HIV, Stigma and teh Jernlisms (again)

4 min read November 27, 2013 at 12:11pm on Health, Infection and Science

This Sunday is World AIDS Day.  The theme for our local campaign is "Zero". Zero new infections. Zero AIDS-related deaths. Zero discrimination. The Queensland Government HIV strategy aligns nicely with these messages. The four priority areas are:

  1. Implement a comprehensive prevention campaign.
  2. Promote increased uptake of testing.
  3. Ensure 90% of positive patients are on treatment
  4. Increase community awareness and reduce stigma and discrimination

It's point 4 that I'm going to talk about today. You may have seen me retweet a couple of links yesterday on HIV in Greece.  I've included the photos below in case they get eaten by the internet.


Tweet posted by timmyconspiracy (since deleted)


There was also a screenshot of the primary report that this was based on - from WHO's Review of Social Determinants of Health in the European Region. The relevant section is page 112 of the PDF at the other end of that link, which I've reproduced below (also from timmyconspiracy)



Surely if the WHO put it in one of their technical reports, it must be the real deal, hey?  It was certainly taken as authoritative by several sources in the media.

The trouble is, it's just not true.

(Official WHO erratum here: thanks, Paul Davis for pointing out I forgot to link this)


You'll notice the statistic about HIV infections in the WHO report isn't specifically referenced.  Reading around this, it is variably attributed to a statement by the Greek Health Minister (can't find any primary evidence of this) or based on an article (actually a letter) in The Lancet.  This letter says specifically:

"A significant increase in HIV infections occurred in late 2010...with half of the currently observed increases attributable to infections among IV drug users.

"An authority report described accounts of deliberate self-infection by a few individuals to obtain access to benefits of €700 per month and faster admission onto drug substitution programmes."

That second sentence was referenced to the Report of the ad-hoc Expert Group of the Greek Focal Point on the Outbreak of HIV/AIDS in 2011. Its points were:

  • The increase in cases occurred without any change in harm reduction interventions
  • Increased law-enforcement crackdown on IVDUs resulted in less access of drug use support workers to the users
  • Increased needle-sharing and unsafe sexual practices
  • An important factor in these risk behaviours are the economic crisis

and finally:

"An additional factor the committee believed worth considering is the well founded suspicion that some problem users are intentionally infected with HIV because of the benefit they are entitled to...and also because they are granted "exceptional admission" to the substitution programme."

Further background is in the EMCDDA report on HIV/AIDS among IDUs in Greece:

I won't block quote big sections of the report, but abstracting it for you, the issues identified were very similar

  • Most of the increase in cases were centred on Athens
  • Increase in prostitution by users unable to fund their habit in other ways due to the economic crisis
  • Opioid substitution clinics in Athens have a long waiting list so less IVDUs in Athens are on a program
  • Very limited coverage of needle/syringe programs in Greece compared to other countries in Europe.

So let's be very clear on this.  Some Athenian drug dependency doctors put in a report they had a "well founded suspicion that some problem users" were self-infecting in 2011 and this managed to make its way into a WHO report as saying that "half of new infections in 2013" were self-infected.

Obviously WHO dropped the ball with this one.  An authoritative scientific report on social determinants to make an outrageous claim without reference is really just not good enough.  But where was the critical journalism of this report?  The UKs Daily Mail managed to quote the original report with the suspicion quote, but still said "research said around half of new cases could be self-inflicted".  Based on what?

My thoughts

Why is any of this important in Australia?  Adding the stigma of people deliberately infecting themselves onto the already significant challenges experienced by people who are down-and-out and turning to drugs and prostitution is hardly going to contribute to either better health outcomes or better community acceptance the people or their disease.

Secondly, there is the clear evidence that a policing and enforcement policy on IV drug use not only does not work, but also results in worse health outcomes. I have signed the Vienna Declaration - and I encourage all of you who believed in evidence-based policy to sign it as well.

This year's Kirby Report found that 2% of newly diagnosed HIV infections were associated with IVDU. This figure is similar to previous years, and is only a small fraction of the figure for some overseas countries - up to 40% according to the most recent UNAIDS report. Maintaining tough on drugs does not work, and any cuts to NSPs or other (evidence-based) harm minimisation programs could potentially open the door to a more generalised HIV epidemic than we currently have.

And none of this helps people who are living with HIV get on with their life, free of discrimination.