A paper entitled ‘UNAIDS’ Modes of Transmission model misinforms HIV prevention efforts in Africa’s generalized epidemics‘ has recently been added to the Social Science Research Network. Considering how hugely influential the model in question has been, this piece of research should go a long way towards challenging the institution’s lies about modes of HIV transmission.
But that’s only if UNAIDS accepts that some of their most damaging bloopers need to be ironed out before their Modes of Transmission Surveys can be in any way credible in the future. The institution likes to repeat it’s slogan, ‘Know your Epidemic, Know your Response’. But their facile model makes all serious HIV epidemics look the same; it makes them all look as if heterosexual transmission accounts for the bulk of transmission, and as if non-sexual transmission, through unsafe healthcare, unsafe blood supplies, etc, contribute almost nothing to these epidemics.
The author of the paper, David Gisselquist, goes through each serious error in turn to show that a huge proportion of HIV infections currently remain unexplained by the model. These infections were clearly not a result of heterosexual transmission. Making requisite changes to the model shows that about half of HIV transmissions in heterosexual couples were not a result of heterosexual sex. The model also depends on very questionable data; better data is available, but UNAIDS seem reluctant to use it.
Gisselquist writes in his conclusion: “considering the MOT model’s failure to “find” enough infections to explain epidemic trajectories in Uganda and Swaziland, it is notable that data from many studies suggest an important contribution from blood-borne risks”. UNAIDS has always had some kind of blind spot when it comes to blood-borne risks. When Gisselquist and others suggested more than 10 years ago that unsafe healthcare should be on the HIV agenda, Catherine Hankins, at the time chief medical officer at the institution, is said to have reacted angrily.
But Hankins went on to reject the view that unsafe healthcare might play a more significant role in HIV transmission. She seems to be of the opinion that warning people about unsafe healthcare will dilute the ‘message’ about sexual transmission. However, this is just arguing in a circle: if the message about sexual transmission has been seriously exaggerated and the message about non-sexual transmission dangerously diminished, people need to be warned about both kinds of risk, because avoiding sexual and non-sexual risks require very different kinds of information and actions.
Hankins estimates that 25% of injections in Africa are unsafe. But it is clearly her view about ‘African’ sexuality that holds the most weight in her defence of UNAIDS’ policy of ignoring non-sexual transmission: “In Africa, if you’ve had sex with someone at some point, the door isn’t considered closed on picking up on that relationship again.”
Gisselquist points out that the UNAIDS Modes of Transmission Model is seriously flawed and uses questionable data. But what about the way results have been interpreted? Everyone using the models must make the kind of assumption Hankins makes, that Africans are inherently promiscuous in a way that ‘Western’ people are not. What about the conclusion that the estimated 25% of unsafe injections do not need to be addressed, because if healthcare associated transmission was high in Africa, it would be higher in India, where an estimated 50% of injections are unsafe? Is safe healthcare only required to reduce the risk of HIV transmission? Is it not a right?
Gisselquist rightly attacks the use of UNAIDS’ model for its serious technical flaws. But I am questioning the legitimacy of UNAIDS, an institution that uses overtly racist arguments to prop up their flawed model of HIV transmission in Africa, where the most serious epidemics are to be found. Doubtless, this flawed model sells a lot of drugs, in the form of earlier treatment, treatment as prevention, pre-exposure prophylaxis and whatever else attracts the customary spontaneous standing ovation at the numerous pharmacy-sponsored annual HIV events. But it is precisely this instance of institutional racism that lies behind the continued failure to reduce HIV transmission in some of the worst epidemics in the world.