about destroying marriage and traditional gender roles than stopping AIDS.

She also wrote a book.

Johannes said...

I have always found it very odd that the infection rates differ so vastly.

I even had a look at aids skeptics' views.

However the idea that AIDS is not an infectious desease seems to be stupid since the HI virus certanly exists and has been found in many bodies suffering from these symptoms, and generally AIDS simply havin the form of and epidemic.

But the idea that there are additional non-sexual forms of transmission (they would have to be quite effective). Especially since it's propably a lot easier to change peoples medical habbits than to keep them from having sex.

Garg Unzola said...

The first study seems to suggest that kids are not at sexual risk between the ages of 2 to 11. This is certainly not the case. There are some traditional beliefs that hold that you can get rid of Aids by sleeping with a virgin. This is one reason why the rape statistics in South Africa is shocking
(highest per capita in the world).

I find it very unlikely that South Africa's high Aids rates are a result of non-sexual transfer. The little medical care we do have is of world class quality.

I think the most blame falls on Thabo Mbeki and his Aids denialism.

David Friedman said...

Re Garg's comments. The first of the two articles discusses the "sex with a virgin as a cure" theory of transmission, and offers evidence against it. You might want to read it, perhaps check its sources, and see if you find the argument convincing.

Anonymous said...

I've read some convincing claims that the AIDS numbers in Africa are inflated due to foreign aid influences. When AIDS became the favorite politically correct disease of the left, countries began to allocate foreign aid to fight AIDS versus less glamorous diseases such as malaria and tuberculosis. Naturally, countries dependent on foreign aid are incentivized to inflate their AIDS numbers. Given how AIDS works, it is easy to call a death from tuberculosis or some other infectious disease an AIDS death.

Unknown said...

It sounds like a reasonable theory. The only way it could happen from sloppy medical procedures is if they give someone an injection then give another an injection with the same needle right after (within the next few minutes) without cleaning it properly. HIV doesn't survive outside of the human body for very long.

I would guess that if one needle was being used to immunize a lot people quickly one after the other without proper cleaning that the HIV in the infected person's blood could only stay alive long enough to infect the next person but not the whole group.

Anonymous said...

There are some liberties taken with the numbers. The first report over looks breast feeding. The authors are using the formula total aids children - parents with aids = medical transmission. The authors need to look at non parent interactions with aids children as possible routes of transmission.

The second reports references a report on aids surviving up to 4 weeks outside the body. The CDC puts the survival rate at 1% to 10% after just a few hours outside the body. Also, to some degree the authors seem to accept that Africans are as open or honest as Europeans about their sexual history.

I think the 2 reports are trying to push too hard to put aids on the medical community. These guys are using models to reach their conclusions while at the same time other groups using models have come to opposite conclusions. More field research needs to be done on the cultural and true sexual practices of Africans.

As an example, the second report mentions that DNA sequencing found 13% of partners didn't have the same strain of aids. I remember some years ago, a US hospital did sampling of births using blood types and found that 10% of fathers listed on the birth certificate, couldn't have been the father. Just because someone claims to be monogamist doesn't make it true.

montestruc said...

My understanding is that in Africa the big problem is HIV piggybacking on bacterial infections such as syphilis or gonorrhea. The virus is literally a DNA molecule strand while the bacteria are cells and can become infected with the HIV virus.

Once you are infected with the bacteria, you have the virus as well.

Matt K said...

I thought HIV could only infect human cells, hence HUMAN Immunodeficiency Virus. I'm no expert but it seems strange to me that HIV would infect bacteria.