On Sun, 4 Feb 2007 00:41:52 -0000, "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl>
wrote:

Who are "them"?

What "exceptionalist reasoning"?

Rest of article binned, because

a) the subject line indicates that it isn't worth reading

<PEDANT>
b) If you can't say clearly in the subject line and first paragraph what it's
about, it's probably not worth reading.
</pedant>



--
Terms and conditions apply.

Steve Hayes
hayesmstw@hotmail.com

It took them a quarter of a century to state the obvious.
And the exceptionalist reasoning for Africa is laughable,
and internally inconsistent. If heterosexual sex is not a
vector for transmission in the west, why should it be
in Africa.

The truth is, there is no epidemic, and that is that.


http://news.bbc.co.uk/2/hi/health/6321683.stm

Expert doubts widespread HIV risk
Intravenous drug user
Intravenous drug users are a key high-risk group


HIV/Aids campaigners are circulating "misconceptions" about who is at risk,
a former World Health Organization expert has warned.

Dr James Chin was head of a WHO Global Programme on Aids unit from 1987-1992.

In a new book, he says people in the general population outside Africa
are unlikely to contract HIV/Aids, as it is restricted to certain high-risk groups.

Campaigners have promoted a message of safer sex which involves
the use of condoms for protection.

UK experts said Dr Chin's views were inaccurate, and misrepresented
current thinking among HIV/Aids bodies.

Dr Chin says HIV prevalence is low in most populations throughout the world
and can be expected to remain low.

He believes this is not because of effective HIV prevention work, but because
infection rates are limited by the numbers in groups whose behaviour puts them
at high risk.

Dr Chin says it is only in sub-Saharan Africa, where unprotected sex outside
marriage is common, that the risk of heterosexual HIV transmission is high.

In other parts of the world, he says HIV is seen only in men who have sex
with other men, intravenous drug users and female sex workers.

And he says that, unless the clients or partners of people in these groups
also indulge in high-risk behaviour, the virus will not spread.

'Difficult to transmit'

However Dr Chin says these facts have been "minimised and ignored" by
UNAids and Aids activists because it is "politically and socially more
acceptable" to say HIV risk behaviours are present in all populations.

Writing in "The Aids Pandemic", Dr Chin says: "These activists do not want
to further stigmatise persons or population groups who have such high risk
levels of HIV risk behaviours and who are already marginalised.

"By refusing to accept the fact that HIV is very difficult to transmit sexually
without the highest levels of sexual risk behaviours, Aids programmes have
avoided labelling some populations as being more promiscuous than others.

"It is a much more socially and politically correct public health message to
say that sexual promiscuity exists in all populations and thus the risk of
epidemic heterosexual HIV transmission to the general public, or to
ordinary people can be prevented only by aggressive programmes
directed at the general population, and especially to youth."

He cited studies which showed the risk of someone in the general
population of contracting HIV from any single sexual act was, at
the highest estimate, one in 1,000.

And he says the failure to recognise this means that scarce public health
resources in countries where HIV prevalence is low are being wasted
on prevention programmes being targeted at the public, when it is the
high-risk groups who should be targeted.

'Disservice'

Dr Purnima Mane, director of policy evidence and partnerships at UNAids
said: "Without having access to the full text of the book, it is very difficult
for UNAids to comment on it."

But she said: "The Aids response has always invited a high-level of debate
and discussion. UNAids welcomes this debate and stands by its scientific
approach.

"Twenty-five years into the Aids epidemic has shown the world how the
epidemic has continued to evolve and how the response must also evolve.

Dr Mane added: "UNAids data is not influenced by political or fundraising agendas."

Lisa Power, head of policy at the UK's Terrence Higgins Trust said
Dr Chin's views may have been accurate 10 to 15 years ago, but
were not true now.

"He is overstating his case. Sub-Saharan Africa is not the only place
to have heterosexual epidemics and most AIDS activists no longer
espouse a one-size-fits-all approach to HIV prevention work.

"Some authorities are wrong to misrepresent their HIV epidemiology
in order to maximise public interest in the issue.

"But Chin is doing a similar disservice by misrepresenting current HIV
planning and thinking in order to maximise public interest in his book."

Ms Power said there was a need for campaigns targeted at high-risk
groups and more general information to ensure better public
understanding of HIV and sexual health in order to tackle the
stigma surrounding the disease."

The Aids Pandemic: the collision of epidemiology with political
correctness is published by Radcliffe Publishing at £27.50.

Alex <avdeelen.REMOFETHIS1@wanadoo.nl> wrote


Africa has a hugely prevalent high risk perversion. Dry sex. This make a
huge difference to the spread of all infections.
http://www.cirp.org/library/disease/HIV/baleta1/

Unfortunately, public education in this regard wouldn't make us the biggest
potential market for .. anything.

As everyone that's at all informed knows, lesion-causing virus-permeable
condoms, extremely deadly poisons and unlikely abstinence are the entire
answer. Until, of course, there's a useless and possibly harmful vaccine.

Get with the program. Obviously with a scam this size, there's money to be
made. Invest in big pharm. Place a bet on who manages to pull off a PR
campaign to force their vaccines on schoolchildren. Maybe one of them can
convince us that with 100000000000 of us getting infected every minute or
so, we'd better just buy all their stocks of AZT and put it in our water
supply. Big money.



Love, however it looks

--
Rahasya
nospam_rahasya@meditate.co.za

It took them a quarter of a century to state the obvious
And the exceptionalist reasoning for Africa is laughable
and internally inconsistent. If heterosexual sex is not
vector for transmission in the west, why should it b
in Africa

The truth is, there is no epidemic, and that is that

http://news.bbc.co.uk/2/hi/health/6321683.st

Expert doubts widespread HIV ris
Intravenous drug use
Intravenous drug users are a key high-risk grou

HIV/Aids campaigners are circulating "misconceptions" about who is at risk
a former World Health Organization expert has warned

Dr James Chin was head of a WHO Global Programme on Aids unit from 1987-1992

In a new book, he says people in the general population outside Afric
are unlikely to contract HIV/Aids, as it is restricted to certain high-risk groups

Campaigners have promoted a message of safer sex which involve
the use of condoms for protection

UK experts said Dr Chin's views were inaccurate, and misrepresente
current thinking among HIV/Aids bodies

Dr Chin says HIV prevalence is low in most populations throughout the worl
and can be expected to remain low

He believes this is not because of effective HIV prevention work, but becaus
infection rates are limited by the numbers in groups whose behaviour puts the
at high risk

Dr Chin says it is only in sub-Saharan Africa, where unprotected sex outsid
marriage is common, that the risk of heterosexual HIV transmission is high

In other parts of the world, he says HIV is seen only in men who have se
with other men, intravenous drug users and female sex workers

And he says that, unless the clients or partners of people in these group
also indulge in high-risk behaviour, the virus will not spread

'Difficult to transmit

However Dr Chin says these facts have been "minimised and ignored" b
UNAids and Aids activists because it is "politically and socially mor
acceptable" to say HIV risk behaviours are present in all populations

Writing in "The Aids Pandemic", Dr Chin says: "These activists do not wan
to further stigmatise persons or population groups who have such high ris
levels of HIV risk behaviours and who are already marginalised

"By refusing to accept the fact that HIV is very difficult to transmit sexuall
without the highest levels of sexual risk behaviours, Aids programmes hav
avoided labelling some populations as being more promiscuous than others

"It is a much more socially and politically correct public health message t
say that sexual promiscuity exists in all populations and thus the risk o
epidemic heterosexual HIV transmission to the general public, or t
ordinary people can be prevented only by aggressive programme
directed at the general population, and especially to youth.

He cited studies which showed the risk of someone in the genera
population of contracting HIV from any single sexual act was, a
the highest estimate, one in 1,000

And he says the failure to recognise this means that scarce public healt
resources in countries where HIV prevalence is low are being waste
on prevention programmes being targeted at the public, when it is th
high-risk groups who should be targeted

'Disservice

Dr Purnima Mane, director of policy evidence and partnerships at UNAid
said: "Without having access to the full text of the book, it is very difficul
for UNAids to comment on it.

But she said: "The Aids response has always invited a high-level of debat
and discussion. UNAids welcomes this debate and stands by its scientifi
approach

"Twenty-five years into the Aids epidemic has shown the world how th
epidemic has continued to evolve and how the response must also evolve

Dr Mane added: "UNAids data is not influenced by political or fundraising agendas.

Lisa Power, head of policy at the UK's Terrence Higgins Trust sai
Dr Chin's views may have been accurate 10 to 15 years ago, bu
were not true now

"He is overstating his case. Sub-Saharan Africa is not the only plac
to have heterosexual epidemics and most AIDS activists no longe
espouse a one-size-fits-all approach to HIV prevention work

"Some authorities are wrong to misrepresent their HIV epidemiology
in order to maximise public interest in the issue.

"But Chin is doing a similar disservice by misrepresenting current HIV
planning and thinking in order to maximise public interest in his book."

Ms Power said there was a need for campaigns targeted at high-risk
groups and more general information to ensure better public
understanding of HIV and sexual health in order to tackle the
stigma surrounding the disease."

The Aids Pandemic: the collision of epidemiology with political
correctness is published by Radcliffe Publishing at £27.50.

On Sun, 4 Feb 2007 00:41:52 -0000, "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl
wrote

Who are "them"

What "exceptionalist reasoning"

Rest of article binned, becaus

a) the subject line indicates that it isn't worth readin

<PEDANT
b) If you can't say clearly in the subject line and first paragraph what it'
about, it's probably not worth reading
</pedant


--
Terms and conditions apply.

Steve Haye
hayesmstw@hotmail.co

Alex <avdeelen.REMOFETHIS1@wanadoo.nl> wrot

Africa has a hugely prevalent high risk perversion. Dry sex. This make
huge difference to the spread of all infections
http://www.cirp.org/library/disease/HIV/baleta1

Unfortunately, public education in this regard wouldn't make us the bigges
potential market for .. anything

As everyone that's at all informed knows, lesion-causing virus-permeabl
condoms, extremely deadly poisons and unlikely abstinence are the entir
answer. Until, of course, there's a useless and possibly harmful vaccine

Get with the program. Obviously with a scam this size, there's money to b
made. Invest in big pharm. Place a bet on who manages to pull off a P
campaign to force their vaccines on schoolchildren. Maybe one of them ca
convince us that with 100000000000 of us getting infected every minute o
so, we'd better just buy all their stocks of AZT and put it in our wate
supply. Big money


Love, however it look

--
Rahasy
nospam_rahasya@meditate.co.z

It took them a quarter of a century to state the obvious
And the exceptionalist reasoning for Africa is laughable
and internally inconsistent. If heterosexual sex is not
vector for transmission in the west, why should it b
in Africa

The truth is, there is no epidemic, and that is that

http://news.bbc.co.uk/2/hi/health/6321683.st

Expert doubts widespread HIV ris
Intravenous drug use
Intravenous drug users are a key high-risk grou

HIV/Aids campaigners are circulating "misconceptions" about who is at risk
a former World Health Organization expert has warned

Dr James Chin was head of a WHO Global Programme on Aids unit from 1987-1992

In a new book, he says people in the general population outside Afric
are unlikely to contract HIV/Aids, as it is restricted to certain high-risk groups

Campaigners have promoted a message of safer sex which involve
the use of condoms for protection

UK experts said Dr Chin's views were inaccurate, and misrepresente
current thinking among HIV/Aids bodies

Dr Chin says HIV prevalence is low in most populations throughout the worl
and can be expected to remain low

He believes this is not because of effective HIV prevention work, but becaus
infection rates are limited by the numbers in groups whose behaviour puts the
at high risk

Dr Chin says it is only in sub-Saharan Africa, where unprotected sex outsid
marriage is common, that the risk of heterosexual HIV transmission is high

In other parts of the world, he says HIV is seen only in men who have se
with other men, intravenous drug users and female sex workers

And he says that, unless the clients or partners of people in these group
also indulge in high-risk behaviour, the virus will not spread

'Difficult to transmit

However Dr Chin says these facts have been "minimised and ignored" b
UNAids and Aids activists because it is "politically and socially mor
acceptable" to say HIV risk behaviours are present in all populations

Writing in "The Aids Pandemic", Dr Chin says: "These activists do not wan
to further stigmatise persons or population groups who have such high ris
levels of HIV risk behaviours and who are already marginalised

"By refusing to accept the fact that HIV is very difficult to transmit sexuall
without the highest levels of sexual risk behaviours, Aids programmes hav
avoided labelling some populations as being more promiscuous than others

"It is a much more socially and politically correct public health message t
say that sexual promiscuity exists in all populations and thus the risk o
epidemic heterosexual HIV transmission to the general public, or t
ordinary people can be prevented only by aggressive programme
directed at the general population, and especially to youth.

He cited studies which showed the risk of someone in the genera
population of contracting HIV from any single sexual act was, a
the highest estimate, one in 1,000

And he says the failure to recognise this means that scarce public healt
resources in countries where HIV prevalence is low are being waste
on prevention programmes being targeted at the public, when it is th
high-risk groups who should be targeted

'Disservice

Dr Purnima Mane, director of policy evidence and partnerships at UNAid
said: "Without having access to the full text of the book, it is very difficul
for UNAids to comment on it.

But she said: "The Aids response has always invited a high-level of debat
and discussion. UNAids welcomes this debate and stands by its scientifi
approach

"Twenty-five years into the Aids epidemic has shown the world how th
epidemic has continued to evolve and how the response must also evolve

Dr Mane added: "UNAids data is not influenced by political or fundraising agendas.

Lisa Power, head of policy at the UK's Terrence Higgins Trust sai
Dr Chin's views may have been accurate 10 to 15 years ago, bu
were not true now

"He is overstating his case. Sub-Saharan Africa is not the only plac
to have heterosexual epidemics and most AIDS activists no longe
espouse a one-size-fits-all approach to HIV prevention work

"Some authorities are wrong to misrepresent their HIV epidemiology
in order to maximise public interest in the issue.

"But Chin is doing a similar disservice by misrepresenting current HIV
planning and thinking in order to maximise public interest in his book."

Ms Power said there was a need for campaigns targeted at high-risk
groups and more general information to ensure better public
understanding of HIV and sexual health in order to tackle the
stigma surrounding the disease."

The Aids Pandemic: the collision of epidemiology with political
correctness is published by Radcliffe Publishing at £27.50.

Alex <avdeelen.REMOFETHIS1@wanadoo.nl> wrot

Africa has a hugely prevalent high risk perversion. Dry sex. This make
huge difference to the spread of all infections
http://www.cirp.org/library/disease/HIV/baleta1

Unfortunately, public education in this regard wouldn't make us the bigges
potential market for .. anything

As everyone that's at all informed knows, lesion-causing virus-permeabl
condoms, extremely deadly poisons and unlikely abstinence are the entir
answer. Until, of course, there's a useless and possibly harmful vaccine

Get with the program. Obviously with a scam this size, there's money to b
made. Invest in big pharm. Place a bet on who manages to pull off a P
campaign to force their vaccines on schoolchildren. Maybe one of them ca
convince us that with 100000000000 of us getting infected every minute o
so, we'd better just buy all their stocks of AZT and put it in our wate
supply. Big money


Love, however it look

--
Rahasy
nospam_rahasya@meditate.co.z

On Sun, 4 Feb 2007 00:41:52 -0000, "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl
wrote

Who are "them"

What "exceptionalist reasoning"

Rest of article binned, becaus

a) the subject line indicates that it isn't worth readin

<PEDANT
b) If you can't say clearly in the subject line and first paragraph what it'
about, it's probably not worth reading
</pedant


--
Terms and conditions apply.

Steve Haye
hayesmstw@hotmail.co

It took them a quarter of a century to state the obvious
And the exceptionalist reasoning for Africa is laughable
and internally inconsistent. If heterosexual sex is not
vector for transmission in the west, why should it b
in Africa

The truth is, there is no epidemic, and that is that

http://news.bbc.co.uk/2/hi/health/6321683.st

Expert doubts widespread HIV ris
Intravenous drug use
Intravenous drug users are a key high-risk grou

HIV/Aids campaigners are circulating "misconceptions" about who is at risk
a former World Health Organization expert has warned

Dr James Chin was head of a WHO Global Programme on Aids unit from 1987-1992

In a new book, he says people in the general population outside Afric
are unlikely to contract HIV/Aids, as it is restricted to certain high-risk groups

Campaigners have promoted a message of safer sex which involve
the use of condoms for protection

UK experts said Dr Chin's views were inaccurate, and misrepresente
current thinking among HIV/Aids bodies

Dr Chin says HIV prevalence is low in most populations throughout the worl
and can be expected to remain low

He believes this is not because of effective HIV prevention work, but becaus
infection rates are limited by the numbers in groups whose behaviour puts the
at high risk

Dr Chin says it is only in sub-Saharan Africa, where unprotected sex outsid
marriage is common, that the risk of heterosexual HIV transmission is high

In other parts of the world, he says HIV is seen only in men who have se
with other men, intravenous drug users and female sex workers

And he says that, unless the clients or partners of people in these group
also indulge in high-risk behaviour, the virus will not spread

'Difficult to transmit

However Dr Chin says these facts have been "minimised and ignored" b
UNAids and Aids activists because it is "politically and socially mor
acceptable" to say HIV risk behaviours are present in all populations

Writing in "The Aids Pandemic", Dr Chin says: "These activists do not wan
to further stigmatise persons or population groups who have such high ris
levels of HIV risk behaviours and who are already marginalised

"By refusing to accept the fact that HIV is very difficult to transmit sexuall
without the highest levels of sexual risk behaviours, Aids programmes hav
avoided labelling some populations as being more promiscuous than others

"It is a much more socially and politically correct public health message t
say that sexual promiscuity exists in all populations and thus the risk o
epidemic heterosexual HIV transmission to the general public, or t
ordinary people can be prevented only by aggressive programme
directed at the general population, and especially to youth.

He cited studies which showed the risk of someone in the genera
population of contracting HIV from any single sexual act was, a
the highest estimate, one in 1,000

And he says the failure to recognise this means that scarce public healt
resources in countries where HIV prevalence is low are being waste
on prevention programmes being targeted at the public, when it is th
high-risk groups who should be targeted

'Disservice

Dr Purnima Mane, director of policy evidence and partnerships at UNAid
said: "Without having access to the full text of the book, it is very difficul
for UNAids to comment on it.

But she said: "The Aids response has always invited a high-level of debat
and discussion. UNAids welcomes this debate and stands by its scientifi
approach

"Twenty-five years into the Aids epidemic has shown the world how th
epidemic has continued to evolve and how the response must also evolve

Dr Mane added: "UNAids data is not influenced by political or fundraising agendas.

Lisa Power, head of policy at the UK's Terrence Higgins Trust sai
Dr Chin's views may have been accurate 10 to 15 years ago, bu
were not true now

"He is overstating his case. Sub-Saharan Africa is not the only plac
to have heterosexual epidemics and most AIDS activists no longe
espouse a one-size-fits-all approach to HIV prevention work

"Some authorities are wrong to misrepresent their HIV epidemiology
in order to maximise public interest in the issue.

"But Chin is doing a similar disservice by misrepresenting current HIV
planning and thinking in order to maximise public interest in his book."

Ms Power said there was a need for campaigns targeted at high-risk
groups and more general information to ensure better public
understanding of HIV and sexual health in order to tackle the
stigma surrounding the disease."

The Aids Pandemic: the collision of epidemiology with political
correctness is published by Radcliffe Publishing at £27.50.

Alex <avdeelen.REMOFETHIS1@wanadoo.nl> wrot

Africa has a hugely prevalent high risk perversion. Dry sex. This make
huge difference to the spread of all infections
http://www.cirp.org/library/disease/HIV/baleta1

Unfortunately, public education in this regard wouldn't make us the bigges
potential market for .. anything

As everyone that's at all informed knows, lesion-causing virus-permeabl
condoms, extremely deadly poisons and unlikely abstinence are the entir
answer. Until, of course, there's a useless and possibly harmful vaccine

Get with the program. Obviously with a scam this size, there's money to b
made. Invest in big pharm. Place a bet on who manages to pull off a P
campaign to force their vaccines on schoolchildren. Maybe one of them ca
convince us that with 100000000000 of us getting infected every minute o
so, we'd better just buy all their stocks of AZT and put it in our wate
supply. Big money


Love, however it look

--
Rahasy
nospam_rahasya@meditate.co.z

On Sun, 4 Feb 2007 00:41:52 -0000, "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl
wrote

Who are "them"

What "exceptionalist reasoning"

Rest of article binned, becaus

a) the subject line indicates that it isn't worth readin

<PEDANT
b) If you can't say clearly in the subject line and first paragraph what it'
about, it's probably not worth reading
</pedant


--
Terms and conditions apply.

Steve Haye
hayesmstw@hotmail.co

On Sun, 4 Feb 2007 00:41:52 -0000, "Alex"
<avdeelen.REMOFETHIS1@wanadoo.nl> wrote:

Ah...which "obvious"? This is just Chin's opinion.

HIV has already spread outside "traditional" risk groups in the US.
But vulnerable groups like MSM, sex workers and activities like needle
sharing remain important areas to target prevention.

By contrast, none of what Chin says remotely supports your psychotic
viewpoint that HIV doesn't exist or cause AIDS.

Say--does Manto have AIDS?

George M. Carter

"GMCarter" <fiar@verizon.net> wrote in message
news:4ggbs2516sstg8g4rk0kg76varvcpnoj2f@4ax.com...
1. HIV does not cause AIDS
2. The economy is booming and Stats SA are not number fiddlers
3. There are plenty of jobs for everyone including the young people who have
left the country and they must now reaffirm their patriotic values and come
home.
4. Crime is not out of control in South Africa
5. Banks should not be involved in politics!

"Rahasya" <nospam_rahasya@meditate.co.za> schreef in berich
news:C1EAF8F5.A9F0%nospam_rahasya@meditate.co.za..

Oh yes, the myth of 'dry sex'. If this is so good or widespread, ho
come no one in the West is practicing it

I thought this hoardy myth was buried at the same time as 'mosquito
spread HIV'

Chin's claim for exceptionalism in Africa is that people in Africa hav
sex 'more often' than people in the rest of the world, not 'differently
than people in the rest of the world

Both claims of course are ridiculous, and an appeal to racis
mythology, rather than common sense evidence or statistical proof

Again, no one outside the AIDS indutry has proven that either exist
Either claim would need confirmation from mainstream publications

Ale

http://www.virusmyth.net/aids/data/cgstereotypes.ht

Aside from the voyeurism and the lack of verification that attends these sensationalist claims, n
one has ever shown that people in Rwanda, Uganda, Zaire, and Kenya - the so-called "AIDS belt" - ar
more sexually active than people in Nigeria which has reported only 21,905 AIDS cases out of
population of 120 million or Cameroon which reported 13,576 cases in 14 million.(25) N
continent-wide sex surveys have ever been carried out in Africa. Nevertheless, conventiona
researchers perpetuate racist stereotypes about insatiable sexual appetites and carnal exotica. The
assume that AIDS cases in Africa are driven by a sexual promiscuity similar to what produced - i
combination with recreational drugs, sexual stimulants, venereal disease, and the over-use o
antibiotics - the early epidemic of immunological dysfunction among a small sub-culture of urban ga
men in the West.(26

The research from Africa suggests nothing of the sort. In 1991 researchers from Médicins San
Frontières and the Harvard School of Public Health did a survey of sexual behavior in Moyo distric
of northwest Uganda. Their findings revealed behavior that was not very different from that of th
West. On average, women had their first sex at age 17, men at 19. Eighteen per cent of women and 50
of men reported premarital sex; 1.6% of the women and 4.1% of the men had had casual sex in th
month preceding the study, while 2% of women and 15% of men had done so in the preceding year.(27


http://www.cirp.org/library/disease/HIV/brewer1

Mounting anomalies in the epidemiology of HI
in Africa: cry the beloved paradig

Devon D Brewer PhD1, Stuart Brody PhD2, Ernest Drucker PhD3
David Gisselquist PhD4, Stephen F Minkin BA6, John J Potterat BA5
Richard B Rothenberg MD MPH7 and François Vachon MD

(Authors are listed alphabetically

1University of Washington, Seattle, Washington, USA, 2Institute of Medical Psychology and Behaviora
Neurobiology, University of Tübingen, Germany, 3Department of Epidemiology and Social Medicine
Montefiore Medical Center/Albert Einstein College of Medicine, New York City, USA, 4Hershey, PA
USA, 5Colorado Springs, Colorado, USA, 6Network for Infection Prevention, Brattleboro, Vermon
05302, USA, 7 Department of Family and Preventive Medicine, Emory University School of Medicine
Atlanta, GA, USA, 8University of Paris 7, Franc

Keywords: HIV, Africa, risk factors, epidemiology, heterosexual transmission, medical transmissio
Introductio

There is substantial dissonance between much of the epidemiologic evidence and the current orthodox
that nearly all of the HIV burden in sub-Saharan Africa can be accounted for by heterosexua
transmission and the sexual behaviour of Africans. The mounting toll of HIV infection in Africa i
paralleled by a mounting number of anomalies in the many studies seeking to account for it. We
propose that existing data can no longer be reconciled with the received wisdom about the
exceptional role of sex in the African AIDS epidemic.
Anomalies in sub-Saharan Africa

Discontinuity between HIV and STIs During the 1990s HIV propagated rapidly in Zimbabwe, increasing
at an estimated rate of 12% annually. At the same time, the overall sexually transmitted infections
(STI) burden declined an estimated 25% and while there was a parallel increase in reported condom
use by high-risk persons (prostitutes, lorry drivers, miners, and young people)1. This example
frames the problem: why would a relatively low efficiency sexually transmitted virus like HIV outrun
more efficiently transmitted STI2? In the notable four-cities study3, many common sexual risk
factors linked to HIV transmission (eg, high rate of partner change, sex with prostitutes, and low
condom use) were not correlated with HIV prevalence-although some risk markers (young age at first
coitus or marriage, large age difference between partners) and presumed facilitating factors (lack
of circumcision, genital herpes, and trichomoniasis, but not bacterial STI) were. In addition,
concurrency of sexual partnerships was not correlated with HIV prevalence, yet was associated with
bacterial STI4.It is of concern that many key sexual transmission variables are not associated with
a large HIV epidemic in Africa, yet do correlate, as expected, with other STIs.

Transmission efficiency

A study of HIV transmission efficiency in Africa, using data from serodiscordant couples5, produced
estimates remarkably similar to those reported for couples in the developed world6. Observed
probabilities presumably reflect some of the influence of facilitating factors (eg, unorthodox
sexual practices, circumcision status, STI exposure, etc) recruited to explain the 'turbo effect'7
noted in Africa's epidemiologic context. Recent empiric research casts doubt that such co-factors
can sufficiently amplify the force of infectivity to account for observed trends in the sexual
transmission of HIV in Africa8. The anomalies regarding transmission efficiency are well illustrated
by a recent study in South Africa9. The authors recognized that, to explain HIV acquisition by 16-18
year old women in their study, they needed to postulate a per partnership transmission probability
of 0.92 (0.49, assuming double the number of reported partnerships per woman). By extension, the
per-contact probability of transmission would be 0.34, making heterosexual sex in this context
second only to transfusion in HIV transmission efficiency. Similarly, a model developed to assess
the impact of STI on transmission of HIV posited an extraordinary 33-fold increase in transmission
efficiency of the latter in the presence of the former10.
Reported sexual activity

Levels of sexual activity reported in a dozen general population surveys in Africa11 are comparable
to those reported elsewhere, especially in North America and Europe. Perhaps more importantly, there
appears to be little correlation with the level of risky sexual behaviour shown in these surveys and
the epidemic trajectories observed in these countries. (Comparison with country-specific data
reported by UNAIDS 2000; data not shown.) The four-city study provides similar discordance12. For
example, Yaounde (in Cameroon, a nation with low and stable prevalence) had the highest level of
risky behavioural markers. Ndola (in Zambia, a nation that has experienced a rapid rise in HIV) had
the smallest proportion of both men and women who reported a non-spousal sex partner in the previous
12 months. Ndola's other markers were similar to those in Dakar, Senegal and Cotonou, Benin, other
areas with low, stable prevalence.
Transmission dynamics

Rapid propagation (of at least bacterial STI) has been associated with core groups13, which make up
a small proportion of the susceptible population and are proposed to be responsible for most
community transmission. Such groups appear to be associated with differing forms of sexual net-work
'geometry'. This geometry demonstrably differs with transmission intensity14-16. Evidence suggests
that endemic and declining HIV/STI burdens are associated with dendritic (many open-ended termini)
patterns of sexual partner connections, while epidemicity is associated with cyclic (closed loops,
reflecting cohesiveness and density) patterns. There are few data on the architecture of sociosexual
networks in Africa, but the available information suggests predominantly dendritic patterns (eg,
contact with prostitutes and then contact with stable and usually monogamous consorts who are
network termini). We are aware of no study from sub-Saharan Africa suggesting cyclic sexual network
architecture. Without evidence of appropriate network configurations on a scale considerably larger
than that observed in developed countries, rapid propagation of HIV in Africa would be difficult to
sustain.

Studies have associated putative sexual core groups with HIV transmission in Africa. For example,
women who work as prostitutes and their partners have frequently been observed to have high HIV
prevalence. Confusion may arise, however, over conflating the terms 'high risk person' and 'core
group'. The former have been labelled in some way, but are not necessarily part of an interconnected
group of individuals through whom infection percolates (ie, core group). As noted, such persons
would have to be part of an interactive, cyclic group, rather than nodes along a dendritic chain.

Other anomalous findings

A higher HIV prevalence has been observed in women seen in prenatal, postpartum, and induced
abortion settings than in their community counter-parts17. In a number of studies, there appears to
be a discrepancy between the observed prevalence in women undergoing reproductive medical care, and
the prevalence that would be observed in such a group from heterosexual transmission alone. Though
few in number, there continue to be reports of HIV seropositivity in persons denying coital exposure
and in persons claiming a sole lifetime sexual partner who is reportedly HIV negative17. Similarly,
there are persistent reports of HIV in infants with seronegative mothers17. A recent large survey
from South Africa measured an HIV prevalence of 5.6% in children 2-14 years of age 18. Given
mortality from HIV among children who acquire it in Africa, there would appear to be a substantial
proportion of such a disease burden that is unexplained by maternal and sexual transmission.
Alternatives

A number of these observations raise the question of an alternative route of transmission, for which
medical care and the use of injections are prime candidates17,19-22. Prostitutes, for example, are
often recruited for studies from STI clinics, where treatment is frequently given by injection,
where non-sterile equipment is used with high frequency, and wherein the underlying prevalence of
HIV is high7. Many studies that have assessed the impact of sexual activity on HI
transmission -notably those in Mwanza and Rakai, whose discordant results are still a subject o
debate23-failed to consider the potential confounding effects of medical care in the propagation o
HIV24

Rapid HIV transmission in Africa has often occurred in countries with good access to medical care
like Botswana, Zimbabwe, and South Africa. For example, high rates in rural South Africa hav
paralleled aggressive efforts to deliver health care to rural populations. It is difficult t
understand how improved access to health care, with its offers of public health messages, fre
condoms, and preventive services, would be associated with increased HIV transmission. Similarly
HIV prevalence is often higher in cities and among persons of high socioeconomic attainment than i
rural areas or among less fortunate persons. Favourable access to health care is one of th
differences that distinguishes between these groups

Reactions to the anomalies and alternative

Since early in the African epidemic, when AIDS was demographically associated with sexually activ
populations25, studies of HIV transmission in Africa have generally failed to control for possibl
parenteral confounding26. The importance of this route of infection was well known in the West an
in Asia but quickly dismissed in Africa27. The risk of parenteral transmission of HIV is based o
good estimates of transmission efficiency, which varies depending on type of injection an
circumstances that produce reuse of contaminated equipment. For example, needle stick exposure (HI
transmission probability: about one in 30028, medical injection (recently estimated at approximatel
one in 3020), or illicit-drug injection (about one in 10029), is much more efficient tha
penile-vaginal exposure (about one in 100030)

There is the expectation that, were iatrogenic transmission of HIV common, one would notic
substantial HIV prevalence in populations of (non-sexually experienced) children. Regrettably
although a large proportion of Africa's population falls in that category, few serosurveys conducte
in Africa have included large enough samples from, say, children aged five through 12 to confidentl
dismiss this possibility. As more information accumulates that addresses this issue, a cleare
perspective on the magnitude of non-sexual, non-maternal transmission in children will emerge

The risk of exposure to HIV via medical injections is likely to vary with background prevalence an
with the specific medical practices in different settings. The demand for consistency and coherenc
that we have placed on the heterosexual hypothesis should be applied to estimating the role o
medical transmission. Its role should vary with background (initial) prevalence, and should b
related to the degree of medical hygiene exercised. The same biological basis that exists fo
heterosexual transmission should be established for medical transmission. (As an aside, such
demonstration poses substantial ethical problems. No investigator should knowingly observe the us
of a needle that has a high probability of being contaminated with HIV, but at a minimum, th
demonstration of HIV RNA in needles that were to have been used on patients would be an importan
element in establishing a biological base.) The transmission of blood-borne pathogens with differin
biological characteristics, notably hepatitis B and C31, should be consistent with parentera
transmission of HIV. Finally, the social epidemiology of HIV (male to female ratios, for example
should be consistent with observations about non-sexual exposure

Conclusio

In North America, Europe, and many parts of Asia, the ignition of regional epidemics and rapid HI
transmission has been associated principally with the sharing of contaminated injecting equipmen
and with anal intercourse. Though heterosexual intercourse has been virtually the sole explanatio
offered for the AIDS epidemic in sub-Saharan Africa, to our knowledge in no other part of the worl
has penile-vaginal exposure (as opposed to 'heterosexual sex') been demonstrated to initiate o
sustain rapid HIV propagation.

HIV is not transmitted by 'sex', but only by specific risky practices. It is not transmitted by
'injections', but only by contaminated implements, which need to be clearly differentiated as to
type and frequency of injection and by the conditions of the exposure setting. In virtually all
societies affected by HIV to date, both routes seem to play important roles. If we are to understand
and intervene in each of these epidemics, well-designed studies at both the population and
individual levels are urgently needed. It is vital that these be properly controlled for parenteral
exposure, specific sexual practices, and other co-factors2,17,24,32 and the complex and specific
social patterns and networks that accompany them33.

Dispassionate assessment of our conclusions admittedly depends on a willing suspension of disbelief,
since the current paradigm is deeply embedded. Counter arguments can (and will) be levelled at each
of the anomalies noted, but the depth and breadth of concerns deserve fair scrutiny. At issue in a
re-evaluation of the heterosexual hypothesis are the profound implications for our interventive
approach, and for the kinds of social and financial commitments that must be made. Finally, Africans
deserve scientifically sound information on the epidemiologic determinants of their calamitous AIDS
epidemic.
References

1 Decosas J, Padian N. The profile and context of the epidemics of sexually transmitted infections
including HIV in Zimbabwe. Sex Transm Infect 2002;78(Suppl 1):140-6

2 Potterat JJ, Brody S. HIV epidemicity in context of STI declines: a telling discordance
(letter). Sex Transm Infect 2002; 78:467 [Full Text]

3 Buve A, Carael M, Hayes RJ, et al. The multicentre study on factors determining the differential
spread of HIV in four African cities: summary and conclusions. AIDS 2001;5(Suppl 4):S127-31
[Abstract]

4 Rothenberg R, Potterat J, Gisselquist D. Concurrency and sexual transmission (letter). AIDS
2002;16:678-80

5 Gray RH, Wawer MJ, Brookmeyer R, et al. Probability of HIV-1 transmission per coital act in
monogamous, heterosexual, HIV-1 discordant couples in Rakai, Uganda. Lancet 2001;357:1149-53

6 Downs AM, De Vicenzi I, European Group on Heterosexual Transmission of HIV: relationship to the
number of unprotected sexual contacts. J Acquir Immune Defic Syndr 1996;11:388-95

7 Vachon F, Coulaud JP, Katlama C. Epidémiologie actuelle du syndrome d'immunodéficit acquis en
dehors des groupes à risque. Presse Médicale 1985;14:1949-50

8 Gisselquist D, Potterat JJ. Heterosexual transmission of HIV in Africa: an empiric estimate. Int
J STD AIDS 2003;14:162-73

9 Auvert B, Ballard R, Campbell C, et al. HIV infection among youth in a South African mining town
is associated with herpes simplex virus-2 seropositivity and sexual behavior. AIDS 2001;15:883-98

10 Robinson NJ, Mulder DW, Auvert B, Hayes RJ. Modelling the impact of alternative HIV intervention
strategies in rural Uganda. AIDS 1995;9:1263-70 [PubMed]

11 Carael M, Cleland J, Deheneffe J-C, Ferry B, Ingham R. Sexual behavior in developing countries:
implications for HIV control. AIDS 1995;9:1171-5

12 Buve A, Lagarde E, Carael M, et al. Interpreting sexual behaviour data: validity issues in the
multicentre study on factors determining the differential spread of HIV in four African cities. AIDS
2001;15(Suppl 4):S1117-26 [Abstract]

13 Thomas JC, Tucker MJ. The development and use of the concept of a sexually transmitted disease
core. J Infect Dis 1996;176(Suppl 2):S134-43 [PubMed]

14 Potterat JJ, Muth SQ, Rothenberg RB, et al. Network structure as an indicator of epidemic phase.
Sex Transm Infect 2002;78(Suppl 1):i152-8

15 Potterat JJ, Phillips-Plummer L, Muth SQ, et al. Risk network structure in the early epidemic
phase of HIV transmission in Colorado Springs. Sex Transm Infect 2002; 78(Suppl 1):i159-63

16 Potterat JJ, Rothenberg RB, Muth SQ. Network structural dynamics and infectious disease
propagation. Int J STD AIDS 1999;10:182-5 [PubMed]

17 Gisselquist D, Rothenberg R, Potterat J, et al. HIV infections in sub-Saharan Africa not
explained by sexual or vertical transmission. Int J STD AIDS 2002;13:657-66 [PubMed]

18 Shisana O, Simbayi L, Bezuidenhout F, et al. Nelson Mandela/HSCR study of HIV/AIDS: South African
national HIV prevalence, behavioural risks and mass media: household survey 2002. Cape Town, Human
Sciences Research Council 2002. http://www.hsrc.ac.za/research/npa/S...05Keynote.html

19 Simonsen L, Kane A, Lloyd J, et al. Unsafe injections in the developing world and transmission of
bloodborne pathogens: a review. WHO Bull 1999;77:789-800

20 Gisselquist DP. Estimating HIV-1 transmission efficiency through unsafe medical injections. Int J
STD AIDS 2002; 13:152-9 [Abstract]

21 Drucker EM, Alcabes PG, Marx PA. The injection century: consequences of massive unsterile
injecting for the emergence of human pathogens. Lancet 2001;358:1989-92

22 Potterat JJ, Brody S. Does sex explain HIV transmission dynamics in developing countries?
(Letter) Sex Transm Dis 2001;28:730

23 Grosskurth H, Gray R, Hayes R, et al. Control of sexually transmitted diseases for HIV-1
prevention: understanding the implications of the Mwanza and Rakai trials. Lancet 2000;355:1981-7
[PubMed]

24 Gisselquist D, Potterat J. Confound it: latent lessons from the Mwanza trial of STD treatment to
reduce HIV transmission. Int J STD AIDS 2003;14:179-84 [Abstract]

25 Quinn TC, Mann JM, Curran JW, Piot P. AIDS in Africa: an epidemiologic paradigm. Science
1986;234:955-63 [Abstract]

26 Gisselquist D, Rothenberg R, Potterat J, Drucker E. Non-sexual transmission of HIV has been
overlooked in developing countries (letter). BMJ 2002;324:235

27 Gisselquist D, Potterat J, Brody S, Vachon F. Let it be sexual: how health care transmission of
AIDS in Africa was ignored. Int J STD AIDS 2003;14:148-61

28 Tokars JI, Marcus R, Culver DH. Surveillance of HIV infection and zidovudine use among health
care workers after occupational exposure to HIV-infected blood. Ann Intern Med 1993;118:913-19 [Full
Text]

29 Kaplan EH, Heimer R. A model-based estimate of HIV infectivity via needle sharing. JAIDS
1992;5:1116-18 [PubMed]

30 Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV. N Engl J Med 1997;336:1072-8

31 Madhava V, Burgess C, Drucker E. Epidemiology of chronic hepatitis C virus infection in
sub-Saharan Africa. Lancet Infect Dis 2002;2:293-302 [PubMed]

32 Gisselquist D, Potterat JJ. Uncontrolled HSV-2 as a co-factor in HIV transmission (response to
Sutcliffe et al.). JAIDS (in press)

33 Aral SO, Holmes KK. Social and behavioral determinants of the epidemiology of STDs:
industrialized and developing countries, in Holmes KK, Sparling PF, Mårdh P-A, et al. (eds):
Sexually transmitted diseases (3rd edn). New York: McGraw-Hill Book Co, Inc., 1999:39-76

(Accepted 15 December 2002)

Correspondence to: Mr J J Potterat, 301 South Union Blvd,
Colorado Springs, Colorado USA 80910

"Skokkie" <glenton@hotmail.com> wrote in message
news:eq4km2$h1k$1@ctb-nnrp2.saix.net...
Definitely correct when do you pick up your commission cheque
from the party offices ?

"Rahasya" <nospam_rahasya@meditate.co.za> schreef in bericht
news:C1EAF8F5.A9F0%nospam_rahasya@meditate.co.za.. .
Oh yes, the myth of 'dry sex'. If this is so good or widespread, how
come no one in the West is practicing it?

I thought this hoardy myth was buried at the same time as 'mosquitos
spread HIV'?

Chin's claim for exceptionalism in Africa is that people in Africa have
sex 'more often' than people in the rest of the world, not 'differently'
than people in the rest of the world.

Both claims of course are ridiculous, and an appeal to racist
mythology, rather than common sense evidence or statistical proof.

Again, no one outside the AIDS indutry has proven that either exist.
Either claim would need confirmation from mainstream publications.

Alex


http://www.virusmyth.net/aids/data/cgstereotypes.htm

Aside from the voyeurism and the lack of verification that attends these sensationalist claims, no
one has ever shown that people in Rwanda, Uganda, Zaire, and Kenya - the so-called "AIDS belt" - are
more sexually active than people in Nigeria which has reported only 21,905 AIDS cases out of a
population of 120 million or Cameroon which reported 13,576 cases in 14 million.(25) No
continent-wide sex surveys have ever been carried out in Africa. Nevertheless, conventional
researchers perpetuate racist stereotypes about insatiable sexual appetites and carnal exotica. They
assume that AIDS cases in Africa are driven by a sexual promiscuity similar to what produced - in
combination with recreational drugs, sexual stimulants, venereal disease, and the over-use of
antibiotics - the early epidemic of immunological dysfunction among a small sub-culture of urban gay
men in the West.(26)

The research from Africa suggests nothing of the sort. In 1991 researchers from Médicins Sans
Frontières and the Harvard School of Public Health did a survey of sexual behavior in Moyo district
of northwest Uganda. Their findings revealed behavior that was not very different from that of the
West. On average, women had their first sex at age 17, men at 19. Eighteen per cent of women and 50%
of men reported premarital sex; 1.6% of the women and 4.1% of the men had had casual sex in the
month preceding the study, while 2% of women and 15% of men had done so in the preceding year.(27)



http://www.cirp.org/library/disease/HIV/brewer1/

Mounting anomalies in the epidemiology of HIV
in Africa: cry the beloved paradigm

Devon D Brewer PhD1, Stuart Brody PhD2, Ernest Drucker PhD3,
David Gisselquist PhD4, Stephen F Minkin BA6, John J Potterat BA5,
Richard B Rothenberg MD MPH7 and François Vachon MD8

(Authors are listed alphabetically)

1University of Washington, Seattle, Washington, USA, 2Institute of Medical Psychology and Behavioral
Neurobiology, University of Tübingen, Germany, 3Department of Epidemiology and Social Medicine,
Montefiore Medical Center/Albert Einstein College of Medicine, New York City, USA, 4Hershey, PA,
USA, 5Colorado Springs, Colorado, USA, 6Network for Infection Prevention, Brattleboro, Vermont
05302, USA, 7 Department of Family and Preventive Medicine, Emory University School of Medicine,
Atlanta, GA, USA, 8University of Paris 7, France

Keywords: HIV, Africa, risk factors, epidemiology, heterosexual transmission, medical transmission
Introduction

There is substantial dissonance between much of the epidemiologic evidence and the current orthodoxy
that nearly all of the HIV burden in sub-Saharan Africa can be accounted for by heterosexual
transmission and the sexual behaviour of Africans. The mounting toll of HIV infection in Africa is
paralleled by a mounting number of anomalies in the many studies seeking to account for it. We
propose that existing data can no longer be reconciled with the received wisdom about the
exceptional role of sex in the African AIDS epidemic.
Anomalies in sub-Saharan Africa

Discontinuity between HIV and STIs During the 1990s HIV propagated rapidly in Zimbabwe, increasing
at an estimated rate of 12% annually. At the same time, the overall sexually transmitted infections
(STI) burden declined an estimated 25% and while there was a parallel increase in reported condom
use by high-risk persons (prostitutes, lorry drivers, miners, and young people)1. This example
frames the problem: why would a relatively low efficiency sexually transmitted virus like HIV outrun
more efficiently transmitted STI2? In the notable four-cities study3, many common sexual risk
factors linked to HIV transmission (eg, high rate of partner change, sex with prostitutes, and low
condom use) were not correlated with HIV prevalence-although some risk markers (young age at first
coitus or marriage, large age difference between partners) and presumed facilitating factors (lack
of circumcision, genital herpes, and trichomoniasis, but not bacterial STI) were. In addition,
concurrency of sexual partnerships was not correlated with HIV prevalence, yet was associated with
bacterial STI4.It is of concern that many key sexual transmission variables are not associated with
a large HIV epidemic in Africa, yet do correlate, as expected, with other STIs.

Transmission efficiency

A study of HIV transmission efficiency in Africa, using data from serodiscordant couples5, produced
estimates remarkably similar to those reported for couples in the developed world6. Observed
probabilities presumably reflect some of the influence of facilitating factors (eg, unorthodox
sexual practices, circumcision status, STI exposure, etc) recruited to explain the 'turbo effect'7
noted in Africa's epidemiologic context. Recent empiric research casts doubt that such co-factors
can sufficiently amplify the force of infectivity to account for observed trends in the sexual
transmission of HIV in Africa8. The anomalies regarding transmission efficiency are well illustrated
by a recent study in South Africa9. The authors recognized that, to explain HIV acquisition by 16-18
year old women in their study, they needed to postulate a per partnership transmission probability
of 0.92 (0.49, assuming double the number of reported partnerships per woman). By extension, the
per-contact probability of transmission would be 0.34, making heterosexual sex in this context
second only to transfusion in HIV transmission efficiency. Similarly, a model developed to assess
the impact of STI on transmission of HIV posited an extraordinary 33-fold increase in transmission
efficiency of the latter in the presence of the former10.
Reported sexual activity

Levels of sexual activity reported in a dozen general population surveys in Africa11 are comparable
to those reported elsewhere, especially in North America and Europe. Perhaps more importantly, there
appears to be little correlation with the level of risky sexual behaviour shown in these surveys and
the epidemic trajectories observed in these countries. (Comparison with country-specific data
reported by UNAIDS 2000; data not shown.) The four-city study provides similar discordance12. For
example, Yaounde (in Cameroon, a nation with low and stable prevalence) had the highest level of
risky behavioural markers. Ndola (in Zambia, a nation that has experienced a rapid rise in HIV) had
the smallest proportion of both men and women who reported a non-spousal sex partner in the previous
12 months. Ndola's other markers were similar to those in Dakar, Senegal and Cotonou, Benin, other
areas with low, stable prevalence.
Transmission dynamics

Rapid propagation (of at least bacterial STI) has been associated with core groups13, which make up
a small proportion of the susceptible population and are proposed to be responsible for most
community transmission. Such groups appear to be associated with differing forms of sexual net-work
'geometry'. This geometry demonstrably differs with transmission intensity14-16. Evidence suggests
that endemic and declining HIV/STI burdens are associated with dendritic (many open-ended termini)
patterns of sexual partner connections, while epidemicity is associated with cyclic (closed loops,
reflecting cohesiveness and density) patterns. There are few data on the architecture of sociosexual
networks in Africa, but the available information suggests predominantly dendritic patterns (eg,
contact with prostitutes and then contact with stable and usually monogamous consorts who are
network termini). We are aware of no study from sub-Saharan Africa suggesting cyclic sexual network
architecture. Without evidence of appropriate network configurations on a scale considerably larger
than that observed in developed countries, rapid propagation of HIV in Africa would be difficult to
sustain.

Studies have associated putative sexual core groups with HIV transmission in Africa. For example,
women who work as prostitutes and their partners have frequently been observed to have high HIV
prevalence. Confusion may arise, however, over conflating the terms 'high risk person' and 'core
group'. The former have been labelled in some way, but are not necessarily part of an interconnected
group of individuals through whom infection percolates (ie, core group). As noted, such persons
would have to be part of an interactive, cyclic group, rather than nodes along a dendritic chain.

Other anomalous findings

A higher HIV prevalence has been observed in women seen in prenatal, postpartum, and induced
abortion settings than in their community counter-parts17. In a number of studies, there appears to
be a discrepancy between the observed prevalence in women undergoing reproductive medical care, and
the prevalence that would be observed in such a group from heterosexual transmission alone. Though
few in number, there continue to be reports of HIV seropositivity in persons denying coital exposure
and in persons claiming a sole lifetime sexual partner who is reportedly HIV negative17. Similarly,
there are persistent reports of HIV in infants with seronegative mothers17. A recent large survey
from South Africa measured an HIV prevalence of 5.6% in children 2-14 years of age 18. Given
mortality from HIV among children who acquire it in Africa, there would appear to be a substantial
proportion of such a disease burden that is unexplained by maternal and sexual transmission.
Alternatives

A number of these observations raise the question of an alternative route of transmission, for which
medical care and the use of injections are prime candidates17,19-22. Prostitutes, for example, are
often recruited for studies from STI clinics, where treatment is frequently given by injection,
where non-sterile equipment is used with high frequency, and wherein the underlying prevalence of
HIV is high7. Many studies that have assessed the impact of sexual activity on HIV
transmission -notably those in Mwanza and Rakai, whose discordant results are still a subject of
debate23-failed to consider the potential confounding effects of medical care in the propagation of
HIV24.

Rapid HIV transmission in Africa has often occurred in countries with good access to medical care,
like Botswana, Zimbabwe, and South Africa. For example, high rates in rural South Africa have
paralleled aggressive efforts to deliver health care to rural populations. It is difficult to
understand how improved access to health care, with its offers of public health messages, free
condoms, and preventive services, would be associated with increased HIV transmission. Similarly,
HIV prevalence is often higher in cities and among persons of high socioeconomic attainment than in
rural areas or among less fortunate persons. Favourable access to health care is one of the
differences that distinguishes between these groups.

Reactions to the anomalies and alternatives

Since early in the African epidemic, when AIDS was demographically associated with sexually active
populations25, studies of HIV transmission in Africa have generally failed to control for possible
parenteral confounding26. The importance of this route of infection was well known in the West and
in Asia but quickly dismissed in Africa27. The risk of parenteral transmission of HIV is based on
good estimates of transmission efficiency, which varies depending on type of injection and
circumstances that produce reuse of contaminated equipment. For example, needle stick exposure (HIV
transmission probability: about one in 30028, medical injection (recently estimated at approximately
one in 3020), or illicit-drug injection (about one in 10029), is much more efficient than
penile-vaginal exposure (about one in 100030).

There is the expectation that, were iatrogenic transmission of HIV common, one would notice
substantial HIV prevalence in populations of (non-sexually experienced) children. Regrettably,
although a large proportion of Africa's population falls in that category, few serosurveys conducted
in Africa have included large enough samples from, say, children aged five through 12 to confidently
dismiss this possibility. As more information accumulates that addresses this issue, a clearer
perspective on the magnitude of non-sexual, non-maternal transmission in children will emerge.

The risk of exposure to HIV via medical injections is likely to vary with background prevalence and
with the specific medical practices in different settings. The demand for consistency and coherence
that we have placed on the heterosexual hypothesis should be applied to estimating the role of
medical transmission. Its role should vary with background (initial) prevalence, and should be
related to the degree of medical hygiene exercised. The same biological basis that exists for
heterosexual transmission should be established for medical transmission. (As an aside, such a
demonstration poses substantial ethical problems. No investigator should knowingly observe the use
of a needle that has a high probability of being contaminated with HIV, but at a minimum, the
demonstration of HIV RNA in needles that were to have been used on patients would be an important
element in establishing a biological base.) The transmission of blood-borne pathogens with differing
biological characteristics, notably hepatitis B and C31, should be consistent with parenteral
transmission of HIV. Finally, the social epidemiology of HIV (male to female ratios, for example)
should be consistent with observations about non-sexual exposure.

Conclusion

In North America, Europe, and many parts of Asia, the ignition of regional epidemics and rapid HIV
transmission has been associated principally with the sharing of contaminated injecting equipment
and with anal intercourse. Though heterosexual intercourse has been virtually the sole explanation
offered for the AIDS epidemic in sub-Saharan Africa, to our knowledge in no other part of the world
has penile-vaginal exposure (as opposed to 'heterosexual sex') been demonstrated to initiate or
sustain rapid HIV propagation.

HIV is not transmitted by 'sex', but only by specific risky practices. It is not transmitted by
'injections', but only by contaminated implements, which need to be clearly differentiated as to
type and frequency of injection and by the conditions of the exposure setting. In virtually all
societies affected by HIV to date, both routes seem to play important roles. If we are to understand
and intervene in each of these epidemics, well-designed studies at both the population and
individual levels are urgently needed. It is vital that these be properly controlled for parenteral
exposure, specific sexual practices, and other co-factors2,17,24,32 and the complex and specific
social patterns and networks that accompany them33.

Dispassionate assessment of our conclusions admittedly depends on a willing suspension of disbelief,
since the current paradigm is deeply embedded. Counter arguments can (and will) be levelled at each
of the anomalies noted, but the depth and breadth of concerns deserve fair scrutiny. At issue in a
re-evaluation of the heterosexual hypothesis are the profound implications for our interventive
approach, and for the kinds of social and financial commitments that must be made. Finally, Africans
deserve scientifically sound information on the epidemiologic determinants of their calamitous AIDS
epidemic.
References

1 Decosas J, Padian N. The profile and context of the epidemics of sexually transmitted infections
including HIV in Zimbabwe. Sex Transm Infect 2002;78(Suppl 1):140-6

2 Potterat JJ, Brody S. HIV epidemicity in context of STI declines: a telling discordance
(letter). Sex Transm Infect 2002; 78:467 [Full Text]

3 Buve A, Carael M, Hayes RJ, et al. The multicentre study on factors determining the differential
spread of HIV in four African cities: summary and conclusions. AIDS 2001;5(Suppl 4):S127-31
[Abstract]

4 Rothenberg R, Potterat J, Gisselquist D. Concurrency and sexual transmission (letter). AIDS
2002;16:678-80

5 Gray RH, Wawer MJ, Brookmeyer R, et al. Probability of HIV-1 transmission per coital act in
monogamous, heterosexual, HIV-1 discordant couples in Rakai, Uganda. Lancet 2001;357:1149-53

6 Downs AM, De Vicenzi I, European Group on Heterosexual Transmission of HIV: relationship to the
number of unprotected sexual contacts. J Acquir Immune Defic Syndr 1996;11:388-95

7 Vachon F, Coulaud JP, Katlama C. Epidémiologie actuelle du syndrome d'immunodéficit acquis en
dehors des groupes à risque. Presse Médicale 1985;14:1949-50

8 Gisselquist D, Potterat JJ. Heterosexual transmission of HIV in Africa: an empiric estimate. Int
J STD AIDS 2003;14:162-73

9 Auvert B, Ballard R, Campbell C, et al. HIV infection among youth in a South African mining town
is associated with herpes simplex virus-2 seropositivity and sexual behavior. AIDS 2001;15:883-98

10 Robinson NJ, Mulder DW, Auvert B, Hayes RJ. Modelling the impact of alternative HIV intervention
strategies in rural Uganda. AIDS 1995;9:1263-70 [PubMed]

11 Carael M, Cleland J, Deheneffe J-C, Ferry B, Ingham R. Sexual behavior in developing countries:
implications for HIV control. AIDS 1995;9:1171-5

12 Buve A, Lagarde E, Carael M, et al. Interpreting sexual behaviour data: validity issues in the
multicentre study on factors determining the differential spread of HIV in four African cities. AIDS
2001;15(Suppl 4):S1117-26 [Abstract]

13 Thomas JC, Tucker MJ. The development and use of the concept of a sexually transmitted disease
core. J Infect Dis 1996;176(Suppl 2):S134-43 [PubMed]

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(Accepted 15 December 2002)

Correspondence to: Mr J J Potterat, 301 South Union Blvd,
Colorado Springs, Colorado USA 80910

"Steve Hayes" <hayesmstw@hotmail.com> schreef in bericht
news:repost.71903.j4aas2909695r8drjjvpd8eibfn3qqi8 8f@4ax.com...
The idea that things in Africa are different from the rest of the world.
The idea that there is no heterosexual HIV/AIDS epidemic anywhere except Africa.
The idea that Africans 'have sex differently', revived as the 'dry sex', 'baby sex', etc. myths.
The idea that Africans 'have sex more often'.
The idea that in Africa, HIV is spread by mosquitos, recently revived as the idea that
malaria is a vector for vulnerability to HIV infection and transmission.

Note that none of these ideas are never confirmed by statistically sound research
whether from specialists in the relevant fields or not.

The truth is that the cheap tests (ELISA) used for both surveys and diagnosis in Africa
are hypersensitive, and are basically unconfirmed, when in the West they are only used
to guard the blood supply, for which a hypersensitive test is actually useful. It is used in
surveys, but never used on it's own in diagnosis of HIV infection in individual patients.

ELISA is too sensitive to be used on it's own in Africa. That is the
truth no one is yet willing to own up to.

HIV/AIDS figures in Africa will _always_ be overstated, as long as
surveys depend on these tests.

Alex

By the way, dr. Chin had some interesting things to say about HIV, and
the downward revision of HIV statistics in Africa. The difference made here,
is the switch from Antenatal Clinic Surveys (of small numbers of pregnant
women at antenatalc clinics) to DHS surveys (Demographic and Health
Surveys), which take about 10,000 people who are statistically representative
for the general population (age, gender, income, region, etc.). And what a
difference that makes. Read on...

BOSTON GLOBE:
Estimates on HIV called too high
New data cut rates for many nations
By John Donnelly, Globe Staff | June 20, 2004
http://www.boston.com/news/world/art...lled_too_high/


Washington Post
Essentially the same article, two years later (April 2006)
http://www.washingtonpost.com/wp-dyn...7.html?sub=new


Just for some levity,

http://www.sciencedaily.com/releases...0930080923.htm

Frog Peptides Block HIV In Lab Study
A new weapon in the battle against HIV may come from an unusual source -- a
small tropical frog. Frog Venom Could Be Vital Weapon In Combatting Cancer
And Heart Disease (September 21, 2001) -- Researchers at the University of
Ulster have uncovered a vital weapon in the fight against killer conditions like
cancer and heart

There seems to be a glitch in the news programme's software
that reposts the very same message (with the very same message
ID) several times.

Alex wrote:

Same reasons you've been given every time you've made that statement
over the years. They haven't changed.

B/