Some recent propaganda pieces

PrEP in Nigeria and “HIV” testing in U.S. emergency care settings

The first piece I’ll address today is the following, out of Nigeria:

NHVMAS Educates Journalists On New Prevention Technologies Against HIV

Is it just me, or is the title of this piece totally condescending? Let’s “educate” some journalists, shall we?

The New HIV Vaccine and Microbicides Advocacy Society (NHVMAS), conducted a 3- days awareness and sensitisation campaign on New Prevention Technologies against HIV for some journalists in health rapporteur in Lagos state.

The programme was held at NHVMAS office in Ojodu Berger, Lagos from 21st to 23rd November, 2023.

The education awareness centered mainly on Pre-exposure prophylaxis popularly known as PrEP which according to one of the facilitators, Richard Benson includes but not limited to oral PrEP, Long Acting Injectable PrEP and Dapivirine vaginal ring.

The very first section asks the question: Who should use PrEP? (Besides teenagers and senior citizens, supposedly?) Here’s their answer:

PrEP is targeted at people that have substantial risk of acquiring HIV infection which includes Men who have sex with men (MSM), Transgender individuals’ Heterosexual women and men: serodiscordant couples (either of the partner is positive while the other is negative), Female sex workers (FSW), Sexually active adolescents.

I’m trying to wrap my head around the fact that, if I’m reading this correctly, they are recommending PrEP for all sexually active adolescents (that’s bound to work out well), but for adults, only for serodiscordant couples. Do supposedly promiscuous adolescents somehow become chaste as adults? That doesn’t seem likely. Regarding adolescents, the article does state that “The anatomy of the female adolescent increases her risk of HIV infection. [Ed: How?] Also teenage pregnancy is high and the risk of HIV infection increases 2 to 3 times during pregnancy and about 4 times six months postpartum.” This is especially interesting given that pregnancy is a known cause of false-positive “HIV tests.” Perhaps a better intervention would be to quit testing, and especially to quit testing pregnant women. Other than that, it looks like the objective is to rain PrEP from the sky in the hopes that everyone will take it.

The article concludes by asserting the urgency of the need for the Dapivirine vaginal ring. Given that PrEP Watch itself gives an underwhelming efficacy rate of a “35% reduction” in risk of acquiring HIV-positivity for the ring, I’ll be very surprised if this takes off. Why even bother, when there are supposedly methods that are “99% effective”? Perhaps it’s because that effectiveness rate is completely bogus, as we will learn later this week when I do a deep dive into the iPreX PrEP study.

Moving on to the next piece of propaganda, I received the shocking news that less than 1% of patients receiving emergency medical care bother to get tested for “HIV.”

Less than 1% in US emergency departments are tested for HIV

I don’t know about you, but when my son broke his arm last summer, the last thing in the world I’d have expected would be to have him tested for “HIV.” No matter, this is a statistic that is troubling the folks over at the CDC.

Despite recommendations for universal screening, less than 1% of people attending emergency departments in the United States are tested for HIV, with no improvement in recent years, according to a report published in the journal AIDS.

In the US, about 13% of people living with HIV don’t know they have it. Emergency departments are key settings for increasing HIV testing and reducing undiagnosed HIV. In the US, they often serve as a safety net for people who are uninsured or have barriers to using other health services, and may be disproportionately affected by HIV. Blood samples are routinely taken, so HIV can easily be included in a battery of tests.

It’s rather creepy that they want to just throw in an “HIV” test on top of your CBC and platelet count. I also want to draw attention yet again to the fact that 13% of people in the U.S. that are “HIV positive” don’t know they have it—are they showing up with full blown, early 1980s style AIDS in emergency rooms? This article would imply not. Also, I’d like to remind the reader yet again that fully 45% of those that are positive and know that they are positive are not “retained in care” on antiretroviral drugs. Where is the AIDS epidemic? It didn’t disappear because of ARVs, obviously.

Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended opt-out HIV testing for patients aged 13 to 64 in emergency departments and other healthcare settings where the local prevalence of HIV infection is greater than 0.1%. People with risk factors for HIV should be screened at least once a year. A similar recommendation from the US Preventive Services Task Force (USPSTF) should mean that insurers cover the cost of HIV testing.

Given that the overall prevalence of “HIV positivity” in the U.S. has been constant at 0.3% of the population for the forty years it’s been recorded, one would assume that this recommendation for universal testing would apply in the vast majority of places. Let’s take a quick look at what the actual numbers of people opting to be tested are:

Each year between 2014 and 2017, between 0.5% and 0.7% of attendees were tested for HIV, rising to 1.1% in 2018. Testing then decreased to 0.8% in 2019, although this was the year in which the Ending the HIV Epidemic in the US initiative was launched and put a new emphasis on testing programmes in order to reduce undiagnosed HIV. In 2020 the COVID pandemic meant that fewer people used emergency departments and their staff were overstretched – the absolute number of HIV tests declined but the proportion of patients tested remained stable at 0.8%.

Overall, the piece isn’t super interesting, but it’s good to know the numbers, and heartening to know that a lot of patients simply don’t want to be tested for “HIV.” If that is the result of critical thinking or of trusting one’s instinct, then that’s great news.

The article doesn’t mention this possibility so I’m speculating here. We know that there is subtle discrimination at play when it comes to “HIV testing.” My own personal experience, and that of many people I know, is that most doctors really don’t try to push “HIV testing” if you’re obviously not in a risk group. I wonder how much of this phenomenon of so-called under-testing is driven by doctors who are internally classifying people’s “need” for testing based on their perception of the patient’s “risk group” status.

To conclude, there is an air of desperation in these articles. Panic abounds that the medical system is neither testing nor medicating nearly enough people. I would argue that we’re testing and medicating far too many.

As usual, sound off in the comments!

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