Sorting Out AIDS and Africa

Previously I posted about questions regarding how many cases of "AIDS" in Africa are actually AIDS and how many are other diseases.

I got a comment that seemed to suggest that I would not doubt that all of the cases are genuine AIDS if I were to see for myself the circumstances in Africa. While I admit to ignorance as far as first-hand knowledge goes, I do not think that undertone I detect (that I am downplaying how bad things are in Africa) is accurate. Nor, necessarily, would more experience in Africa disprove the idea that AIDS is being over-diagnosed, unless I had the tools to give every supposed AIDS patient an HIV antibody test.

In any case, the concern is not that we are being too generous or too caring about Africa; the concern is that we may be reducing Africa's health and disease problems to a single issue because it is easier to understand, and in the process we may be not treating other problems.

In other words, Africa has a lot of diseases; we need to make certain that we don't get so focused on AIDS that we ignore other diseases, particularly diseases that we could easily cure with minimal effort:

And why are we to worry so terribly much about AIDS in Africa even as we ignore the millions of Africans each year who die of readily curable diseases like malaria, tuberculosis, and diarrhea? Yes, diarrhea.

Moreover, there is the concern that the focus on African AIDS is less about compassion for Africans and more because it serves the ends of American AIDS activist groups (Read the article linked in the quote above).

Also important is the consideration of the role politics plays in how we view the African AIDS epidemic; for example, while it became very clear in the 90s that AIDS is primarily spread in the western world by anal sex (mostly by homosexual and bisexual males) and intravenous drug use, there is still the belief that in Africa it is spread mostly heterosexually through vaginal intercourse.

Michael Fumento has been challenging that assumption, backed by a study in The International Journal of STDs and AIDS. Penile-vaginal transmission is difficult (in a study over a period of ten years, 19% of women and 2.4% of men in a relationship with an HIV-positive person of the opposite sex contracted HIV from them). In particular, the female-to-male risk is so low, it seems unlikely that HIV could have the multigenerational spread (i.e. person A gives it to person B who gives it to person C who gives it to person D) through heterosexual sex that would be necessary to spread an epidemic even if male-to-female transmission were more frequent. That is, if women cannot spread it back to men, then it cannot spread more than one generation through heterosexual sex.

A common thought is that this is because of the fact that men in Africa don't get circumcised as often as in the west, and being uncircumcised makes it easier to transmit HIV from women to men.

Unfortunately for this school of thought, female-to-male heterosexual HIV transmission is pretty low regardless of circumcision (risk is reduced from 1 in 80 to 1 in 200)*, so being uncircumcised in unlikely to explain the higher AIDS rates in Africa.

So how does AIDS spread? Fumento suggests two ways:

(1) There is a lot of reuse of hypodermic needles in Africa, often without any sterilization. So there is a good chance that HIV is spread through medical care that involves skin puncture. This is quite likely the largest single risk factor in spreading HIV in Africa.

Yet almost certainly greater [than sex] – and more controllable – contributors to the African epidemic are "contaminated punctures from such sources as medical injections, dental injections, surgical procedures, drawing as well as injecting blood, and rehydration through IV tubes," says Brody.

You don't even need to go to a clinic to be injected with HIV: Almost two-thirds of 360 homes visited in sub-Saharan Africa had medical injection equipment that was apparently shared by family members. This, says Brody, can explain why both a husband and wife will be infected.

(2) There is a lot of homosexual activity going on that doesn't register, although this is likely a smaller part of the problem than dirty needles.

For example, German anthropologist Kurt Falk reported in the 1920s that bisexuality was almost universal among the male populations of African tribes he studied. Medical records also show that African men who insist they're straighter than the proverbial arrow often suffer transmissible anorectal diseases.

Why is this important? Because, if true, it means that what Africa needs most in order to fight AIDS is clean needles or needle-sterilization equipment. Moreover, any attempt to reduce sexual risk factors should be the most focused on eliminating or making safer anorectal sexual practices. Preferably, in my opinion, bisexual customs ought to be eliminated wherever possible (it seems to me that much of this sort of homosexual sex is not related to homosexuality [i.e. a primary attraction to one's own sex] as we understand it in the west, and so a lot of it should be stoppable without taking the Africans to Exodus International.

In any case, it is wise to try to find out exactly what is happening in Africa if we are going to fight AIDS there. For that matter, all attemtps to eliminate AIDS need to rely on honesty and truth rather than political agendas.

That is all.

*It is not clear if 1 in 80 this means 1 out of 80 sexual encounters or 1 out of 80 year-long sexual relationships, or 1 out of 80 something else.