Pre-Exposure Prophylaxis or PrEP

Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. This blog looks at some of the pros and cons of PrEP.

Saturday, February 19, 2011

Is Most HIV Spread By Sex? No, But Billions of Dollars Say Otherwise

Most of the billions of dollars currently being spent on HIV go to treating and caring for those already infected. A small amount is being spent on 'preventing' HIV but most of that is targeted at sexual transmission, despite the evidence that this is not the only type of transmission. It may not even be the most common type of transmission.

My remarks apply to African countries because that's where HIV epidemics are worst, where most HIV positive people live and where most people at risk of being infected live. It's where HIV, rather mysteriously, almost always spreads through heterosexual sex, while everywhere else in the world it mainly spreads through anal sex and injecting drug use.

One third of research and development funding for over 30 'neglected' diseases is spent on HIV, according to the G-Finder report by Policy Cures, an 'independent' group that happens to rub shoulders with some of the top HIV industry and pharmaceutical players. None of the money spent on HIV R&D is being spent on nosocomial or iatrogenic transmission, transmission that occurs as a result of unsafe medical treatment. HIV drugs, whether they are pre-exposure prophylaxis (PrEP), microbicides, vaccines or antiretrovirals, are aimed at sexual transmission.

In fact, HIV, TB and malaria R&D funding accounts for more than two thirds of all funding, amounting to over two billion dollars a year. Conditions that maim and kill millions of people every year, such as water-borne and food-born conditions, only receive a fraction of this amount. (Although it's interesting to note that the authors of the report are aware of the significance of diarrheal diseases.)

As for provision of clean water and sanitation which would reduce incidence of all of these conditions, this is not even discussed in polite circles.

Developing health services and facilities is not much discussed either. Pharmaceutical and other companies competing for billions of what is, after all, public money, know that if money was spent on health services and facilities and improving access to them, they would end up with far fewer customers.

So, there is no evidence that HIV is almost always transmitted sexually, even in African countries. But an awful lot of money is being spent on 'preventing' sexual HIV transmission while next to none is being spent on non-sexual transmission. And being able to talk about sex and promiscuity is quite a blessing for an otherwise sterile industry. So don't expect attitudes to change quickly.

[For more about nosocomial and iatrogenic HIV transmission, see my other blog, HIV in Kenya.]


1 comment:

Roger said...

I'll have to disagree with you at least on the point of HIV being mainly caused by unsafe injection.

This is an old proposal that was rejected back in 2004. See

This being taken out of the equation, IDU not being a common practice in Sub Saharan Africa and anal sex being limited, what remains is sexual transmission which has been demonstrated in numerous study in Uganda, Tanzania, Zambia and elsewhere.

This is not to say that other means of transmission do not exist, but they are not the main cause of transmission.

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