TCS Daily

A Bloody Mess

By Roger Bate - July 9, 2004 12:00 AM

Persistent remarks from AIDS activists and experts about sexual practices, especially anal sex in Africa, as the only major cause of the spread of AIDS are unhelpful. And recent statements from the Catholic Church are fanning the flames, too. By focusing solely on sex, we ignore the problems of infected blood, poor needle policy and other iatrogenic causes of the disease.

Pope John Paul II's Lenten message earlier this year focused on violence against children -- sexual abuse, human trafficking and the use of child soldiers. These are proper and noble aims for church activities. Brave, too, since child sex abuse is an in-house problem. But any hope that such discussions would raise awareness of the suffering of children was partially deflected by unguarded comments made by an over-zealous Jesuit missionary about AIDS, drugs and condoms.

Monsignor Paul Cordes, President of the Pontifical Council of the Vatican's charity arm, Cor Unum delivered the message, highlighting that the high cost of anti-retroviral therapy was preventing children receiving treatment. He said the Vatican was making ongoing efforts (through the WTO and UN General Assembly) to make treatment affordable.

During questions, the Monsignor declined to answer one about condom policy, but US Jesuit doctor, Father Angelo D'Agostino (who believes that it is Africans' culture of polygamy which causes the spread of AIDS) took the opportunity to weigh in with a sideswipe at the research-based pharmaceutical industry -- accusing it of "genocidal action" by "refusing" to make drugs affordable in Africa, even after making large profits.

Father D'Agostino was sharing the platform to publicize the Vatican's new fundraising postage stamp issue, which aims at raising $620,000 for organizations, such as the Children of God Relief Institute in Nairobi, that look after and educate AIDS orphans. I don't suppose that his outburst did much of a service to the campaign, nor that he will be invited back.

Aside from his indiscipline, Father D'Agostini is wrong and he's not alone. Firstly, it is fatuous to accuse the only providers of effectual AIDS treatment of genocide. Drug companies do not cause HIV infection. It's also worth noting that, for all its high cost and side effects, AZT has been around since 1987. Drug companies were not slow to throw R&D at AIDS, and continue to do so, especially through recently-developed public-private partnerships. The fact is that drug development is expensive and only businesses which make a profit can afford to do it.

It is commonly supposed that most HIV transmission in Africa is caused by heterosexual intercourse; but properly controlled studies conclude that the rate of heterosexual transmission in Africa is no different than anywhere else in the world. What is worthy of note is that adult HIV sufferers also have high rates of TB and sexually-transmitted diseases and so are generally immuno-compromised.

As a transmitter of HIV, each act of (unprotected) heterosexual intercourse has an efficiency of one per cent or less, that is, a one-in-a-hundred chance of causing infection. On the other hand, HIV transmission by blood transfusion is almost 100 per cent effective in each case. Of all routes of HIV infection, transfusion of infected blood is at the same time the most efficient and the most amenable to prevention by known technologies and systems, such as testing of donors and screening of blood.

These startling facts have long been known. Despite this, a sizeable amount of HIV infection in Africa had been iatrogenic -- that is, caused by doctors or medical intervention. How could this be?

Hypodermic syringes are still routinely re-used without sterilization; injections are routinely overused, for example, for giving vitamins. Moreover, voluntary blood donation is rare outside western countries. So if a patient needs blood urgently, his family may be able to help and the patient will be receive a direct transfusion. However, where this is not possible, touts who work the hospital entrances contact "professional" blood donors, whom the family must pay, but about whom nothing much is known. The family will only do this when desperate since no tests are performed on the donor or his blood. Alas, there is no shortage of desperation in Africa and other les developed regions of the globe.

An under-appreciated fact is that children and women of childbearing age carry most of the burden of HIV infection. This is no coincidence -- the main recipients of transfused blood are children (more than 50%) who become anemic due to repeated bouts of malaria (anemia itself is a significant cause of death) and pregnant women, who often become anemic due to frequent pregnancies, hemorrhaging and abortion.

This isn't just a problem for Africa. Two doctors, writing to the British Medical Journal two years ago, said:

"In China we believe that iatrogenic infection, acquired through paid blood donation and receiving blood products, is a major contributor to the HIV epidemic."

The Chinese Vice Minister of Health himself admitted at a Press Conference in late 2001 that "30,000 - 50,000 paid blood donors have become infected," but this is widely believed to be an underestimate. A rough estimate of the impact can be made: many of those who are known to be infected were plasma donors who gave blood over 100 times. But even if they gave blood just 10 times following seroconversion this would mean that 500,000 people could have acquired HIV from these blood products alone.

The infected blood problem was recognized in the early 80s as a key culprit in the growing AIDS epidemic, but has since been eclipsed by the unnatural sex/condom story. The condom policy has the added (perhaps overriding) attraction to those who hold the underlying belief that there are just too many people in the world. The tragedy is that cleaning up blood supply is relatively easy, while changing supposed sexual attitudes is an infinite task.

The cause of HIV infection has become disturbingly politicized among the health establishment. Many of its members are aware that, should the infected blood story become more widely known, they must carry responsibility for more than half of HIV spread in the last ten years. As such, the health establishment is unlikely to shine a light on this aspect of the HIV/AIDS epidemic. It would be good if a non-medical organization would proselytize it. The Catholic Church has enormous clout in the developing world. Instead of issuing irresponsible accusations of genocide, it would be better for Church officials involved in the AIDS fight to focus its efforts on some of the real causes of the spread of HIV.

Dr Roger Bate is a director of health advocacy group Africa Fighting Malaria and a visiting fellow of the American Enterprise Institute.


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