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February 19, 2003

Dirty needles cause AIDS in Africa?

Dirty needles 'spread Africa Aids' blares the headline. I hope this isn't the public health version of 'Cold Fusion.' If true, it would make the epidemic far more soluble in my judgement, rather than complex cultural tendencies and grinding poverty, the problem could be rectified by targeting public health budgets. But I am skeptical, unfortunately.

1) How did Uganda control its epidemic with condoms and education if needles are spreading the disease?

2) Why are prosperous regions like Botswana, South Africa and until recently Zimbabwe (once prosperous before the blossoming of kleptocracy) the new heart of the epidemic (you can't be telling me that chaotic western Africa has better public health services!).

3) Why does circumcision seem to prevent the spread of AIDS? (this is a contested claim, but I am pretty convinced by the fact that uncircumcised Zulus have far higher rates that circumcised Xhosas in South Africa).

Granted, the new research does not claim all the spread is due to needles, but 60% is non-trivial. I'm all for overturning conventional wisdom, but one study does not a paradigm shift make....

Posted by razib at 11:14 PM

It would certainly go a long way toward explaining why there is no heterosexual AIDS in the US.

Posted by: Gracían at February 20, 2003 08:06 AM

None? Not much, but I thought that it was significant among prostitutes and possibly other extremely sexually active people. I'm sure that I have heard the figure of a 1% male to female transmission rate and a smaller (.2%?) female to male rate. Still, the field is full of disinformation so I can't be sure.
By the way, I think that re-testing is in inadequate estimate of the reliablilty of SATs. The issue is their correlation to other IQ tests. I had perfect PSAT and SAT scores, but my IQ only tested in the 150s when I was a kid and should have declined further by the time I was 16. (childhood scores are higher)

Posted by: michaelvassar at February 20, 2003 11:06 AM

I discount the circumcision idea. Otherwise Europeans, who are nearly all uncircumcised would have higher rates than Americans, where it is much more common.

Just seems like a convenient reason to continue chopping off foreskins and selling them to biotech companies here in the USA.

(keep your hands off my foreskin....well, unless you're a hot chick)

Posted by: David at February 20, 2003 01:52 PM

AIDS isn't smeared over the whole of US society.
see here.

Posted by: razib at February 20, 2003 02:10 PM

I suspect that the Uganda triumph is pretty mythical. Who knows what is really happening there. The triumph sounds to me like do-gooder propaganda.

Posted by: John Ray at February 20, 2003 11:13 PM

No raz, it ain't. But in both Europe and the US, the cases are concentrated in the homosexual and/or IV drug usin' crowds.

If circumcision were important, I suspect you'd see higher rates among those crowds in Europe.

Posted by: David at February 21, 2003 10:02 AM

well-i don't think there's any point in arguing circumcision for well educated populations. and there have been meta-analyses that show it doesn't matter in africa-that HIV correlates with non-Islam. but i'd rather have africa circumcised than muslim :)

{also, thailand has a far higher HIV rate than circumcised philipines-the latter also has an active sex trade....}

Posted by: razib at February 21, 2003 01:39 PM

The beneficial effect of circumcision is indirect : It seems that HIV transmission is amplified by the presence of other STDs (ie those who already have gonnorhea(for example) will catch hiv even easier). Since circumcision itself seems to reduce the incidence of such STDs it's supposed to indirectly protect against HIV.

Posted by: ogunsiron at February 25, 2003 01:33 AM