HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

Abstinence-based HIV programs in Africa may put married women at risk

Posted by Henry Bauer on 2008/09/25

Is this a non sequitur? Or something even worse?

My Google Alert for “HIV” periodically offers me head-spinning puzzlers like this one. Naturally I read it eagerly, searching for enlightenment.

The stage is set with the tale of a young virgin who married a 10-years-older man. [Hardly need to read further, does one!?]

After he died, she discovered that she and their 4 children were all “HIV-positive”. [I knew it!]

“There is no way to know exactly when he contracted the AIDS virus, but he did”, we’re told — but since he was never tested, the only evidence is circumstantial.

Now there’s the explanation I was looking for:

“Uganda has been touted as Africa’s most successful country in reducing HIV infection rates, both by its government, which is eager to gain international approval, and by the Bush administration, which funds the controversial abstinence-based ‘ABC’ campaign that now dominates HIV prevention efforts in Uganda and much of Africa. But since abstinence advice is considered irrelevant for married women [for good and sufficient reason, one must surely admit], and married couples are the least likely to use condoms to prevent infection [as some Africans point out, they do like to have children], experts [not named, as usual — we can or must take their expertise on trust] now consider married women among the most at-risk Ugandans for contracting HIV, a factor that could be contributing to Uganda’s current failure to curb rates of new infections.”

That married women are most at risk of testing HIV-positive is a very old story [To avoid HIV infection, don’t get married — 18 November 2007;  HIV demographics further confirmed — 26 February 2008]  Among the reasons are that married women tend to be in the age range where people are most likely to test positive (increasingly from adolescence into young middle age) and that they are likely to bear children: pregnancy is one reason for testing HIV-positive, and some women remain HIV-positive thereafter, at least in South Africa  [HIV demographics are predictable . . . , 27 August 2008].

But the HIV/AIDS Establishment and its experts are impervious to the lessons of actual data, so they say things like — from “Dr. David Serwadda, director of the Institute of Public Health at Makerere University in Kampala”: “Increasingly, people assume that marriage is a safe institution. But there are also extramarital relationships. Married women don’t see why they are at risk, yet they are very much at risk . . .  You could have sex for the first time in marriage, but after that, men are very likely to go outside of marriage and sleep with other women.”
It’s not clear whether Serwadda was extrapolating from his own behavior in so indicting by innuendo a huge proportion of African husbands as promiscuous, adulterous, and irresponsible. But evidently he’s an expert, so he must know what he’s talking about.

“The number of ‘discordant’ couples, or those with one person testing positive and one negative, has been growing, and is an area of concern for many who work to fight HIV”.
Do people think about what they write on these matters, I wonder quite often. As more and more discordant couples are discovered, should one not consider this as possible evidence that “HIV-positive” status may not be transmissible at all? Particularly as we’re talking about Africa, where HIV/AIDS has spread like wildfire — reflecting, according to James Chin, former epidemiologist at the World Health Organization, concurrent multiple sexual partnerships with continually changing partners among 20-40% of adult sub-Saharan Africans. How do those individuals remain uninfected, in those discordant couples? Does only the “HIV-positive” partner have sex, and only outside marriage, while the HIV-negative one is celibate?

“Couples are now encouraged to come for counseling about HIV and to test together. Yet many still do not disclose test results to their spouse for fear of reprisal.”
Do we know that, having heard it from those who are afraid to tell their spouses, or is this just the usual shibboleth that requires no supporting evidence, because everyone knows it to be the case, because everyone knows that women are not empowered, especially not in sub-Saharan Africa?
“’We get ladies who tell us, frankly, I can’t reveal my status [to my new husband]. I fear, who will feed me?’ according to Grace Oling, assistant medical coordinator at TASO in Mulago”.
How many such ladies? Sufficient to extrapolate to the population as a whole?

“Some widowed women, who appear healthy thanks to life-saving anti-retroviral drugs”
Another shibboleth: if someone is HIV-positive and healthy, that can only be the result of antiretroviral drugs?! What about all the “elite controllers” and “long-term non-progressors”?

“Compounding the problem is the fact that few people actually know their HIV status in Uganda . . . only about 12 percent of the population has actually been tested” . . .
which has never prevented UNAIDS and WHO from disseminating purported numbers for the country as a whole. Thus
“Overall, Uganda’s HIV rates have decreased since the peak of the epidemic in the early 1990s, when they soared as high as 30 percent” —
a figure that was based on tests at pre-natal clinics, where women always test positive more often than non-pregnant women do. The sharply reduced estimates from UNAIDS a few years ago were revised for precisely this reason.

2 Responses to “Abstinence-based HIV programs in Africa may put married women at risk”

  1. dale said

    Dr. Bauer,
    Perhaps you’ll comment on “perinatal HIV transmission” from your perspective — both as a geographical and interpersonal phenomenon.

  2. Henry Bauer said

    Dale:

    I can’t do better than refer you to the comprehensive monograph by the Perth group on mother-to-child transmission, http://www.theperthgroup.com/monograph.html

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s