June 2010 HIV Extensive Update

1) HIV Risk from Brazilian Prostitutes Contact with 50,185 encounters of 16,000 people is virtually zero.
2) Viral Load is chief predictor of heterosexual HIV transmission risk
3) Brazil Success in HIV battle because it REJECTED U.S. Aid requiring them to denounce their legal prostitution.
4) Update on HIV risk in the U.S. "Myth of Heterosexual AIDS" confirmed.

It has been a long time since i updated my HIV research. HIV has not been much of a heterosexual issue for the last decade. With the new Brazil HIV prostitution study, I am updating some of my research.

1) Brazilian Prostitute Study
A very in depth scientific research article published in the MIT Technology Review 6/18/10 concludes that prostitution is very unlikely to cause HIV Epidemics. The MIT review is of a Swedish study published June 9, 2010 by Umea University Dept of Physics and Sociology Dept of Stockholm University.

A key factor in the spread of HIV is the viral load. During the chronic infection stage, the load is low enough that it requires several contacts between two individuals over a short period of time for the infection to spread - probably repeated contact with the same partner within a month. This frequent contact is rare in commercial prostitution.

The acute stage of HIV where transmission is most likely appears to last for only for a couple of weeks. This just isn't long enough to spread given the rate of contact that occurs in commercial prostitution.

2) Viral Load is chief predictor of heterosexual HIV transmission risk
See extensive study supporting the Brazilian report in The New England Journal of Medicine at
http://www.endo.gr/cgi/content/full/342/13/921
and Risk of HIV Transmission Is Raised by High Viral Load, Presence of Genital Ulcers
at http://www.guttmacher.org/pubs/journals/2715601a.html

3) Brazil Success in HIV battle because it REJECTED U.S. Aid requiring them to denounce their legal prostitution.
Brazil is a model for the world in reducing HIV because it REJECTED U.S. AID!!! HIV was a huge issue in Brazil before an aggressive condom campaign that could be a model for the rest of the world. But it had to first reject from the U.S. $48 million in HIV prevention funding in order to be effective.

Two 2003 United States laws—one related to AIDS, the other to sex trafficking—required all recipients of U.S. assistance to sign a pledge denouncing prostitution, even if U.S. funds are not used for projects directly related to prostitution. In 2005, Brazil wrote to the United States Agency for International Development (USAID) declining to condemn prostitution, effectively rejecting the remainder of a grant for $48 million. In 2006, USAID officially declared Brazil ineligible to renew the AIDS prevention grant because Brazil would not condemn prostitution as "dehumanizing and degrading."

Brazil considered its partnerships with prostitutes—in distributing contraceptives, educating the public about the disease, and voluntary testing—critical to its overall AIDS prevention strategy. One Ministry of Health pamphlet depicts a character, "Maria Without Shame," a scantily-clad sex worker who encourages prostitutes to take pride in their work and use condoms.

Pedro Chequer, director of Brazil’s National AIDS Control Programme, was quoted as saying "we can't control [the disease] with principles that are Manichean, theological, fundamentalist and Shiite." and "sex workers are part of implementing our AIDS policy and deciding how to promote it. They are our partners. How could we ask prostitutes to take a position against themselves?" Despite the fact that Brazil has the largest population of Roman Catholics in the world, the Brazilian Roman Catholic Church has not demanded the abstinence-only prevention strategies, voicing only intermittent "mild complaints" about government programs which refuse to acknowledge moral or religious issues.

Dave notes that Thailand very early also had a very effective condom campaign. When I was is Bangkok and Pattaya many reception desks for massage had bowls full of condoms and required by all the take out bar girls you "bar fined." When pressured by the U.S. moralist to pass law against prostitution they wisely did not eliminate the previous law making "special services" legal under the "Entertainment Places Act." Therefore, most prostitution is legal in Thailand except the local brothels long a tradition and law rarely enforced on them, unless under aged or forced prostitution.

4) Update on HIV risk in the U.S. "Myth of Heterosexual AIDS" confirmed.
Since HIV is so isolated in the Western world to high risk groups and rates are so low outside of needle sharing drug users and unprotected anal sex, not much has been written about it in the last few years that I have seen.

Basically "The Myth of Heterosexual AIDS" (title of book from decade ago) has been proven true. There are specific cultural reasons why most HIV is in Africa and certain other regions.

Latest data on risk factors seems generally agreed upon for unprotected sex. But remember the risk is zero if your partner isn't HIV+. In the U.S. and most of the Western world it is hard to find anyone HIV+ having sex, other than needle sharing drug addicts on the streets.

Unprotected Risk with someone HIV+:
Risk of female to males intercourse transmission is 0.5 per 1000

Male to female is twice as high but still very small 1 in 1000

Again this assumes of course that the partner is HIV infected - if not the risk is zero.

Condoms reduce risk with in infected person by about 85%.

Oral sex far less, anal sex 17 per 1000 receiving it and 1-6 in per 1000 (very low) for male giving anal sex.
Again assuming partner is HIV+ and no condom used.

Blood transfusion almost certain risk if infected - 900 per 1000.

In addition:
Heterosexual transmission reduced 51%-60% in circumcised men per 3 African studies.

Risk would probably be higher if very frequent repeated contact with the same HIV infected person due to the viral load
differences pointed out in the Swedish study reported on the MIT blog.

Sources:
MIT: http://www.technologyreview.com/blog/arxiv/25347/?ref=rss
Original Brazil Prostitution Study: http://arxiv.org/ftp/arxiv/papers/1006/1006.2856.pdf
Risk in the U.S.: http://en.wikipedia.org/wiki/HIV
Brazil rejecting U.S. Aid: http://en.wikipedia.org/wiki/HIV/AIDS_in_Brazil