WHO says AIDS won't move into the hetero population.

[casebro]

http://timesofindia.indiatimes.com/India/Threat_of_global_AIDS_epidemic_over_says_WHO/articleshow/3115367.cms

Seems AIDS is a live-style disease. If you don't live in sub-Sahara Africa, are not a gay male, and not a sex-industry worker or customer, or IV street drug user, there just isn't going to be a hetero epidemic. This from the World Health Organization, not Duesenberg.

I'm not surprised.

Now maybe we can free up more assets to fight some of the more common diseases. I wonder how much DDT the world can buy for use against Malaria, for the cost of the "Aids kills EVERYBODY" ad campaign?

[Reality Check]

I agree. AIDS is a live-style disease. The same as gonorrhea, syphilis, hepatitis B, etc.
The live-style choice is that of having unsafe sex.

[gnome]

WHO says AIDS won't move into the hetero population.

WHO.

That's what I'm asking, who says?

WHO!

[Gevaudan]

Now maybe we can free up more assets to fight some of the more common diseases. I wonder how much DDT the world can buy for use against Malaria, for the cost of the "Aids kills EVERYBODY" ad campaign?

Hey, if all those people are going to live in areas where there are malaria-carrying mosquitoes, they should be prepared for the consequences of their lifestyle choice.

[balrog666]

http://timesofindia.indiatimes.com/India/Threat_of_global_AIDS_epidemic_over_says_WHO/articleshow/3115367.cms

Seems AIDS is a live-style disease. If you don't live in sub-Sahara Africa, are not a gay male, and not a sex-industry worker or customer, or IV street drug user, there just isn't going to be a hetero epidemic. This from the World Health Organization, not Duesenberg.

I'm not surprised.

Now maybe we can free up more assets to fight some of the more common diseases. I wonder how much DDT the world can buy for use against Malaria, for the cost of the "Aids kills EVERYBODY" ad campaign?


Wow! Just like we all knew 25 years ago!

But it's nice to see that WHO has joined the 20th century at least - now if they'd just move into the 1990's ...

[orange31]

"HIV was earlier regarded as a risk to populations everywhere, irrespective of the percentages that practised unsafe sexual behaviour. "
(from the article; italics mine)

???That sounds incorrect and is incomprehensible.
The disease in hetero spreads by 'unsafe' (no condoms).
One could argue that promiscuity is more prevalent in sub-sahara africa than in asia, I don't know myself. Politically sensitive topic.

But also, don't forget that HIV had at least a 50 year head start in africa, as well. I would also think HIV is under-reported in the poorer groups in asia. If the public hospitals in those countries are essentially wards with few to no medicines, you think they're doing detailed epidemiologic and serologic testing?

[GreyICE]

http://timesofindia.indiatimes.com/India/Threat_of_global_AIDS_epidemic_over_says_WHO/articleshow/3115367.cms

Seems AIDS is a live-style disease. If you don't live in sub-Sahara Africa, are not a gay male, and not a sex-industry worker or customer, or IV street drug user, there just isn't going to be a hetero epidemic. This from the World Health Organization, not Duesenberg.

I'm not surprised.

Now maybe we can free up more assets to fight some of the more common diseases. I wonder how much DDT the world can buy for use against Malaria, for the cost of the "Aids kills EVERYBODY" ad campaign? Hopefully they'll go after a sensible strategy, rather than a philosophical one of "100% DDT."

By the way, you have misunderstood the problem. You have conflated a successful strategy for dealing with the problem (education and awareness raising worldwide) with a lack of the problem in the first place.

[balrog666]

"HIV was earlier regarded as a risk to populations everywhere, irrespective of the percentages that practised unsafe sexual behaviour. "
(from the article; italics mine)

???That sounds incorrect and is incomprehensible.
The disease in hetero spreads by 'unsafe' (no condoms).
One could argue that promiscuity is more prevalent in sub-sahara africa than in asia, I don't know myself. Politically sensitive topic.

But also, don't forget that HIV had at least a 50 year head start in africa, as well. I would also think HIV is under-reported in the poorer groups in asia. If the public hospitals in those countries are essentially wards with few to no medicines, you think they're doing detailed epidemiologic and serologic testing?


AIDS has a different definition in sub-Saharan Africa - as defined politically anyway.

[pchams]

Are ya new?
AIDS is in every society.
The vectors just differ.
I'm just glad I'm immune, with my filthy lifesyle and all...ya know...being atheist.
(This atheist = Monogamous, non-intravenous drug using, non-vamipe, baby-eating-free, non-first attender, non-medical personnel)

[skeptigirl]

Getting back to the OP, I'm not sure what campaign directed at the wrong populations this guy is referring to. That has never been the case in the US. I wonder if he is referring to something WHO has been doing?

It makes no sense to me as written by the news articles.

Here's another version (http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/threat-of-world-aids-pandemic-among-heterosexuals-is-over-report-admits-842478.html).Threat of world Aids pandemic among heterosexuals is over, report admits

A 25-year health campaign was misplaced outside the continent of Africa. But the disease still kills more than all wars and conflictsThere has been no 25 year campaign I have ever heard about that didn't target specific at risk populations.

And if men use prostitutes then their partners are at risk. That includes married men who are really gay on the side but hiding it. And IVDUsers of both genders put non-using partners at risk. But obviously a disease which is spread in blood and by sexual exposure is not going to infect a monogamous couple who are exposed.

Just which assets do you think are being wasted, casebro? Or are you suggesting we should just let gays, hemophiliacs and babies of drug users die out?

[Ivor the Engineer]

I read the piece in The Independent and thought it was subtle propaganda from the 'circumcision will save Africa' lobby.

[Aitch]

But obviously a disease which is spread in blood and by sexual exposure is not going to infect a monogamous couple who are exposed.

Unless they get a dodgy blood transfusion. Or their dentist/tattooist doesn't sterilize his instruments properly. Or have those vectors been debunked?*

* Serious question - I don't know.

[skeptigirl]

Unless they get a dodgy blood transfusion. Or their dentist/tattooist doesn't sterilize his instruments properly. Or have those vectors been debunked?*

* Serious question - I don't know.No, not at all. Anyone can get HIV given the exposure occurring and obviously there are potential risks for everyone. I was trying to give the short answer.

As far as the dental thing, based on probability and all the evidence, the FL dentist who infected 6 people with HIV more likely than not, did it on purpose. Theoretically it is possible. Both HIV and hepatitis C are rarely transmitted now by health care accidents. That wasn't true before we had better methods of preparing blood products and good screening tests. But there are still cases. Hep B is more easily transmitted because it lives longer in dried blood and it takes so little to infect a person.

[skeptigirl]

I read the piece in The Independent and thought it was subtle propaganda from the 'circumcision will save Africa' lobby.This is about the only thing that makes the article make sense.

[Mister Agenda]

I think the issue of spreading to the heterosexual population has to do with the level of risk involved in vaginal coitus vs. anal. AIDS is much more likely to be spread by anal sex due to greater permeability of the tissues involved and greater chance of blood contact. The risk of contracting AIDS from vaginal coitus is much greater for women than for men, but it is still a low enough risk that there really isn't a chance of it reaching epidemic proportions in the heterosexual population when a man can have sexual relations with a woman infected with AIDS for a year and still have a good chance of still not being infected (yet) providing they don't engage in anal sex. It's just not contagious enough in those circumstances.

My GUESS about the difference in Africa is that it has to do with female circumcision increasing the risk of blood contact and/or, due to limited birth control options, more frequent heterosexual anal sex.

[godless dave]

The OP misconstrues the WHO article. WHO isn't saying AIDS won't spread to the heterosexual population, they're saying it won't become a pandemic in the heterosexual population.

[skeptigirl]

I think the issue of spreading to the heterosexual population has to do with the level of risk involved in vaginal coitus vs. anal. AIDS is much more likely to be spread by anal sex due to greater permeability of the tissues involved and greater chance of blood contact. The risk of contracting AIDS from vaginal coitus is much greater for women than for men, but it is still a low enough risk that there really isn't a chance of it reaching epidemic proportions in the heterosexual population when a man can have sexual relations with a woman infected with AIDS for a year and still have a good chance of still not being infected (yet) providing they don't engage in anal sex. It's just not contagious enough in those circumstances.....Wow, this is exactly the myth the comments in the article are going to perpetuate. And it supports the OP conclusion as well. I wonder if the WHO authority realizes how easily his comments will be misinterpreted.

Care to provide evidence supporting your rather incredible claim "a man can have sexual relations with a woman infected with AIDS for a year and still have a good chance of still not being infected (yet) providing they don't engage in anal sex."

[casebro]

Skeptgirl, EVERYBODY engages in vaginal sex. There is obviously some scientific reason why the vast majority of cases are within the small group who either engage in anal sex, or exchange blood in other ways.

Do you have a better explanation? I do know that the CDC calls hetero cases "hetero" rather than 'vaginal transmission'.

[robinson]

Skeptgirl, EVERYBODY engages in vaginal sex.

Uh, no, not everybody. Gay men for example.

[skeptigirl]

Skeptgirl, EVERYBODY engages in vaginal sex. There is obviously some scientific reason why the vast majority of cases are within the small group who either engage in anal sex, or exchange blood in other ways.

Do you have a better explanation? I do know that the CDC calls hetero cases "hetero" rather than 'vaginal transmission'.You are drawing the false conclusion that one variable is the cause for lowered rates of transmission, (vaginal intercourse) when in fact a different variable is at work, (number of partners).

Factors Limiting the Rate of Spread of HIV/AIDS (http://www.cdc.gov/ncidod/eid/vol7no3_supp/levin.htm)What limits the rate at which HIV spreads through a population? Although at least 50 million persons are infected with HIV, the human population (more than 6 billion persons) consists almost entirely of susceptible persons, and the global rate of increase in new HIV infections does not appear to have abated. However, unlike the case with influenza and measles, considerable geographic and cultural variation exists in the epidemiology of HIV/AIDS. In effect, the HIV pandemic has been largely restricted to subpopulations—risk groups within which the likelihood of infection is substantially greater than that in the population at large, e.g., gay men, injection drug users, and sex workers, their patrons, and their spouses (or other sex partners). The fact patrons of prostitutes and the partners of these at risk groups are included is evidence vaginal intercourse is not the variable operating here. Exposure to blood and numbers of partners, and being a partner of someone who is in those two groups are the variables.

Within those risk groups, anal intercourse and having the vagina increase the risk even more.

[RecoveringYuppy]

Wow, this is exactly the myth the comments in the article are going to perpetuate. And it supports the OP conclusion as well. I wonder if the WHO authority realizes how easily his comments will be misinterpreted.

Care to provide evidence supporting your rather incredible claim "a man can have sexual relations with a woman infected with AIDS for a year and still have a good chance of still not being infected (yet) providing they don't engage in anal sex."

http://www.cirp.org/library/disease/HIV/gray2/

[Mister Agenda]

You are drawing the false conclusion that one variable is the cause for lowered rates of transmission, (vaginal intercourse) when in fact a different variable is at work, (number of partners).

Factors Limiting the Rate of Spread of HIV/AIDS (http://www.cdc.gov/ncidod/eid/vol7no3_supp/levin.htm)The fact patrons of prostitutes and the partners of these at risk groups are included is evidence vaginal intercourse is not the variable operating here. Exposure to blood and numbers of partners, and being a partner of someone who is in those two groups are the variables.

Within those risk groups, anal intercourse and having the vagina increase the risk even more.

I admit I was speculating (and indicated so) about why AIDS is so pandemic in some parts of Africa, but I have a feeling it is not because they have so many more partners than less-affected populations...

[Mister Agenda]

Wow, this is exactly the myth the comments in the article are going to perpetuate. And it supports the OP conclusion as well. I wonder if the WHO authority realizes how easily his comments will be misinterpreted.

Care to provide evidence supporting your rather incredible claim "a man can have sexual relations with a woman infected with AIDS for a year and still have a good chance of still not being infected (yet) providing they don't engage in anal sex."

What myth are you referring to? Are you claiming that unprotected anal intercourse is no more risky than unprotected vaginal intercourse? Or that AIDS is likely to become pandemic among hetero populations on continents besides Africa?

I frequently enjoy your posts, skeptigirl, you live up to your handle. I don't recall seeing you make an argument from incredulity before.

[casebro]

I admit I was speculating (and indicated so) about why AIDS is so pandemic in some parts of Africa, but I have a feeling it is not because they have so many more partners than less-affected populations...

One major factor in Sub-Sahara's 'epidemic' is the fact that LOTS of the patients haven't even had a lab test to prove the Aids diagnosis. Over 1/3 by some reports. It seems to be a politically driven diagnosis- I believe it was mentioned in the linked article in the OP?

Hmm, I wonder how much DDT could be purchased with the money wasted on un-needed Aids treatments?

[casebro]

You are drawing the false conclusion that one variable is the cause for lowered rates of transmission, (vaginal intercourse) when in fact a different variable is at work, (number of partners).

Factors Limiting the Rate of Spread of HIV/AIDS (http://www.cdc.gov/ncidod/eid/vol7no3_supp/levin.htm)The fact patrons of prostitutes and the partners of these at risk groups are included is evidence vaginal intercourse is not the variable operating here. Exposure to blood and numbers of partners, and being a partner of someone who is in those two groups are the variables.

Within those risk groups, anal intercourse and having the vagina increase the risk even more.

"The fact patrons of prostitutes and the partners of these at risk groups are included is evidence vaginal intercourse is not the variable operating here."

So you agree that the vaginal route is less risky?

Logic tells me that most sex workers with vaginae ALSO have anus' (ani?). And hair. Should we assume that anti-viral shampoo would prevent the spread? And fingernails. and nasal passages.... Have skinned knees been eliminated? Why assume vaginal virus entry without proof?

Any studies?

Any discussion as to why the CDC calls it 'hetero exposure' instead of 'vaginal exposure'?

[GreyICE]

Is someone seriously challenging the notion that HIV spreads through classical missionary style sex?

Yes, people, it's God's punishment for doing something besides missionary.

Stop epic failing. We've documented pretty well that any time there's body fluid - body fluid contact, especially if that fluid rapidly enters the blood stream, there's a risk of HIV infection. It can spread through sores in the mouth, for pete's sake. We've documented spreads through pretty much every method of sex, without getting too graphic.

And no, there is no ethical double blind experiment for HIV transmission (unless you're named Mengele), so some of this stuff is pattern-based, rather than direct scientific study. On pattern-based, there MAY be a lower chance of it spreading through vaginal rather than anal, there is definitely a much lower chance of it spreading through oral, but everything I read said a larger factor was the viral concentration in the bloodstream - a much more important factor than anal or vaginal, afaik.

[skeptigirl]

I guess the difference here is I am considering risk at infectious viral loads and not when viral loads are relatively low. So I'll concede there are lower rates of transmission I wasn't considering. But it doesn't change my issues with casebro's false assumptions hetero sex is not an issue.

http://www.cirp.org/library/disease/HIV/gray2/

From your linkTransmission probabilities increased from 0·0001 per act at viral loads of less than 1700 copies/mL to 0·0023 per act at 38 500 copies/mL or more (p=0·002)....

The overall probability of transmission per coital act of 0·0011 in the Rakai population is within the range of transmission probabilities per act (0·0001-0·0020), reported from prospective studies of European, north American, and Thai heterosexual couples.2-7... In contrast, European, US, and Thai investigations found frequent condom use among HIV-1-discordant couples.3-7 The European and US epidemics are predominantly caused by HIV-1 subtype B, the Thai epidemic by subtypes E and B, and the Ugandan epidemic by subtypes A and D. Therefore, since the transmission probabilities per act of sexual intercourse in these populations are similar, the generalised HIV-1 epidemic in Uganda is unlikely to be caused by a greater infectivity of subtypes A and D....emphasis mine.

There are some assumptions there I'm not sure are supportable about the comparable subtypes. And you have to be careful comparing different cultures because you don't know how different typical sex is for a couple. I would venture to say it is quite different in populations where women are liberated. ;)

But the biggest problem trying to apply this to unprotected heterosexual intercourse with other than a monogamous partner (assuming that is what one is trying to apply this to) is the viral load. They do not mention transmission risk at levels above 38 500 copies/mL except to say "and higher". We don't know how much higher that means but it is clear risk increases with increasing viral loads.

Predicting prognosis with viral load (http://www.aidsmap.com/cms1031927.asp)The researchers found that men with viral load above 55,000 copies/ml on the Roche RT-PCR test or 30,000 copies/ml on the Chiron bDNA test had a very substantial risk of developing symptomatic illness within three years. For example, if a man had a viral load above 55,000 copies/ml and a CD4 cell count above 750 cells/mm3, he had a 33% risk of disease progression within three years. If his viral load was above 55,000 copies/ml and CD4 count was below 200 cells/mm3, he had an 86% risk of developing AIDS within three years....

The MACS study found that measuring viral load can identify different risks of disease progression between two symptom-free people who had the same CD4 cell count but different viral load....

HIV viral load slowly increases over the course of the infection. The notion that HIV viral load remains fairly static for years has been disproved. One study analysed blood samples taken over a 17-year period. It found viral load increased by an average of 0.12 log10 per year, although a higher rate of increase was predictive of more rapid disease progression (Sabin 1998). Another study found that viral load increased annually by 23% (Lyles 1999)...

...A meta-analysis of studies in which rates of disease progression had been compared by gender found that on average, the viral load of women was 41% higher at any given CD4 cell count than men. Nine studies were available for analysis, and all but one showed lower viral load in women (Napravnik 2002)....

...It was largely assumed that there was no difference between men and women in terms of viral load and disease progression. However, a growing body of evidence shows that there is a sex-based difference in viral load.

Viral load models (http://www.jr2.ox.ac.uk/bandolier/band41/b41-5.html#Heading10)Mathematical modelling of viral load and disease progression is possible [7]. In the absence of antiretroviral treatment, patients with a viral load of 100,000 molecules/mL are at risk of progression to AIDS in fewer than three years. Those with a viral load of about 300,000 molecules/mL are at risk in less than one year. But with lower viral load, the time to progressing to AIDS extends, so that at 10,000 molecules/mL patients have at least 2.8 years and up to 19 years.

This was an interesting hypothesis (http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17954909)By analyzing two cohorts of untreated patients, we quantify the relationships between both viral load and infectiousness and the duration of the asymptomatic infectious period. We find that, because both the duration of infection and infectiousness determine the opportunities for the virus to be transmitted, this suggests a trade-off between these contributions to the overall transmission potential. Some public health implications of variation in set-point viral load are discussed. We observe that set-point viral loads are clustered around those that maximize the transmission potential, and this leads us to hypothesize that HIV-1 could have evolved to optimize its transmissibility, a form of adaptation to the human host population. We discuss how this evolutionary hypothesis can be tested, review the evidence available to date, and highlight directions for future research.Their graph shows viral loads can go as high as 10 million copies per milliliter of blood. Viral loads > 100,000 on up into the millions is a lot different than viral loads at 40,000 copies per ml.

So I don't think these studies showing low rates of transmission mean that all exposures are such low risk. And the assumptions made in the OP that the millions of cases are mostly coming from IVDU and anal sex is still false.

If you look at figure 1 in this report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a2.htm#tab), the percentage of new cases by source of infection heterosexual contact surpassed IVDU in about 1999 in the US.

[skeptigirl]

I admit I was speculating (and indicated so) about why AIDS is so pandemic in some parts of Africa, but I have a feeling it is not because they have so many more partners than less-affected populations...Actually, that is one of the most significant reasons. The initial epidemic really took off when a new trucking road complete with the usual prostitution that follows opened up crossing Uganda. The low status of women contributes greatly because they cannot often refuse sex, their economic position makes them dependent on men. And the simple fact HIV took hold in Africa a decade before the rest of the world is the other major factor.

[skeptigirl]

What myth are you referring to? Are you claiming that unprotected anal intercourse is no more risky than unprotected vaginal intercourse? Or that AIDS is likely to become pandemic among hetero populations on continents besides Africa?

I frequently enjoy your posts, skeptigirl, you live up to your handle. I don't recall seeing you make an argument from incredulity before.That is not what I said, in fact I said that anal sex increased the risk. But what casebro seems to be saying is it is all anal sex and IVDU and that vaginal intercourse is not much risk at all. That assumption on his part is false.

[Ivor the Engineer]

Estimates of risk of infection based on self-reporting of what type of sex people have been having seem rather suspect to me. People lie about sex. A lot.

[skeptigirl]

One major factor in Sub-Sahara's 'epidemic' is the fact that LOTS of the patients haven't even had a lab test to prove the Aids diagnosis. Over 1/3 by some reports. It seems to be a politically driven diagnosis- I believe it was mentioned in the linked article in the OP?

Hmm, I wonder how much DDT could be purchased with the money wasted on un-needed Aids treatments?You would again be mistaken here. While of course some HIV case numbers are estimates and the numbers vary widely, but the number of people with positive tests in Sub-Saharan Africa is in the tens of millions. HIV testing is cheap and easy to do. I pay less than $10/test wholesale in the US when I order HIV testing. It used to be $3.

So regardless of the estimates, the actual cases have devastated some areas of the continent. The rates vary from place to place even within Sub-Saharan Africa which has the highest prevalence.

Which political conspiracy would you be referring to? Many of these countries have bad situations because their leaders denied there was a problem and refused to provide prenatal anti-retrovirals which prevent the majority of newborn HIV infections.

[skeptigirl]

"The fact patrons of prostitutes and the partners of these at risk groups are included is evidence vaginal intercourse is not the variable operating here."

So you agree that the vaginal route is less risky? Of course. But that doesn't mean vaginal intercourse is practically risk free as you are implying.

Logic tells me that most sex workers with vaginae ALSO have anus' (ani?). And hair. Should we assume that anti-viral shampoo would prevent the spread? And fingernails. and nasal passages.... Have skinned knees been eliminated? Why assume vaginal virus entry without proof?Someone else can waste their time answering this bizarre statement.

...
Any discussion as to why the CDC calls it 'hetero exposure' instead of 'vaginal exposure'?Is this another conspiracy theory?

[skeptigirl]

Estimates of risk of infection based on self-reporting of what type of sex people have been having seem rather suspect to me. People lie about sex. A lot.So are you suggesting everyone with HIV is into anal sax and lying about it including studies of multiple cultures where anal intercourse might be extremely uncommon?

[skeptigirl]

Well you boys can ignore the risk and have your fun. I'm not sure I care too much about this particular minority misconception.

[fagin]

Actually, that is one of the most significant reasons. The initial epidemic really took off when a new trucking road complete with the usual prostitution that follows opened up crossing Uganda. The low status of women contributes greatly because they cannot often refuse sex, their economic position makes them dependent on men. And the simple fact HIV took hold in Africa a decade before the rest of the world is the other major factor.

AIDS does hit hetero populations. It is epidemic in South Africa (70% + of deaths between 15 and 49 caused by AIDS).
http://www.avert.org/aidssouthafrica.htm

Factors seem mainly due to position of women in society etc, but thinking along various comments relating to fluid transfer, there is a huge amount of prostitution, often breadline stuff for food etc. This leads to a high level of STD's and therefore far more likely to be vaginal sores, scabs etc, hence easy entry for fluids, similar to problems with anal sex.

[AgeGap]

I work as a nurse and was recently bitten by a patient. The bite drew blood. I have colleagues who have had recent needle-stick injuries. There are risk factors for all of us. The epidemiologists thought that the impact of the disease would be greater. Perhaps the advertising in the 1980s had the desired effect.

[fagin]

I work as a nurse and was recently bitten by a patient. The bite drew blood. I have colleagues who have had recent needle-stick injuries. There are risk factors for all of us. The epidemiologists thought that the impact of the disease would be greater. Perhaps the advertising in the 1980s had the desired effect.

Depends where you live:

In 2006 the HIV prevalence rate among pregnant women was 29.1%.

from Wiki article on AIDS in SA.

[fagin]

AIDS orphans a sad problem throughout Africa, a good many of them infected themselves.

[skeptigirl]

I work as a nurse and was recently bitten by a patient. The bite drew blood. I have colleagues who have had recent needle-stick injuries. There are risk factors for all of us. The epidemiologists thought that the impact of the disease would be greater. Perhaps the advertising in the 1980s had the desired effect.Well now you are in my area of expertise.

To my knowledge, there has never been a case of a health care worker getting HIV from a patient bite. I am only aware of one case of a documented transmission of HIV from a bite, it was an assault during a robbery and was more than a simple injury.

There have only been a couple hundred on the job HIV infections in health care workers in Western countries since the HIV pandemic began, almost all involving more blood, deeper punctures, and/or very high viral loads (in one case an exposure to a viral culture).

The rate of hep C transmission is only a little higher in health care workers.

But hepatitis B was killing 200 health care workers a year in the US alone. Even now with a vaccine available ~1,000 new infections a year are still occurring in health care workers.

[Ivor the Engineer]

So are you suggesting everyone with HIV is into anal sax and lying about it including studies of multiple cultures where anal intercourse might be extremely uncommon?

No, I'm saying any numbers based on self-reports of private behaviour should be treated with extreme caution, especially when the behaviour in question is sex.

[Mister Agenda]

That is not what I said, in fact I said that anal sex increased the risk. But what casebro seems to be saying is it is all anal sex and IVDU and that vaginal intercourse is not much risk at all. That assumption on his part is false.

I was referring to the part where you characterized my claim that a couple where one of them is infected would have a good chance of going a year without both of them being infected as 'incredible'. :)

Even at the higher .02 chance of infection per exposure, it would not be unusual for someone with AIDS to have sex with their partner several times a month for a year without passing on the disease. Of course sooner or later their luck will run out, and sooner could be the first time.

Personally I wouldn't risk it, AND I think the safer sex practices followed to avoid AIDS are the best way to protect yourself. No doubt the AIDS rate among all groups outside of Africa is lower partly because of the influence of campaigns promoting such practices and Africa would have a lower AIDS rate if they were able to take the same precautions we do.

I don't think we're in significant disagreement on the facts--I've found this thread very informative in that regard, it looks like my guess about Africa was pretty far off the mark. We're probably not too far apart in interpretation either, I don't view the WHO report as a license to disregard the risks of unprotected sex. I just think that the conditions for an Africa-style pandemic among heterosexuals are not present, PROVIDING a more infectious strain (higher viral load, perhaps) isn't introduced.

[RecoveringYuppy]

That is not what I said, in fact I said that anal sex increased the risk. But what casebro seems to be saying is it is all anal sex and IVDU and that vaginal intercourse is not much risk at all. That assumption on his part is false.
Well, the statistic he cited appears accurate based on the evidence. I suppose you could turn it around and ask him to quantify what rate and amount of vaginal intercourse leads to a high probability of infection.

[casebro]

Re: Needle stick transmissions, last time I looked it up, the rate is about 1:5,000. That is about the same as the Aids rate in the general population. In fact, I wonder about how many health care providers manage to pass off a spurious workers comp claim for Aids acquired via their leisure activities?

And, Skeptgirl: We do agree on the fact that vaginal transmission is lots harder than anal. I say so much harder that it accounts for the lack of the epidemic moving into the hetero population. I never said impossible. You do agree that after 25 years of scaremongering, that there is no Hetero Epidemic. And the experts at WHO say there won't be one either.

No "Political Conspiracy" either. Just a Ponzi scheme with no Ponzi. The media knows that scaremongering sells news. The Scientists know that scaremongering begets grants. And it's all just a growth sector of the economy. Good for everybody.

And even directly beneficial to sufferers of other virus's. AZT works for Shingles and other stuff.

But should we all lie awake worrying about our grandchildren? I don't.

[Deetee]

Re: Needle stick transmissions, last time I looked it up, the rate is about 1:5,000. That is about the same as the Aids rate in the general population. In fact, I wonder about how many health care providers manage to pass off a spurious workers comp claim for Aids acquired via their leisure activities?

Dunno what you looked that up in. Transmission by needlestick from a known positive source is around 1:350.
I suggest you go to this UK document (http://www.bashh.org/guidelines/2006/pepse_0206.pdf), look at table 2 (The risk of HIV transmission) and check the references for the source of the information.

When a health care worker reports a needlestick, they all have a baseline blood test done or stored, so that if they later claim to have caught HIV (or hepatitis) from the event, the blood can be checked and it can confirm if the worker was infected at the time of the injury. Makes perfect sense and avoids the scenario you suggest happens.

And, Skeptgirl: We do agree on the fact that vaginal transmission is lots harder than anal. I say so much harder that it accounts for the lack of the epidemic moving into the hetero population. I never said impossible. You do agree that after 25 years of scaremongering, that there is no Hetero Epidemic. And the experts at WHO say there won't be one either.

There was never the dreaded "explosive" breakout into the heterosexual population that people feared and predicted might happen, so in that regard, one could claim there has not been a "hetero epidemic". But the definition of "epidemic" is relative. If 20 people in your town developed green monkey disease, that may be regarded as an epidemic. If one in 150 kids get autism, that may be regarded as an epidemic. Regarding HIV, sufficient numbers of "low risk" heterosexuals have acquired HIV in places like the USA for it to be said there is an epidemic. It is just that it pales in comparison to the numbers transmitted through the high risk routes, so is less noticeable.

And even directly beneficial to sufferers of other virus's. AZT works for Shingles and other stuff.
No it doesn't. Only thymidine kinase inhibitors work for herpes group viruses.
AZT is a reverse transcriptase inhibitor. Herpes group viruses (varicella, shingles, herpes) do not replicate using this enzyme.

But should we all lie awake worrying about our grandchildren? I don't.
Considering what other avoidable risks our children seem to constantly engage in, you probably shouldn't. But if your g/daughter is promiscuous, and has frequent unprotected vaginal sex with partners who may be from higher risk groups, then you should be worried and lose a bit of sleep.
At least, that is what any caring and responsible parent/grandparent would do. I can't speak for you and your attitude though.

[GreyICE]

Casebro - this reads like you're assuming AIDS isn't dangerous, then working backwards to find evidence to support your conclusion. Bad numbers, bad facts, angry rhetoric, I don't think you arrived at this conclusion by examining the evidence.

[casebro]

Casebro - this reads like you're assuming AIDS isn't dangerous, then working backwards to find evidence to support your conclusion. Bad numbers, bad facts, angry rhetoric, I don't think you arrived at this conclusion by examining the evidence.

Yes, I have an opinion. I have no problem that you have an opinion about my opinion. And I value yours as much as you value mine.

And just as the scaremongering by interested parties sells news and gets grants, I realize that a contrary position starts discussions. Until I started this thread, there hadn't been any posts on this topic. And there hasn't been any refutation of the link in the OP either.

ETA: I see by the tally that this thread is running about 30:1 readers to posts, when the usual is about 10:1. Lots of people are interested in this discussion.

Seems to me that Aids, being a life style disease, is like occupational diseases. Like Mesothelioma in Asbestos workers. Those at high risk should take precautions. The rest of us need lesser caution.

[GreyICE]

Yes, I have an opinion. I have no problem that you have an opinion about my opinion. And I value yours as much as you value mine. Fair enough. I'll choose to take it as a compliment that you make your insults so roundabout.

But opinions, casebro, are like ******** - they're best kept out of public sight. Stick with facts. And it is a FACT that you have screwed up the numbers, it is a FACT that your arguments have been based on bad information, and it is a FACT that you are speculating that documented methods of transmission are caused by lifestyle activities with no evidence. These FACTS are evidence that leads to an inevitable conclusion - that you are, in fact, unconcerned with facts, and that your entire argument is an opinion that you have garnished with a window dressing of numbers and a veneer of respectability you are trying to steal from science by hijacking it's language. But your argument, it's still a fool in prince's clothing.

And just as the scaremongering by interested parties sells news and gets grants, I realize that a contrary position starts discussions. Until I started this thread, there hadn't been any posts on this topic. And there hasn't been any refutation of the link in the OP either. What refutation is necessary? A projection was revised based on superior evidence and better models, which predicts a low, consistent AIDS rate in the general population. The only thing suggesting anything like what you're saying comes at the very end:
Dr de Cock admitted there were "elements of truth" to such criticism. There has been a view that UNAIDS had deliberately exaggerated the size and trend of the projected pandemic, besides hyping the potential for HIV in general populations creating an impression that just about everyone was at risk of AIDS.

"This led to billions of dollars being spent on AIDS rather than on other serious illnesses which face an acute fund crunch," a health ministry official said. All there is is the world's most oblique statement (There has been a view indeed) and a quote from an anonymous source. You don't need to refute stuff like that, it's not even well-developed enough to be wrong.

Seems to me that Aids, being a life style disease, is like occupational diseases. Like Mesothelioma in Asbestos workers. Those at high risk should take precautions. The rest of us need lesser caution.Right. Go have unprotected sex. I'll sit here and laugh at you.

"I didn't get AIDS. What's this 'Hep-ah-tight-us Bee?' What do you mean 3-6% global infection rates?"

[luchog]

Well, the statistic he cited appears accurate based on the evidence. I suppose you could turn it around and ask him to quantify what rate and amount of vaginal intercourse leads to a high probability of infection.
Nope, not supported by the evidence.

HIV transmission rates through normal vaginal intercourse are indeed very low. However, what is happening in Africa isn't normal intercourse. The problem is the prevalence of high-risk sexual practices, although including anal sex (which is a major issue, particularly due to the fact that it's underreported due to cultural stigmas), is mainly due to unprotected dry sex (http://en.wikipedia.org/wiki/Dry_sex). Transmission rates for dry sex are far higher than for normal vaginal sex.

[RecoveringYuppy]

@luchog

You seem to be talking about something other than what I addressed.

[I Ratant]

Estimates of risk of infection based on self-reporting of what type of sex people have been having seem rather suspect to me. People lie about sex. A lot.
.
Do Too!

[Deetee]

Errr...... Chaps.... Something you should all read, in respect of the OP about WHO and heterosexual transmission.
This is part of a press statement issued by WHO/UNAIDS (http://data.unaids.org/pub/PressStatement/2008/20080611_notetomedia_en.pdf) in response to the story last week.


Correction to AIDS Story in The (http://data.unaids.org/pub/PressStatement/2008/20080611_notetomedia_en.pdf)
Independent (http://data.unaids.org/pub/PressStatement/2008/20080611_notetomedia_en.pdf), 8 June 2008 (http://data.unaids.org/pub/PressStatement/2008/20080611_notetomedia_en.pdf)

New York, 11 June 2008
We wish to clarify misinterpretations concerning WHO and UNAIDS' positions on the status of the AIDS epidemic in recent media articles. The story in the Independent on Sunday titled: “Threat of world AIDS pandemic among heterosexuals is over, report admits” contained a few seriously misleading statements that have led to inferences and conclusions that bear no relation to the highly complex realities of the HIV epidemic.

First and foremost, the global HIV epidemic is by no means over. At the end of 2007, an estimated 33.2 million people were living with HIV. Some 2.5 million people became newly infected that year, and 2.1 million died of AIDS. AIDS remains the leading cause of death in Africa. Worldwide, HIV is still largely driven by heterosexual transmission. The majority of new infections in sub-Saharan Africa occur through heterosexual transmission. We have also seen a number of generalized epidemics outside of Africa, such as in Haiti and Papua New Guinea.

Heterosexual transmission continues to drive the epidemic among sex workers, their clients, and their clients' partners. In addition, prisoners, injecting drug users, as well as men who have sex with men, may also engage in heterosexual relationships. In sub-Saharan Africa almost 60% of adults living with HIV were women, 48% in the Caribbean.

[skeptigirl]

No, I'm saying any numbers based on self-reports of private behaviour should be treated with extreme caution, especially when the behaviour in question is sex.


Well du'h.

Some of the information on source of exposures has been collected anonymously and while people still lie even then, there is no reason to think everyone with HIV is lying about anal intercourse.

[skeptigirl]

Re: Needle stick transmissions, last time I looked it up, the rate is about 1:5,000. That is about the same as the Aids rate in the general population. In fact, I wonder about how many health care providers manage to pass off a spurious workers comp claim for Aids acquired via their leisure activities? It depends on if you are averaging all needlesticks or high vs low risk needlesticks. Such numbers are not useful managing exposures. It is better to look at the volume of blood and viral titers one is exposed to.

There are two studies that have pretty good data for the US. One prospective study collected 1,100 exposure incidents to HIV infected blood in hospitals over 10 years. All had baseline HIV tests and follow up tests. 4 seroconversions occurred.

Another retrospective study study looked at 600+ HIV infected occupational blood exposures where no seroconversion occurred and compared them to 33 incidents where seroconversion occurred. If you were exposed to a large bore needle used in a vein or artery, visible blood on an instrument such as a scalpel, and had a deep puncture, or were otherwise exposed to a high titer of virus, you had a higher risk of seroconversion.

And, Skeptgirl: We do agree on the fact that vaginal transmission is lots harder than anal. I say so much harder that it accounts for the lack of the epidemic moving into the hetero population. I never said impossible. You do agree that after 25 years of scaremongering, that there is no Hetero Epidemic. And the experts at WHO say there won't be one either. This is misleading and not how I would characterize the difference. I would characterize the difference as numbers of partners first and foremost, not vaginal vs anal intercourse.

No "Political Conspiracy" either. Just a Ponzi scheme with no Ponzi. The media knows that scaremongering sells news. The Scientists know that scaremongering begets grants. And it's all just a growth sector of the economy. Good for everybody.HIV as an infectious disease has been downplayed as much as it has been up-played. You might find the parallels in the history of TB interesting. TB meant social stigma and the threat of being locked up in a sanitarium until the 50s. In the Bible the bad one was leprosy. A lot of social nonsense accompanies a lot of diseases and HIV currently tops the list.

And even directly beneficial to sufferers of other virus's. AZT works for Shingles and other stuff.You mean acyclovir and it was not discovered as the result of HIV studies. It was developed to treat herpes. However, lots of the antiviral research in HIV has resulted in antivirals for other viruses like hepatitis B.

But should we all lie awake worrying about our grandchildren? I don't.. Worry is not a useful action. ;)

[skeptigirl]

...
Seems to me that Aids, being a life style disease, is like occupational diseases. Like Mesothelioma in Asbestos workers. Those at high risk should take precautions. The rest of us need lesser caution.Yes, but just be careful what you are claiming results in the life stye hazard. It is numbers of partners and the number of partners your partner has had, not simply vaginal vs anal intercourse.

[skeptigirl]

....
Right. Go have unprotected sex. I'll sit here and laugh at you.

"I didn't get AIDS. What's this 'Hep-ah-tight-us Bee?' What do you mean 3-6% global infection rates?"Good point.

[skeptigirl]

Errr...... Chaps.... Something you should all read, in respect of the OP about WHO and heterosexual transmission.
This is part of a press statement issued by WHO/UNAIDS (http://data.unaids.org/pub/PressStatement/2008/20080611_notetomedia_en.pdf) in response to the story last week.This supports my conclusion it was the way the interview came across to the reporters and how they misinterpreted this.

[JEROME DA GNOME]

Errr...... Chaps.... Something you should all read, in respect of the OP about WHO and heterosexual transmission.
This is part of a press statement issued by WHO/UNAIDS (http://data.unaids.org/pub/PressStatement/2008/20080611_notetomedia_en.pdf) in response to the story last week.

AIDS remains the leading cause of death in Africa. Worldwide


Claiming to clarify a misconception and then stating such a blatant lie.

AIDS is not the leading cause of death in Africa, a continent of almost 1 billion people. Only 2.1 million people died worldwide.

These are the types of blatant falsehoods that are eaten up by the true believers.

[Paulhoff]

http://news.bbc.co.uk/2/hi/health/background_briefings/aids/341288.stm

Paul

:) :) :)

[Loss Leader]

AIDS is not the leading cause of death in Africa, a continent of almost 1 billion people. Only 2.1 million people died worldwide.



You are wrong (http://www.healthnews.com/family-health/leading-causes-death-africa-1024.html).


Again

[skeptigirl]

Are we supposed to just take your word for it, Jerome? Because I see no evidence in that post and as I looked for alternate sources on the leading cause of death in Africa, I couldn't find a single one that said something other than HIV-AIDS.

Leading Causes of Death in Africa (http://www.healthnews.com/family-health/leading-causes-death-africa-1024.html)In this part of the world, 72 percent of all deaths are from communicable diseases compared to 27 percent in all other World Health Organization Regions combined. HIV/AIDS is the leading cause of death for adults in the region, with an estimated 60 percent of the people being infected. ...

Malaria is a major public health problem in Africa, where more than 90 percent of the estimated 300-500 million clinical cases of malaria occur. ... There are nearly 1 million deaths due to malaria each year, the vast majority among children under the age of five....

Tuberculosis (TB) was declared a public health emergency in the African Region in 2005. TB has been on the rise in tandem with HIV/AIDS, because people with HIV whose immune systems are weakened easily contract TB and go on to develop active TB. An estimated 2.4 million new cases, 24 percent of all notified cases worldwide, and half a million TB deaths are reported in the African Region each year.

Of the 20 countries with the highest maternal mortality rates, 19 are in Africa. An estimated 231,000 women died in the African Region in 2002 due to pregnancy and childbirth complications. And Africa’s neonatal death rate is the highest in the world. An estimated 43 out of every 1,000 babies born in 2005 died during their first 28 days of life. Deaths among African children have also been on the rise. In 1960, 14 percent of deaths among children under the age of five worldwide occurred in the Region. That proportion rose to 23 percent in 1980 and to 43 percent by 2003.

Noncommunicable diseases, such as heart disease, hypertension, stroke and injuries represented 27 percent of the total burden of disease in the Region in 2001, but are on the rise. ...

Another major health problem in countries in the Region is road traffic collisions. For example, road traffic collisions cost the Ugandan economy $101 million (U.S.) each year, which is 2.3 percent of gross national product.

Other leading causes of death in the African Region include lower respiratory infections, diarrheal diseases, violence, whooping cough, and protein-energy malnutrition.

Some good news coming out of the Region is that tropical diseases have seen a drastic reduction in cases. ...

Preventable childhood illnesses have also decreased. Measles deaths have declined by more than 50 percent since 1999. In 2005, 75 million children received measles vaccines, and 37 countries were vaccinating 60 percent or more of their children against the disease. And polio has nearly been eradicated in the African Region.

[RecoveringYuppy]

ontinent of almost 1 billion people. Only 2.1 million people died worldwide.
I see other poeple have corrected most of that, but I'll add that the 2.1 million worldwide number was just the toll for last year (2007).

[hecaterin]

A side track, but don't blame malaria on the DDT ban (http://scienceblogs.com/deltoid/2007/05/who_put_out_the_contract_on_ra.php).

[JEROME DA GNOME]

http://news.bbc.co.uk/2/hi/health/background_briefings/aids/341288.stm

Paul

:) :) :)






Please evidence that less than 1.5 million people die each year in Africa; population of almost 1 billion, from all other causes outside of AIDS.

[JEROME DA GNOME]

Are we supposed to just take your word for it, Jerome? Because I see no evidence in that post and as I looked for alternate sources on the leading cause of death in Africa, I couldn't find a single one that said something other than HIV-AIDS.

Leading Causes of Death in Africa (http://www.healthnews.com/family-health/leading-causes-death-africa-1024.html)

Please evidence that less than 1.5 million people die each year in Africa; population of almost 1 billion, from all other causes outside of AIDS

[Loss Leader]

Please evidence that less than 1.5 million people die each year in Africa; population of almost 1 billion, from all other causes outside of AIDS


That's not what "leading cause of death" means, genius.

It means it is the leading cause, not the single cause that outweighs everything else.

If I get a 98 on a test on logic, I may be the leading scorer in the class. But that doesn't mean that everybody else's scores added together won't equal mine. In fact, the next two scorers (96 and 95) together have almost double my score. Even if you, Jerome, were among the lowest scorers in the class, your 57 and the next highest grade of 68 would still combine to be much higher than my score. This is true even though I am still the highest scorer in the class.

Just like that, AIDS is the number one killer in Africa. That does NOT mean that AIDS kills more Africans than all other causes combined. It doesn't mean that AIDS is the most likely cause of death in Africa. All it means is that no single other infectious disease, heart attack, bus accident or any other cause killed more people. In fact, AIDS just passed malaria as the number one killer in Africa. That very likely means that far more people died in Africa from the set of [either malaria or heart disease] than died of AIDS.

So, once again, You Are Wrong.

[fls]

Please evidence that less than 1.5 million people die each year in Africa; population of almost 1 billion, from all other causes outside of AIDS.

I'm with Jerome. What moron said something so stupid?

Oh. No one.

Linda

[Paulhoff]

So what number of people dying of something would then become a bad thing.

Paul

:) :) :)

What a heartless A-H.

[casebro]

I wonder what is the methodology of the Aids census used in those 'causes of death' studies?

If it's true that 1/3 of the patients who supposedly have aids never had an aids test, then 1/3 of the deaths are from other causes. Take out 1/3 of the supposed aids deaths, and the #1 killer becomes Malaria.

Plus: This quote seems poorly worded:
"...World Health Organization Regions combined. HIV/AIDS is the leading cause of death for adults in the region, with an estimated 60 percent of the people being infected. ..."

It means that 60% of the purported Aids cases are in Africa, NOT that 60% of Africans have Aids.

Other sources state that 11% of Sub-Saharan Africans have AIDS, but then if 1/3 of cases are spurious diagnosis, the numbers all shift.

Next thing we'll hear is that Aids treatments that work elsewhere don't seem to work as well on African cases. Of course not, if 1/3 of those cases don't have Aids to begin with.

Seems to all add up to exaggerating the threat.

[Paulhoff]

It is not just the ones that die from AIDS that have the problem.

http://www.avert.org/aafrica.htm

So what is the magic number that have to die to make you feel bad.

Paul

:) :) :)

Sounds like how many Jews have to die in death camps before that becomes a bad thing.

[Ivor the Engineer]

Is there a model which can explain the very different levels of HIV infection around the world/Africa?

To put it another way, does anybody really understand why there is such a spread in the prevalence of HIV around the world/Africa?

[casebro]

I never said Aids is not terrible.

I'm only saying it is bad enough without scaremongering and exaggeration.

I do also find it hard to get worked up over the problems of other people when I have my own situation to worry about. I guess some folks live a pretty comfortable life, if their biggest involvement is to "save the whales", or "free tibet", or health care for the healthy young americans. Or the need to exaggerate the health crisis of those poor starving tribes in some far off land.

[kellyb]

Is there a model which can explain the very different levels of HIV infection around the world/Africa?

To put it another way, does anybody really understand why there is such a spread in the prevalence of HIV around the world/Africa?

Does anyone know if malnutrition increases the HIV viral load?
Also, since it appears that HIV and herpes work together...would extreme malnutrition make a herpes infection more likely to be active as opposed to latent?

[casebro]

Is there a model which can explain the very different levels of HIV infection around the world/Africa?

To put it another way, does anybody really understand why there is such a spread in the prevalence of HIV around the world/Africa?

Sure.

1) Ignorance

2) Sexual ethics

3) Exaggeration

All of which have been coverd in this thread.

[Paulhoff]

Remember it is only reported cases, how many cases aren't reported, I'm sure the number is larger, but how much larger, and with governments saying that there is no AIDS, you can go from there on the real numbers.

Paul

:) :) :)

It is a big problem, there are many good sites on the web that aren't just running up the numbers.

[Deetee]

The HIV/AIDS stats for Africa are not precise, for a number of fairly obvious reasons. Official figures are subject to change as precision improves. This does not mean it is not one of the leading causes of death, or that because there is uncertainty about classification or categorisation that there is not a massive problem - that is pure fallacy (but has often been used by denialists before to suggest "HIV does not exist!").
That's a bit like someone saying: "You said Yorkshire terriers were the commonest dogs in Yorkshire - but they might not be. Therefore, Yorkshire terriers do not exist!"

[kellyb]

Is there a model which can explain the very different levels of HIV infection around the world/Africa?

To put it another way, does anybody really understand why there is such a spread in the prevalence of HIV around the world/Africa?

In a very basic way, it makes sense that the prevalence is highest in Africa, because that's there the original zoonotic event(s?) happened. The virus was "born", and thus adapted to humans there.
This is interesting...

http://www.popline.org/docs/1635/290645.html

Transmission rates of human immunodeficiency virus (HIV) during heterosexual intercourse vary dramatically around the world. In Asia and South America, they are extraordinarily high, whereas in the United States and Europe, rates are much lower even after a large number of unprotected contacts. The transmission rates in Africa also probably are high, but the available studies unfortunately are weak. In Thailand, female-to-male transmission rates per contact were estimated at .056 (1 in 81) compared to .0002 to .0015 (1/5000- 1.5/1000) for male-to-female transmission in the United States and Europe. Male- to-female transmission in Thailand appears to show, as expected, even greater transmission likelihood compared to female-to-male rates. In general, in the United States and Europe, transmission rates within heterosexual couples range from less than 10% to 22%, whereas in Thailand and Brazil, the rates exceed 40%. The much lower transmission rate per contact in the United States and Europe is based on an assumption that HIV transmitters are a homogeneous group. Wiley and colleagues argue that transmitters are likely to be a heterogeneous group with a large percentage of very low frequency transmitters and a small percentage of high frequency transmitters. That hypothesis is given some support by a cluster of cases in rural New York State in which one man appeared to infect 31% of his many contacts. (excerpt)

I spent a while looking, but I couldn't find anything on extreme malnutrition and viral load. I did find this, though...

http://content.nejm.org/cgi/content/abstract/351/1/23

Methods We enrolled 1078 pregnant women infected with HIV in a double-blind, placebo-controlled trial in Dar es Salaam, Tanzania, to examine the effects of daily supplements of vitamin A (preformed vitamin A and beta carotene), multivitamins (vitamins B, C, and E), or both on progression of HIV disease, using survival models. The median follow-up with respect to survival was 71 months (interquartile range, 46 to 80).

Results Of 271 women who received multivitamins, 67 had progression to World Health Organization (WHO) stage 4 disease or died — the primary outcome — as compared with 83 of 267 women who received placebo (24.7 percent vs. 31.1 percent; relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.98; P=0.04). This regimen was also associated with reductions in the relative risk of death related to the acquired immunodeficiency syndrome (0.73; 95 percent confidence interval, 0.51 to 1.04; P=0.09), progression to WHO stage 4 (0.50; 95 percent confidence interval, 0.28 to 0.90; P=0.02), or progression to stage 3 or higher (0.72; 95 percent confidence interval, 0.58 to 0.90; P=0.003). Multivitamins also resulted in significantly higher CD4+ and CD8+ cell counts and significantly lower viral loads. The effects of receiving vitamin A alone were smaller and for the most part not significantly different from those produced by placebo. Adding vitamin A to the multivitamin regimen reduced the benefit with regard to some of the end points examined.

Conclusions Multivitamin supplements delay the progression of HIV disease and provide an effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women.

So, I think that's evidence (in a not very strong, roundabout kind of way)that malnutrition will increase viral load, making a much larger percentage of the population "high transmitters". And on the other end, I wouldn't be surprised if malnutrition also made people more susceptible to becoming infected, by lowering the minimum number of virons needed to jumpstart a chronic infection.

[Ivor the Engineer]

Here's a couple of interesting snippets:

http://www.nam.co.uk/en/news/CF7FB602-2FCE-4171-B25E-CBE352C8C962.asp

An analysis of HIV isolates from 102 individuals very recently infected with HIV shows that in three-quarters of cases, a single virus was the ancestor of all the viruses isolated from that individual, suggesting to the researchers that immune defences against HIV are highly efficient and usually able to prevent infections by swarms of viruses.

http://www.nam.co.uk/en/news/61DD29FB-DFA6-4B2C-94A7-870D4A068955.asp

A topical gel containing the female hormone oestrogen appears to block HIV’s infection of key cells in the foreskin, according to an article published in the online journal PLoS One. The investigators believe that the hormone, which is readily available in a cream, is a “simple, cheap, readily available natural hormone [that] could create a living barrier to HIV that preserves the natural defences of the inner foreskin.”

In 2006, there were an estimated 4 million new HIV infections around the world bringing the total number of cases of HIV to 40 million. In the absence of a vaccine, investigators are attempting to find new methods of preventing HIV infection. There has recently been some excitement about the protective effects of male circumcision, with three studies involving African heterosexual men showing that it reduced their risk of infection with HIV by 50 - 60%.

Circumcision is thought to help prevent infection with HIV because Langerhans cells, which are vulnerable to infection with HIV, are present in large numbers in the foreskin. But Langerhans cells are also part of the body’s natural defence against HIV and only become vulnerable to infection with HIV when exposed to large quantities of HIV virions.

Investigators at the University of Melbourne hypothesised that rather than removing this natural defence mechanism through circumcision, it might be better to enhance it by thickening the layer of protective keratin over the Langerhans cells, meaning that they are exposed to less HIV.

Laboratory studies have shown that the application of oestriol – a synthetic form of oestrogen - to the vaginas of rhesus monkeys reduces their risk of infection with simian immunodeficiency virus (SIV), a virus closely related to HIV. The investigators found that the increased levels of keratin in vaginal tissue protected the rhesus monkeys from infection with the virus.

[fls]

I wonder what is the methodology of the Aids census used in those 'causes of death' studies?

If it's true that 1/3 of the patients who supposedly have aids never had an aids test, then 1/3 of the deaths are from other causes. Take out 1/3 of the supposed aids deaths, and the #1 killer becomes Malaria.

If that's the case, doesn't it worry you that the third leading cause of death (if that's what it works out to) in Africa is an unknown illness that leads to an acquired immunodeficiency?

Other sources state that 11% of Sub-Saharan Africans have AIDS, but then if 1/3 of cases are spurious diagnosis, the numbers all shift.

Next thing we'll hear is that Aids treatments that work elsewhere don't seem to work as well on African cases. Of course not, if 1/3 of those cases don't have Aids to begin with.

Seems to all add up to exaggerating the threat.

We know that some of the cases diagnosed without serology do not have AIDS. We also know that AIDS cases are missed when serology is not done. The studies show that the specificity without serology is about 90%, while the sensitivity is about 50 to 60%. This means that about 80% of your 1/3 would be true positives, and that about 22% of the cases you identified as not having AIDS, would actually have AIDS (if 40% of all deaths are due to AIDS). Which means that the actual number of AIDS deaths in which serology was not done would exceed the number reported in the absence of serology, by about 30 percent. That's a long way from -100%.

Linda

[kellyb]

http://www.nam.co.uk/en/news/CF7FB60...E352C8C962.asp



An analysis of HIV isolates from 102 individuals very recently infected with HIV shows that in three-quarters of cases, a single virus was the ancestor of all the viruses isolated from that individual, suggesting to the researchers that immune defences against HIV are highly efficient and usually able to prevent infections by swarms of viruses.

That makes me think of this:

http://www3.niaid.nih.gov/news/QA/step_qa.htm
Has there been any additional analysis of the STEP data?
On November 7, 2007, additional analyses of the STEP data were presented at an open scientific meeting in Seattle. These analyses suggested that those study participants who received the vaccine may get infected with HIV more easily if they are exposed to the virus.

What's interesting is that, that means a lot of times, people fight the virus off upon exposure.

I wonder if HIV might be mega-adapted to the immune response of the severely malnourished? Malnourishment might both lower people's "threshold" for becoming infected in the first place, and then it also keeps the viral load way up, so the infected are super contagious?

And then there's promescuity and prostitution, which, when combined with starvation...that's "the formula" for highly endemic HIV in heterosexual populations?

http://data.unaids.org/pub/GlobalReport/2006/2006GR-PrevalenceMap_en.pdf
http://ije.oxfordjournals.org/cgi/content/full/32/4/518/F2

ETA:

Then this, too...(herpes)
(this is just an emedicine, but I think it's probably right)

http://www.emedicine.com/PED/topic995.htm

HSV in the immunocompromised patient

Patients with primary immunodeficiencies, AIDS, malignancy, malnutrition, or burns and transplant recipients (eg, bone marrow, organs) receiving immunosuppressive therapy can have unusually severe HSV infections.

Starvation makes herpes worse, which helps HIV.

[casebro]

SNIP

We know that some of the cases diagnosed without serology do not have AIDS. We also know that AIDS cases are missed when serology is not done. The studies show that the specificity without serology is about 90%, while the sensitivity is about 50 to 60%. SNIP

Linda

Were these data from Africa, or from some medical institutes in a first word country?

Do you know of any large scale study of aids rates, of general populations in Africa, that include serology ? Draft physicals perhaps? College admissions physicals? Jail admissions? USA immigration physicals perhaps?

Or where does the much published African Aids rates come from? Phone surveys perhaps? I did read of one study based on "verbal autopsy reports". As if a country with the average daily earnings of $1, they do autopsies on everybody.

[kellyb]

Were these data from Africa, or from some medical institutes in a first word country?

Do you know of any large scale study of aids rates, of general populations in Africa, that include serology ? Draft physicals perhaps? College admissions physicals? Jail admissions? USA immigration physicals perhaps?

Or where does the much published African Aids rates come from? Phone surveys perhaps? I did read of one study based on "verbal autopsy reports". As if a country with the average daily earnings of $1, they do autopsies on everybody.

Stuff like this:

http://www.aidsonline.com/pt/re/aids/abstract.00002030-200108004-00002.htm;jsessionid=LVJTg4bkBB1vP0FHrryN6MNSHGXMH z8b87vnyF7xTf8fmM4CF81Z!669148343!181195629!8091!-1

See for yourself. (http://scholar.google.com/scholar?q=HIV+prevalence+serology+Africa&hl=en&lr=&btnG=Search)

[skeptigirl]

Please evidence that less than 1.5 million people die each year in Africa; population of almost 1 billion, from all other causes outside of AIDS.Here's a suggestion, how about you provide the evidence that contradicts the dozen websites citing HIV-AIDS as the leading cause of death in Africa.

[fls]

Were these data from Africa, or from some medical institutes in a first word country?

From Africa. It wouldn't be relevant in first world countries, since there is no need to find a reasonable way to diagnose AIDS without access to serology.

Do you know of any large scale study of aids rates, of general populations in Africa, that include serology ? Draft physicals perhaps? College admissions physicals? Jail admissions? USA immigration physicals perhaps?

Those would all be selected populations and therefore not generalizable. Better information comes from random samples of the general population in African countries.

Or where does the much published African Aids rates come from? Phone surveys perhaps? I did read of one study based on "verbal autopsy reports". As if a country with the average daily earnings of $1, they do autopsies on everybody.

Phone surveys are not going to be a reliable method in these circumstances (at least, not all by themselves). Data is gathered from vital statistics, census data, public-health reporting, surveillance, research-related activities, surveys, etc.

Linda

[skeptigirl]

I wonder what is the methodology of the Aids census used in those 'causes of death' studies?

If it's true that 1/3 of the patients who supposedly have aids never had an aids test, then 1/3 of the deaths are from other causes. Take out 1/3 of the supposed aids deaths, and the #1 killer becomes Malaria.

Plus: This quote seems poorly worded:
"...World Health Organization Regions combined. HIV/AIDS is the leading cause of death for adults in the region, with an estimated 60 percent of the people being infected. ..."

It means that 60% of the purported Aids cases are in Africa, NOT that 60% of Africans have Aids.

Other sources state that 11% of Sub-Saharan Africans have AIDS, but then if 1/3 of cases are spurious diagnosis, the numbers all shift.

Next thing we'll hear is that Aids treatments that work elsewhere don't seem to work as well on African cases. Of course not, if 1/3 of those cases don't have Aids to begin with.

Seems to all add up to exaggerating the threat.You are so confused as to the facts here I suggest you quit trying to draw independent conclusions until you educate yourself a bit more. And since I'm not sure you are interested in discovering the facts that contradict your preferred conclusions here, I post this for other readers.

In untreated HIV cases: The average time from initial HIV infection to HIV-AIDS is 5 years. The range is ~8 months to decade. The average time from the onset of HIV-AIDS to death is an additional 2 years.

The unidentified cases are for the most part infected with HIV but have not yet developed AIDS. That figure is taking a slice of the population today (or at the single time period the numbers represent.

Any single person with HIV will almost always be diagnosed before death. That's one of the data sources that goes into the 30% estimate along with testing population samples. When you find yourself diagnosing patients only when they present with AIDS onset, you know they have gone a considerable time in the population as unidentified HIV cases.

[casebro]

But you can't link me to an "African aids rate study, with it's methodology"?

I'm asking for studies, you're giving me the consensus, or "common knowledge", aren't you?

[skeptigirl]

...
Do you know of any large scale study of aids rates, of general populations in Africa, that include serology ? Draft physicals perhaps? College admissions physicals? Jail admissions? USA immigration physicals perhaps?

Or where does the much published African Aids rates come from? Phone surveys perhaps? I did read of one study based on "verbal autopsy reports". As if a country with the average daily earnings of $1, they do autopsies on everybody.WHO data takes into account continent wide averages but the numbers differ considerably by country and groups within the countries. Here is an example of two particular studies.

South Africa HIV & AIDS Statistics (http://www.avert.org/safricastats.htm)Based on its sample of 33,033 women attending 1,415 antenatal clinics across all nine provinces, the South African Department of Health Study estimates that 29.1% of pregnant women were living with HIV in 2006. The provinces that recorded the highest HIV rates were KwaZulu-Natal, Mpumalanga and Free State.....

The National HIV Survey is a "household" survey. This involves sampling a proportional cross-section of society, including a large number of people from each geographical, racial and other social group. The researchers take great pains to try to make the sample as representative as possible, and the findings are later adjusted to correct for likely over- or under-representation of individual groups (according to census data).

The survey's fieldworkers visited 12,581 households across South Africa, of which 10,584 (84%) took part in the survey. Of the 24,236 people within these households who were eligible to take part, 23,275 (96%) agreed to be interviewed and 15,851 (65%) agreed to take an HIV test. This means that only 55% of eligible people were tested.

The main reasons given for refusing HIV testing were fear of having a blood sample taken (58%); religious objections to having a blood sample taken (16%) and not wanting to learn HIV status (7%). A further 13% of people who refused were, for various reasons, afraid or mistrustful of the survey. The report of the survey claims that people at high risk for HIV infection were more likely to take part, and the results were adjusted to compensate for this perceived bias.

The response rate is considered "good" by the standards of this type of survey, but is considerably lower than that found in other parts of sub-Saharan Africa.1 2 White people and those of Indian origin were the least cooperative.

Based on this survey, the researchers estimate that 10.8% of all South Africans over 2 years old were living with HIV in 2005. Among those between 15 and 49 years old, the estimated HIV prevalence was 16.2% in 2005.

You seem to have a commonly ignorant belief that Africa is all a tribal zone with grass and mud huts. While those populations exist within Africa, so do the same large modern cities as elsewhere in the world. Being poor and lacking public health infrastructure doesn't mean there are no modern laboratory facilities. And HIV serology is not that complicated to do. They make a test I can run in my office. It only takes a refrigerator to store the test kit in and a drop of blood to test.

[skeptigirl]

[@ casebro]

See for yourself. (http://scholar.google.com/scholar?q=HIV+prevalence+serology+Africa&hl=en&lr=&btnG=Search)He doesn't seem to want to.

People Believe a 'Fact' That Fits Their Views Even if It's Clearly False (http://www.karlloren.com/healthinsurance/p39.htm)

[RecoveringYuppy]

But you can't link me to an "African aids rate study, with it's methodology"?

I'm asking for studies, you're giving me the consensus, or "common knowledge", aren't you?
Doesn't the link I provided back in post 21 address some of your questions?

[kellyb]

He doesn't seem to want to.

People Believe a 'Fact' That Fits Their Views Even if It's Clearly False (http://www.karlloren.com/healthinsurance/p39.htm)

Yeah, I know. I thought it might be worth a shot.
Oh, well.

[JEROME DA GNOME]

Here's a suggestion, how about you provide the evidence that contradicts the dozen websites citing HIV-AIDS as the leading cause of death in Africa.

So, if I provide web-sites that state that the moon is made of cheese than you have to provide evidence that is is not.

:dl:


Did you find out how many people in Africa died of any thing other than AIDS?

[JEROME DA GNOME]

Were these data from Africa, or from some medical institutes in a first word country?

Do you know of any large scale study of aids rates, of general populations in Africa, that include serology ? Draft physicals perhaps? College admissions physicals? Jail admissions? USA immigration physicals perhaps?

Or where does the much published African Aids rates come from? Phone surveys perhaps? I did read of one study based on "verbal autopsy reports". As if a country with the average daily earnings of $1, they do autopsies on everybody.



Any AIDS supporter going to answer these questions?

[Loss Leader]

Any AIDS supporter going to answer these questions?


I never thought of myself that way, but I guess I'm a supporter of some people getting AIDS.



Especially pedophiles.

[casebro]

Doesn't the link I provided back in post 21 address some of your questions?

My read of that link is that it takes 1,000 hetero couplings to transmit the disseae. Isn' that the way a .oo1 risk factor works out?

[Reality Check]

My read of that link is that it takes 1,000 hetero couplings to transmit the disseae. Isn' that the way a .oo1 risk factor works out?

It is better to say that it takes 1 hetero coupling to transmit the disease but the chance per coupling is 0.001 so it could be the first time or it could be the 1000th time.

[casebro]

Okay, I looked up one of the links supplied by my mentors here at JREF. The 2002 Nelson Mandela study in South Africa. Seems solid, with serology. Says about 11%. Some other studies I glanced at seemed to exclude S.A. I wonder why?

ETA, wait a sec. While they did look at several different settings (rural, etc) and several different races, the 11% is the average of the samples. It would need to be adjusted for the ratios of city/rural dwellers. Nuts, my eyes are strained now. More reading will have to wait.

Another study that quoted serology said from 3 to 30 %, in four cities in four countries.

Both studies had much to say about the likely hoods of various risk factors.

Nothing yet on Sub-Saharan Africa as a whole. 20% is somewhere between the low and the high.

[RecoveringYuppy]

My read of that link is that it takes 1,000 hetero couplings to transmit the disseae. Isn' that the way a .oo1 risk factor works out?
You must have read only a very small portion of that link.

[JEROME DA GNOME]

You must have read only a very small portion of that link.

What, do you just read the scary head-lines and move on?

[skeptigirl]

Yeah, I know. I thought it might be worth a shot.
Oh, well.
It's always worth posting, kelly. There are many people reading besides the ones that post.

Jerome is probably a troll anyway. Who knows what he really believes.

[skeptigirl]

I never thought of myself that way, but I guess I'm a supporter of some people getting AIDS.



Especially pedophiles.Bad idea, LL. That would make them even more dangerous.

[skeptigirl]

My read of that link is that it takes 1,000 hetero couplings to transmit the disseae. Isn' that the way a .oo1 risk factor works out?4 in 1,100 HIV infected blood exposures resulted in infection. But that doesn't mean each exposure carries the average risk.

[kellyb]

Okay, I looked up one of the links supplied by my mentors here at JREF. The 2002 Nelson Mandela study in South Africa. Seems solid, with serology. Says about 11%. Some other studies I glanced at seemed to exclude S.A. I wonder why?

ETA, wait a sec. While they did look at several different settings (rural, etc) and several different races, the 11% is the average of the samples. It would need to be adjusted for the ratios of city/rural dwellers. Nuts, my eyes are strained now. More reading will have to wait.

Another study that quoted serology said from 3 to 30 %, in four cities in four countries.

Both studies had much to say about the likely hoods of various risk factors.

Nothing yet on Sub-Saharan Africa as a whole. 20% is somewhere between the low and the high.

Thank you for actually looking around and attempting to increase your level of understanding.
:)
Like someone else said, the prevalence studies are still very imperfect. But HIV is undeniably a massive problem globally. And in S Africa, there's no way to deny that it's HUGE. The African AIDS issue isn't being overhyped.
The science now on HIV in Africa is probably pretty close to the mark. Give or take up to 50%, I'd guess...but it's not like it's way, way off. But because India had numbers inflated by about 50%
http://nacoonline.org/Quick_Links/HIV_Data/....
I think that's possible anywhere.
But I've looked into it, and I think the African figures are probably pretty close.

[Deetee]

My read of that link is that it takes 1,000 hetero couplings to transmit the disseae. Isn' that the way a .oo1 risk factor works out?

1. The transmission risk is an average, as has been pointed out. It does not mean one will need to have sex 1000 times in order to get HIV, any more than you have to throw a die six times in order to get a 6 (a common denialist ploy when discussing this issue).

2. The 0.001 risk quoted in this study is for some couples only - the risk is higher for high viral loads (0.002) and with coexistent genital ulceration (0.004). As the paper states, transmissions rates of 0.1 have been reported in men having sex with prostitutes in Kenya and Thailand.

3. The study looks at monogamous couples who were HIV "discordant", ie one has HIV, the other does not. This introduces significant selection bias into the study, since it preselects couples who have already failed to give each other HIV. The corollary would be like looking at fertility rates in couples, but selecting at the start of the study only couples who had never had a pregnancy. This means a higher rate of "infertile" couples will be selected, and in HIV transmission studies, similar selection leads to relatively more couples who are unlikely to get HIV for some reason (either behaviourally or genetically etc).

4. It is a common denialist fallacy to use the "low" risks of HIV acquisition through heterosex as some kind of proof the virus cannot be transmitted, or cannot cause a heterosexual "epidemic". But think about how infections might work for a moment. Take a 0.001 risk (and ignore the caveats about this being an average risk for the moment) Couples in this survey had sex 9 times a month, or 86 times per year, or roughly (no pun intended) 1000 times in 12 years. So one person will transmit to a partner on average every 12 years. In order for transmission to be sustained, all that is required is for the reproductive number of an infection to be greater than 1 - ie if you give the infection to more than one person, the incidence of the disease increases. HIV's reproductive number is greater than 1 (not by a lot, but by enough).
In the scenario of someone with a transmission risk of 0.1 (like the prostitute examples), the number of contacts per year is way more than 86 - that is more like the number of contacts in a fortnight, and with the greater risk of transmission per contact (coexistent genital ulcers/STDs etc) HIV can spread fairly quickly among those with the riskiest behaviour.

[Rolfe]

Hmmm, how to ask this question delicately?

Some time ago I read some stuff about sexual practices in Africa, specifically that in some African societies it is believed by the men that a naturally lubricated vagina is abnormal, an illness, or a sign of a "loose woman". The women know that in order to keep their men (or to preserve their reputations, I'm not quite sure which is the driving factor), they have to ensure their vaginas are dry. Products are on the market to achieve this - powders and things like that. I remember the name of one concoction was "stay-soft" - named because it would ensure one's man stayed "soft" on his lady-love who used the preparation (soft as in, in love).

This is obviously risky behaviour in an HIV context, because it predisposes to injury of the vagina (and possibly even the penis too, perhaps), and so would increase the risk of heterosexual transmission.

Does anyone know if this is indeed a significant factor in the African epidemic? Is it something people just don't want to talk about? Or is it only a minority interest and so not really significant continent-wide? Or has the practice been educated out of existence?

Rolfe.

[MRC_Hans]

Any AIDS supporter going to answer these questions?WTF is an "AIDS supporter"?

Hans

[Deetee]

Fly-by for Rolfe....

http://www.ncbi.nlm.nih.gov/pubmed/9788473
From the article:One woman explains: "men do not like loose vaginas. If sex is wet the man thinks that I have had sex with someone else and then he won't pay me."

[RecoveringYuppy]

@Rolfe,

Also, see post 48.

[casebro]

I've scrolled through pages and pages of Google Scholar, read pages of studies, and I still can't find any methodology behind the claim of the high rate of HIV in Africa as a continent.

If the WHO stats are based on interviews from the head witch doctor in each country, they are suspect. If based on serology studies, like the Nelson Mandela study in S.A., then they are believable. I'm skeptical, and want a glance at the evidence. Rather than a consensus. The consensus that "HIV will kill us all" has been shown wrong. Other historic consensus' have been disproven, no need to enumerate them. Why do so many of you still believe every opinion that comes along, without any skepticism?

I never said AIDS isn't a deadly disease. Or terrible. All I want is enough data to base my own live on. I'm not interested in what a consensus of witch doctors have to say. Gimme the study, rather than the press release.

[RecoveringYuppy]

All I want is enough data to base my own live on. I'm not interested in what a consensus of witch doctors have to say. Gimme the study, rather than the press release.
What bit of data could possibly be missing that you might find in such a study?

[Rolfe]

@Rolfe,

Also, see post 48.


Ah, I see. I'd missed that when I went through the thread.

As I'm at work, I think I'll pass on following that link!

Rolfe.

[Deetee]

I've scrolled through pages and pages of Google Scholar, read pages of studies, and I still can't find any methodology behind the claim of the high rate of HIV in Africa as a continent.

Perhaps you are looking in the wrong place?
PubMed can link to lots of seroprevalence data in Africa.
A few minutes work gave these; I am sure a few more could yield more:

Malawi (http://www.ncbi.nlm.nih.gov/pubmed/12891068?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
Tanzania (http://www.ncbi.nlm.nih.gov/pubmed/15075547?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed)
Zimbabwe (http://sti.bmj.com/cgi/content/full/82/suppl_1/i42)
Uganda (http://sti.bmj.com/cgi/content/full/82/suppl_1/i36)
Nigeria (http://www.ncbi.nlm.nih.gov/pubmed/18080593?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
Zambia (http://www.ncbi.nlm.nih.gov/pubmed/9677172?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed)
Botswana (http://www.ncbi.nlm.nih.gov/pubmed/12222375?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
African worker survey of several countries (http://www.ncbi.nlm.nih.gov/pubmed/15034992?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

I don't claim these are the definitive; they just happen to be some studies where seroprevalence has been measured in populations or subgroups. The sort of thing you want, I guess, since I assume you mean methodology of the epidemiology surveys, rather than methodology of the HIV antibody testing process.

Also, I came across some stuff about population-based surveys (http://www.ncbi.nlm.nih.gov/pubmed/15930844?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum), and a paper on how WHO gathers data (http://ije.oxfordjournals.org/cgi/reprint/27/1/101) on HIV and its prevalence.

Happy reading!

[JEROME DA GNOME]

But HIV is undeniably a massive problem globally.

I deny it.

In just America almost 1 million people die from medical mistakes.

THE LEADING CAUSE OF DEATH IN THE U.S.
IS THE HEALTH-CARE SYSTEM (http://www.angelfire.com/az/sthurston/Leading_Cause_of_Death_in_the_US.html)


So, 2 million deaths from AIDS Worldwide is really not that big of a deal when put into context.

[fls]

I deny it.

In just America almost 1 million people die from medical mistakes.

THE LEADING CAUSE OF DEATH IN THE U.S.
IS THE HEALTH-CARE SYSTEM (http://www.angelfire.com/az/sthurston/Leading_Cause_of_Death_in_the_US.html)


So, 2 million deaths from AIDS Worldwide is really not that big of a deal when put into context.

What started out as 44,000 has now become 1 million I see.

Can I put you in charge of my retirement funds?

Linda

[Loss Leader]

So, 2 million deaths from AIDS Worldwide is really not that big of a deal when put into context.


Oddly enough, 2 million is exactly the difference between the number of Jews who died in the Holocaust and the number that Jerome thinks died.

Two million is really not that big of a deal when put into context.

[Paulhoff]

JEROME is such a sweet troll, feel his love, no number is to small for him to feel the pain of the loss, children without parents tears at his heartstrings.

http://forums.randi.org/imagehosting/48804755695dc0fbb.gif (http://forums.randi.org/vbimghost.php?do=displayimg&imgid=9564)

Paul

:) :) :)

Please post to the topic at hand and not personal issues.

[Loss Leader]

Oh, they're gonna come in and shut us down for sure.

[skeptigirl]

Ah, I see. I'd missed that when I went through the thread.

As I'm at work, I think I'll pass on following that link!

Rolfe.I think any particular practice would be local, not continent wide except the problem with prostitution and women's lack of rights which is continent wide though perhaps not in every single location.

[Ivor the Engineer]

I think any particular practice would be local, not continent wide except the problem with prostitution and women's lack of rights which is continent wide though perhaps not in every single location.

Problem?

I thought we weren't allowed to judge others' cultural practices as wrong because we might then feel motivated to go "educate" the natives?

Or in other words, who are we to tell Africans how to treat their women or to interfere in their culture or politics?

[The Man]

Oddly enough, 2 million is exactly the difference between the number of Jews who died in the Holocaust and the number that Jerome thinks died.

Two million is really not that big of a deal when put into context.


They must have died later, from medical mistakes.

At least there is something evidenced that Jerome will not deny, the Holocaust

[The Man]

I deny it.

In just America almost 1 million people die from medical mistakes.

THE LEADING CAUSE OF DEATH IN THE U.S.
IS THE HEALTH-CARE SYSTEM (http://www.angelfire.com/az/sthurston/Leading_Cause_of_Death_in_the_US.html)


So, 2 million deaths from AIDS Worldwide is really not that big of a deal when put into context.


Apparently, anyone who dies while being treated by established medicine does so as a result of that treatment. Jerome, do you have any figures identifying how many people die from the treatments purported by the website you linked, or how many people are still alive, due to the current health-care system?

[DarthFishy]

I only have anecdotal evidence to add to this thread. (Though even that level of evidence seems quite a high bar for some in this thread :p)

Living in South Africa I can confirm that AIDS is a very real problem. Yes there are problems with nutrition and general health care as well but that doesn't remove the fact that HIV/AIDS is still the real killer.

If you happen to drive through a rural area in South Africa you will see that at least one part of the rural economy is flourishing: Funeral Services. Small villages will have 2 or 3 different Funeral Services just for their population.

Similarly the prevalence of graveyards, and their increased sizes in these rural areas is also note worthy.

South Africa has had an increase in the quality and availability of medical services to the whole population during the last 20 years or so. And yet there is an increase of Funeral Services, Graveyards etc. I'm afraid that the HIV/AIDS virus is a very real problem.

I can give more anecdotal examples, but I think that anybody denying this kinda of human catastrophe doesn't deserve even that much. :mad:

[skeptigirl]

Problem?

I thought we weren't allowed to judge others' cultural practices as wrong because we might then feel motivated to go "educate" the natives?

Or in other words, who are we to tell Africans how to treat their women or to interfere in their culture or politics?I'm not sure this even deserves an answer. I don't know which "we" you are referring to but I take great interest in improving the lives of women in these horrendous situations.

So either this is a dumb joke, or you are weird.

[Ivor the Engineer]

I'm not sure this even deserves an answer. I don't know which "we" you are referring to but I take great interest in improving the lives of women in these horrendous situations.

So either this is a dumb joke, or you are weird.

I was trying to raise a bit of cog. diss. in those posters (not necessarily you) who berate me for judging other cultures' practices on the one hand, yet on the other seem quite happy to do the same when it's an issue that they feel strongly about.

[skeptigirl]

Yeah, I definitely don't think that was me. But you did post it with my quote. Perhaps that wasn't the best place to bring it up. Especially considering we aren't talking about preserving any culture here. The poverty and lack of rights of women in Africa is a serious problem and contributes specifically to the HIV pandemic. And forced prostitution whether it is from physical force or economic force is not something that is a cultural tradition in need of preserving. It is a very serious problem.

Policy Paralysis:
A Call for Action on HIV/AIDS-Related Human Rights Abuses Against Women and Girls in Africa (http://www.hrw.org/reports/2003/africa1203/)

Just Die Quietly:
Domestic Violence and Women’s Vulnerability to HIV in Uganda (http://www.hrw.org/reports/2003/uganda0803/)

Zambia: Abuses Against Women Obstruct HIV Treatment (http://hrw.org/english/docs/2007/12/18/zambia17575.htm)

Women and HIV/AIDS (http://www.hrw.org/women/aids.html)

SADC Gender and Development Protocol: How it can Save Lives (http://hrw.org/english/docs/2007/08/16/zambia16697.htm)

[fls]

Apparently, anyone who dies while being treated by established medicine does so as a result of that treatment.

That's an important point. On a number of the reports used in the article, that an adverse event occurred in someone who was ill and died is treated as though that person died because of the adverse event rather than their illness. It turns out that those people who were also ill, but did not have an adverse event, died at a similar rate as those who did, but the authors of the article treat them as though they would have all survived.

There is a lot of other major silliness in the article, including double plus counting (i.e. deaths under 'medical error' includes deaths under 'adverse drug reactions' and 'infection', deaths under 'surgery related' includes deaths under 'infection' and 'bedsores' - some deaths get counted 4 or 5 times), mixing up avoidable and non-avoidable death, using the highest number in the range, etc.

Jerome, do you have any figures identifying how many people die from the treatments purported by the website you linked, or how many people are still alive, due to the current health-care system?

Yeah, we can prevent a chemotherapy death by allowing all those people who would have been saved by the chemotherapy we are now withholding (including the person who died from the chemotherapy) to die, but do we want to?

However, it doesn't really matter. We can allow those numbers to all be true and it doesn't make Jerome's argument valid. Because even though doctors think the problem of medical error is one or two orders of magnitude less than claimed by the article, they still consider it a problem worthy of time and effort. Physicians participate in numerous activities every day that are directed towards reducing medical error - automatic notification systems, electronic prescriptions, continuing medical education, consultation with colleagues, review of colleagues medical records, reporting errors, etc. In context, even much smaller problems than 2 million deaths per year are considered worthy of attention, so there's no particular reason to exclude HIV/AIDS from consideration.

Linda

[Paulhoff]

The U.S. Department of Justice reports
797,500 children (younger than 18) were reported missing in a one-year period of time studied resulting in an average of 2,185 children being reported missing each day. 203,900 children were the victims of family abductions. 58,200 children were the victims of non-family abductions. 115 children were the victims of “stereotypical” kidnapping. (These crimes involve someone the child does not know or someone of slight acquaintance, who holds the child overnight, transports the child 50 miles or more, kills the child, demands ransom, or intends to keep the child permanently.)


The biggest part is just children running away over night to a friends house, all children reported missing no matter what are counted.

Figures can lie and liers figure.

Paul

:) :) :)

[casebro]

Hmmm, a little conceptualization re: aids transmission amongst heteros:

Based on the risk factor of .001 for transmission from hiv males to their wives: If a promiscuous woman had a different partner each time she engaged in vaginal sex, and those partners were chosen from a population of males with a 1% HIV rate, then her risk factor has dropped to .00001 per 'coupling'. That's 1 in 100,000 per 1% HIV rate among males. WA-a-a-a-ay to low to start a hetero epidemic in developed countries.

[casebro]

Perhaps you are looking in the wrong place?
PubMed can link to lots of seroprevalence data in Africa.
A few minutes work gave these; I am sure a few more could yield more:

Malawi (http://www.ncbi.nlm.nih.gov/pubmed/12891068?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
Tanzania (http://www.ncbi.nlm.nih.gov/pubmed/15075547?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed)
Zimbabwe (http://sti.bmj.com/cgi/content/full/82/suppl_1/i42)
Uganda (http://sti.bmj.com/cgi/content/full/82/suppl_1/i36)
Nigeria (http://www.ncbi.nlm.nih.gov/pubmed/18080593?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
Zambia (http://www.ncbi.nlm.nih.gov/pubmed/9677172?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed)
Botswana (http://www.ncbi.nlm.nih.gov/pubmed/12222375?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
African worker survey of several countries (http://www.ncbi.nlm.nih.gov/pubmed/15034992?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

I don't claim these are the definitive; they just happen to be some studies where seroprevalence has been measured in populations or subgroups. The sort of thing you want, I guess, since I assume you mean methodology of the epidemiology surveys, rather than methodology of the HIV antibody testing process.

Also, I came across some stuff about population-based surveys (http://www.ncbi.nlm.nih.gov/pubmed/15930844?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Resu