The Wisdom of Whores

Yesterday, I sat at the TED conference in California and watched David Cameron pledge to make policies that support prostitutes.

He didn’t say it in those words, exactly, but he did promise firmly to make policy that “goes with the grain of human nature”. That would be a massive change for the UK: Labour’s old fashioned feminists have allowed their best intentions to get the better of their common sense. That’s saddled us with laws that put prostitutes lives AND livelihoods in danger.

David Cameron is a politician on the stump, so everything he says should be taken with several grains of salt. But the the goody-two-shoes meddling of the likes of Harriet Harman and Jaqui Smith has become so tiresome that maybe we should take Cameron at his word, and hold him to it. Political bondage, in the best possible sense…

So Jacob Zuma is sorry about having unprotected sex with someone three decades younger than himself, who is not one of the five women he’s married. That’s a little better than last week’s “You should be proud that I’ve admitted paternity and paid a fine. What are you all so uptight about?” HIV activists are pretty upset. Me, I prefer to see what he’s done as a good thing.

I’m not one to get uptight about extramarital sex. But I am not president of a country where one in five adults is infected with a still-fatal sexually transmitted virus. Mr. Zuma has rubbed South Africa’s nose in the fact that he racks up as many sex partners as he can, and he doesn’t use condoms.

How is that a good thing? Well, it allows us to say the unsayable: countries get the HIV epidemics they deserve.

Want a hyper-epidemic? All you need is a tradition of polygamy AND high levels of female autonomy. Big Men have their little network of wives and/or lovers. Women buy in to duty sex for the status and security, but get to run their own little networks on the side, for the fun of it. That has been the pattern in South Africa, Swaziland, Botswana, Zambia, Zimbabwe and a number of other countries where more than one adult in seven has HIV.

But woe betide anyone who points this out. At best, you are insensitive to cultural traditions. At worst, you are perpetuating racist myths of the hypersexualised African male, blah, blah, blah.

Now South Africa’s president is unrepentantly living the myth. He has been married five times, and is currently shared by three wives (one of the others killed herself). He’s got another fiancée in the wings for good measure. In 2006 he was acquitted of rape charges, and now we find he’s bonking the daughter of an old mate who’s running the World Cup organising committee. This puts him in good company. In neighbouring Swaziland, where one adult in three has HIV, the king sets an example by taking a new teenaged wife every couple of years — a baker’s dozen so far.

Here’s another thing that Mr. Zuma’s behaviour has laid bare: HIV is a preventable infection. Good governments prevent it. Bad ones hide behind the very culture, tradition and customs that allow the virus to spread, and then throw their hands up when prevalence get so high that HIV will continue to spread even if behaviour does change.

The saintly Nelson Mandela was unforgivably slow to do anything to address the sexual behaviours that were spreading HIV. His successor Thabo Mbeki compounded the problem by simply denying that the sexually transmitted virus was in any way linked to a four-fold rise in death rates among young adults. Besides spotlighting his sexual escapades, Mr. Zuma used his 2006 rape trial to give us a new perspective on how to stay HIV-free. Sorry I had unprotected sex with an HIV-infected woman he said, but don’t worry about me, I had a shower afterwards, so I won’t catch anything.

Unfazed by his flagrant disdain for his own health ministry’s HIV prevention efforts, (or by the pack of corruption charges that stalk him, or by his growing posse of wives) the people of South Africa support Jacob Zuma anyway. It’s a healthy democracy, and that’s their right. But I think it is time that voters in other countries stopped subsidising the fatally bad behaviour of South African leaders. Why should Americans give South Africa over half a billion dollars of PEPFAR money a year, in part to promote abstinence, monogamy and condom use, when the electorate of the country supports a man who is the embodiment of the behaviours and attitudes that spread HIV? Because, you might argue, the government of the richest country in Africa, which is also pocketing over US$ 160 million for HIV from the Global Fund, can’t even organise itself to keep anti-retrovirals in stock. I’d say that’s all the more reason to stop propping up bad leadership on HIV.

This post is for Dot and the thousands of other hard-working health care professionals in South Africa who have to pick up the pieces.

Remember the fabulous singing Nobel prize winner? Now PCR ads are getting sexy again. Though I do have to wonder how may pints the founders of TwistDx had had when they registered their company name. Try saying it out loud even before a pint…

Thanks to Seif, who has yet to take me shoe shopping…

Who would have thought that showing your tits became a better strategy for pulling partners the older you get? Since I’ve never tried e-dating, it has never occured to me that it’s a spectacular source of data for epi-nerds interested in sexual networking. My eyes have been opened by OKCupid, whose data nerds have publish a wonderful analysis of what works and what doesn’t in on-line dating.

I found it slightly depressing that I’m out of the denominator (they only look at data from 18-32 year olds). But I was particularly delighted by this graph:

It looks at the effectiveness of showing clevage in your profile picture. The bad news is that all women’s pulling power falls over time. But Apparently, showing clevage bounces up your chances of getting a date more the older you get. Men, depressingly, don’t lose out on dates as they age. Unless they’re trying to show off their six-pack. Abs shots are less successful the older you get.

Now tell me data analysis is not sexy…

Thanks to Nico, who is definitely in the denominator, but has tragically stopped sharing his wisdom with us.

The other night, I was dining with someone who didn’t know their acronym from their elbow. I had to explain MSM (mice that have sex with mice; no, wait…) and had a special rant about LGBT. For the unitiated that’s Lesbian, Gay, Bisexual and Transgender. It just trips off the tongue, doesn’t it? And it is just about as elegant conceptually as it is linguistically. Those groups don’t actually want to hang out together very often (except, perhaps, where they’re bidding for HIV funding). It’s a bit like forming a trade association for Doctors, Actors, Farmers and Tailors — DAFT.

Inspired by Indonesian petrol stations, which sell “Elpiji” (LPG, liquified petroleum gas), I’ve started writing this most annoying acronym as “Eljibiti”. But The Onion has done it better, in this hilarious spoof report on Gay Pride. LAGALABATATA — the Los Angeles Gay And Lesbian And Bisexual And Transvestite And Transgender Alliance. Like so much else in The Onion, it is so funny because it is so close to the truth.

Thanks to Roger for the smile.

How ethical are HIV prevention trials? Every time we announce results of a trial that compares new HIV infections in a group with or without some new intervention (a microbicide for example, or a vaccine), some journalist or other jumps on the fact that researchers are just watching people get infected. Researchers then explain that everyone in the trial gets given the best possible existing prevention services — counselling, free condoms, treatment for other sexually transmitted infections. But is that really true?

The question was raised for me while I am here in Thailand by a comment on an earlier post. It pointed out that US taxpayers, through CDC, are funding a trial among drug injectors in Thailand that withholds the very thing we know will prevent most infections: sterile needles.

CDC, on its website, points out that withholding clean needles is “consistent with Thai government policy”. And yet the agency itself recognises that needle distribution programmes reduce HIV infections. The Helsinki declaration on medical research ethics says that if you’re trying out a new drug or procedure, you’ve got to try it against the best available alternative.
In the past, I’ve argued that it is reasonable for us to read that as “the best alternative feasibly available in the country where the study is being done”. There’s no point trying a drug designed for use in a developing country against a developed-country regimen which is likely to be better, but which couldn’t ever be offered in the study country because it requires too much money, technology or expertise to administer.

The “we’re using the Thai standard of care” argument is very convenient for CDC researchers. After all, they need quite a few people to get infected, so that they can see if significantly fewer people get infected if they’re using the trial drug, tenofivir.* CDC’s other tenofivir trial, among women in Botswana, has just been downgraded, because the research team has realised that it is not getting enough infections in either group for it to be able to measure a difference. That’s in part because of very high drop-out rates — already a red flag for a prevention method that obliges you to take a pill a day for as long as you’re at risk.

We know that an adequate supply of sterile needles, and the freedom to use them without fear of arrest, can cut HIV infections dramatically among injectors. If the CDC study in Thailand gave enough needles to injectors, they probably wouldn’t have enough infections to give them a trial result. And the tenofovir-based prevention method that’s being tried is a method that could be used by other groups too — gay men and sex workers and other heteros at high risk of exposure, for whom we don’t have such easy prevention options. So you can understand why researchers are reluctant to push the envelope on providing decent prevention to study participants. But in this case, the “local standard of care” argument really doesn’t wash. It would be perfectly feasible for Thailand to provide injectors with clean needles. The country has the technology, the money and the health systems to do that. The only block is a political one. It’s bad enough that Thai authorities live with this blind spot in their otherswise quite pragmatic HIV prevention programme. The US has been just as bad at home, although there’s now light at the end of the tunnel for safe injecting programmes in the US. All the more reason that US researchers (and taxpayers) should refuse to compound Thailand’s unethical policy with unethical research.

*Info on the trials: The Thai and Botswana trials aim to investigate whether uninfected people can take a daily dose of antiretroviral drugs to stop themselves getting infected with HIV if they are exposed to the virus through sex or needle-sharing with infected people. It’s know as Pre Exposure Prophylaxis or PrEP, and you can find our a lot more about it here.

Great news from Vancouver: the city’s safe injecting facility, Insite, is allowed to continue saving lives. For now. It’s the second time that Insite has won a case brought by the right-wing rottweilers of prime minister Stephen Harper. This victory was in the Supreme Court of British Columbia. But Harper may decide to put more taxpayers’ money into lawyers’ pockets by taking it to the nation’s supreme court.

An appeal would fly in the face of the data (which show that Insite reduces overdoses and many of the other frankly nasty things that happen to people who live with addiction to injectible drugs). It would fly in the face of pragmatism — up just one flight of stairs from the safe injecting room is a drug treatment centre which works to help people get off drugs when they’re ready to try. Detox is never an easy thing to achieve; our best bet is to have really strong links between services for current injectors and services that help them stop. But most of all it would fly in the face of any remaining self-respect that Canadians might have about their political system. Because although the newspapers talk of “the Harper government” doing this or that, Canada actually has no government right now, or at least none that answers to the normal description of parliamentary democracy. What right, then, does Harper have to be prosecuting court cases that waste tax dollars and lives?

Harper’s bully boy tactics may work for Insite in the end, though. HealthCanada is typically mealy-mouthed about an appeal, saying: “While the government respects the court’s decision, it is disappointed with the outcome. The government is reviewing the decision carefully. Until this review is complete, it would be inappropriate to speculate on future action on the part of the government of Canada.” But it’s very clear that a Liberal government would not keep banging its head against the wall of common sense that Insite represents. And by sending parliament packing until March, Harper may just have signed the death warrant for his own “government”. That would be good news for Insite users and other Canadians alike.

Thanks to Miriam for bringing this to my attention while I’m in distant Vietnam.

These gems from the delightful “blog” of “unecessary” quotation marks need no comment. Though the comments on “this post” are quite fun.

And from my best side:

Thanks to dkj for driving me to them.

For 20 years, American governments across the political spectrum have ignored a mountain of evidence showing that needle exchanges and other safe injecting programmes are the single most effective HIV prevention tool we have. But just before Christmas, with a minimum of fuss, Congress dropped the ban on federal funding for needle and syringe programmes.

The change, buried in a massive budget bill passed by Congress in mid December and and since signed into law by President Obama, passed with very little comment in the blogosphere. But it has the potential to revolutionise HIV prevention in many parts of the US as well as in other countries. US cities and states have been allowed to provide injectors with clean needles if they (the cities and states) paid for them themselves, but in conservative states it has often been hard to get local politicians to come up with the cash. Similarly, nothing is stopping countries outside the US funding their own harm reduction programmes, but the yeay or nay of the world’s largest funder of HIV programmes can have a huge effect on what local governments choose to do (and not to do!)

Perhaps people didn’t notice the good news about harm reduction because they were caught up in the histrionics of the Drug Warriors in New York City, who are apoplectic that the health department is handing out perfectly sensible advice on how to shoot up safely.

Dubbed “Smack for Dummies” by the New York Post, the pamphlet has the Warriors fretting that young mothers might come across it in a clinic waiting room, read the instructions on keeping your veins healthy, and think: “Hmm, that looks easy. Maybe I’ll try shooting up before I pick the kids up from playgroup this afternoon”.

I’m glad to say that Mayor Bloomberg and the NY health department are both standing firm.

Also in the deluge of good news from Washington — the omnibus spending bill does not earmark any money for abstinence-only sex ed programmes that we know don’t work.

While colleagues at USAID say they haven’t had any official word on the implications of the bill for HIV funding in other countries, everyone’s optimistic that the common sense, so late to arrive, will be quickly exported.

Though I work in a world of addictions, I try and keep mine in the closet. But with others springing out of the closet right left and centre, I’m going to come clean. I’m addicted to rugby. Rugby is said (largely by people who see no glory in the bad haircuts and hystrionic dives of diva soccer players) to be the inverse of soccer, a hooligans’ game played by gentlemen. Crusty gay crusader Peter Tachell, thrilled that Welsh rugby ledgend Gareth Thomas has come out as gay calls it a “very macho sport”. And yes, it’s tough. It pits several hundred kilos of testosterone fueled meat against another several hundred kilos at crotch level. Hands grab balls, though rarely the one in play. Shorts are used as weapons, and lose their coverage. There’s none of that pansy padding which distorts body and soul of American football players. Rugby is pure, hard muscle. Which is why I’ve always maintained it is the most homo-erotic sport on the planet. If you’re not convinced, another photo from the French national team’s iconic :

Homoerotic? Moi?

I don’t mean to belittle Gareth Thomas’s courage in coming out. It’s interesting that his coach’s first reaction was to advise the Lions captain tell his team members, because he guessed (rightly) that they’d provide really important support at a difficult time. He’s not the first player to come out, but it’s rare for guys to do it while they are in the prime of their careers. Hard on the heels of that revelation, former England player Brian Moore has spoken publicly about being sexually abused as a child. I don’t know why rugby players, who have a pretty small following compared to soccer players, have so much more courage than the divas with bad haircuts. When Brazilian superstar Ronaldo got caught with three transgender hookers more than a year ago, he pleaded ignorance, saying he thought they were just vanilla whores. I don’t know if that makes me more worried about homophobia in soccer, or more worried about that a player who earns squillions on the pitch has such a bad eye for a ball….

Christmas in London — what better way to celebrate than carol singing in the streets of Soho with singers from Westmister Abbey and the International Union of Sex Workers? The Rector of St Anne’s parish in Soho swished out in front in long robes and fuschia beret but it was this banner, carried by Nico and Thierry, that really led the way. Note the trick photography — by the time we got out on the streets it was dark and floating with magical snowflakes; the boys were definitely wearing more than body paint.

Soho was full of good cheer; lots of people joined in the carolling and a couple of crusty punks pulled out descant voices that rivalled the cathedral choir’s. There was much cheering for hookers; it made me wonder how many people knew that the jurassic feminists in this Nanny government had just the month before pushed through new legislation that will make it more dangerous for women (and men, and transgenders) to sell sex in the UK.

My challenge the evening of the carol singing was to tear myself away from the Glo-ooooo-ooooo-rias in time to heat up vast vats of mulled wine. I rose to that occasion ok. My challenge for the New Year is somewhat more daunting. TED has announced the programme for its next conference in California, and I’m hugely honoured to be speaking there, in some very great company.

TED talks are not very often about sex. But the best of them can even make statistics sexy. I leave you with this classic from Hans Rosling, an ally in the war on Data Hugging Disorder, but here popping some of the bubbles of the HIV narrative.

Not wanting to be always the purveyor of bad news, I was looking forward to today’s results from the Pro2000 microbicide studies. After hopeful results in an earlier trial, I’d convinced myself the gel would prevent HIV. But it doesn’t.

It’s very depressing news from a huge, well designed and well managed study of over 9,000 women across four countries. I’m fond of saying that if you torture the statistics enough they will confess to anything (as we saw in the recent vaccine trial in northern Thailand.) But however badly you twist the arms of this study, they’re not going to scream success. For the record:

* If you exclude the women who got pregnant or stayed in the trial more than the planned period of one year, there were 130 new infections among those who used the microbicide gel, and 123 in those who used the identical-feeling placebo. Calculated as new infections per 100 woman-years of exposure, that’s 4.5 for the gel and 4.3 for the placebo, making the microbicide 5% more risky. The statisticians are 95% sure that the true effect of the microbicide is somewhere between decreasing risk by18 % or increasing it by 34 %. In other words, we can’t make any claims at all that the product works.

* If you don’t exclude people who got pregnant and look at everyone in the trial for as long as they were enrolled, you get 145 new infections with the microbicide versus 143 without: 4.6 new infections per 100 years of exposure in both. No difference. None. The true effect using this analysis is somewhere between reducing the risk of HIV infection by 21% and increasing it by 26%.

* The researchers also looked at whether women who used the gel consistently were less likely to get infected than those who didn’t. They weren’t.

It is hard to measure consistent use of microbicides in these studies, but researchers compared three sources of information: what all participants reported during study visits, whether all participants brought back used applicators, and what a sub-sample of women recorded in their detailed sex diaries. All point in the same direction: around 90% of women used the gel most of the time. That in itself might be counted a triumph compared to some earlier studies. It means that if we could find something that actually works, women would be quite likely to want to use it. All eyes will now be on the CAPRISA study which is testing a vaginal gel that has antiretorvirals embedded in it.

For my own part, I’m feeling somewhat sheepish as well as disappointed. When the results of an earlier, smaller trial of Pro2000 microbicide showed that it reduced infection by 30%, I was dismissive, bordering on rude, about the tyranny of the statisticians who said the results were “not significant”, and that we needed more research before acting.

I remain impatient with scientists who want to delay any action until we have perfect data. In the field of public health we are often obliged to do the best we can with what we have; as long as policy-makers are prepared to change their approach as the data improve we can save valuable time and lives. But in this case, the caution was well placed. Mea culpa.

Once again, it is worth drawing attention to the most basic fact in this research: 30 years into the epidemic, in a population that had safe sex counselling up the wazoo as well as universal access to condoms and other services such as STI treatment, more than four in 100 women are still getting infected with HIV. Pro2000 may not work, but just urging people to use condoms doesn’t, either. We need to keep looking for something that does.

Finally, some common sense in HIV testing policy in the US. Although you’d be hard pressed to know it from some of the coverage.

Until last Monday, America’s unfathomably illogical health service for the properly poor, Medicaid, refused to pay for HIV testing just as it refuses to pay for all sorts of other screening measures that could allow conditions to be treated early or in some cases prevented enitirely. Now, Medicaid has finally agreed to test its clients for HIV, if they fall into certain categories.

Here’s where the bad reporting comes in. This, for example, from The Goverment Monitor, which reports public sector news:

“The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service.”

So, the two groups that they single out as being “at increased risk” for HIV are pregnant women, and people asking for a test. In fact, of people who have recently had unprotected sex in the United States, pregnant women are among the least likely to be infected with HIV.

The actual decision reads as follows:

CMS will cover both standard and U.S. Food and Drug Administration (FDA)-approved HIV rapid screening tests for:

1. Annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines:

* Men who have had sex with men after 1975;
* Men and women having unprotected sex with multiple [more than one] partners;
* Past or present injection drug users;
* Men and women who exchange sex for money or drugs, or have sex partners who do;
* Individuals whose past or present sex partners were HIV-infected, bisexual or injection drug users;
* Persons being treated for sexually transmitted diseases;
* Persons with a history of blood transfusion between 1978 and 1985;
* Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors; and

2. Voluntary HIV screening of pregnant Medicare beneficiaries when the diagnosis of pregnancy is known, during the third trimester, and at labor.

In other words, perfectly sensibly, pregnant women are NOT classified as at high risk for HIV infection, but are offered tests in any case since services to prevent transmission to their babies are available if need be. Now look at the list of those who ARE considered at higher risk. Again, it is mostly perfectly sensible. I’d prefer to see some sort of time stamp on number two — the overwhelming majority of Americans have had more than one partner in their lives, and most will probably have had unprotected sex with at least two of them. But that really doesn’t put them into a “high risk” category unless they are having sex with those multiple partners during overlapping time periods. Because HIV isn’t highly infectious for very long, you’d really like something more precise, such as “unprotected sex with multiple partners in any given three month period”. The biggest group at higher risk missing from the list is “men who have been incarcerated”. I agree that it is not the incarceration but the behaviours while incarcerated that put people at risk for HIV, and those behaviours are covered elsewhere on the list. But many people zone out what happens in jail — they are unlikely to report having sex with other men if it is something that they only do when they are banged up, for example. And yet we know many people in jail are infected with HIV, and we also know that many of them are having anal sex and shooting up drugs, and therefore likely to pass the virus on to other prisoners.

Another piece of good sense: the decision specifically authorises rapid tests. We know that people are far more likely to get their results and to be tied in to the support and care services they may need if they are offered on-the-spot tests, rather than having to come back or call in for results a week later. It would be nice if other countries (with generally better records on preventative medicine) followed this lead. Any Canadians reading this…?

At breakfast in Bangalore this morning, I was greeted by news of Bollywood’s first on-screen gay kiss. When they’re puckerd up like this, wouldn’t you want to? But the Indian censors may not share my enthusiasm. I am Omar will be screening at the Rotterdam film festival. Check it out and see if the kiss is in.

What’s unsustainable about paying fo sex? I guess it depends on what your budget is, and how randy you are. As Copenhagen turns its thoughts green, its mayor Ritt Bjerregaard sent postcards to Copenhagen hotels urging climate conference delegates to: ‘Be sustainable – don’t buy sex’. In response, the city’s sex workers are offering free rides to any delegate who can produce one of the offending cards, according to Speigel.

Unsustainable? Well, there’s latex to dispose of, or worse still, population growth. But on the upside sex warms you up without needing to burn fossil fuels. It’s a renewable resource. And if it’s on offer for free this week in Copenhagen, it might just provide the positive energy to break some of the log-jams in the negotiations.

I’ve followed the build-up to the conference (beautifully dissected by Sam Kinght, writing in Prospect), with some amusement. Way back when I was writing The Wisdom of Whores, a friend from the World Bank was rolling his eyes at every UN agency’s willingness to hook itself to the HIV wagon. I quoted him thus:

““The UN institutions are professional beggars, and beggars go where the money is,” he said. “So you get “culture and AIDS”, “kids and AIDS”, “fish and AIDS”. I’m just waiting for “climate change and AIDS”.”

It wasn’t until months later that I saw the first headlines linking HIV to climate change. Just recently, there’s been a UNFPA report about it, which means it’s now official. As Rasna Warahp pointed out in Kenya’s The Nation, the real link between HIV and global warming will probably be that as more funding goes to the latter less will go to the former.

An aside, since I’m mentioning both development fashion and the World Bank: I am reliably informed that that venerable institution last week headed off a bid to have every loan reviewed for the effect that it has on trafficking of persons (which in the current climate is more or less equated with trafficking of women into the sex indutry). Just sometimes, common sense does prevail.

Thanks to Ron of greencollar for sharing the determination of the Danish with me.

So another World AIDS Day (and this blog’s second birthday) has come and gone. We learned that 2.7 million mothers, lovers, children, school teachers, preachers, husbands and friends became infected with a rather fragile and still potentially fatal virus last year. Each of those prevention failures cost taxpayers about US$ 3,000. Since we’ve known how to prevent HIV for nearly three decades, that’s pretty pathetic. What we need is radical new approaches, and I’m pleased to suggest one.

Pictured above is the miraculous Ceragem massage bed. Promoters of a clinic in South Africa claim that the bed cures AIDS. That’s great news, of course. But why stop there? A truly visionary charlatan would see much greater possibilities. We know that post-exposure prophylaxis works — that taking antiretrovirals very soon after exposure can prevent HIV taking hold in the body. The big HIV news of 2010 is likely to be that pre-exposure prophylaxis works too — we can prevent HIV taking hold by taking antiretorvirals shortly before we do something dumb like have sex without a condom with someone who’s likely to be infected. What’s the obvious gap? Since most HIV infections are contracted in bed, we could run this miracle bed-cure into pending exposure prophylaxis: let’s prevent HIV taking hold at the very moment that people are swapping infected body fluids. Just have sex in one of our massage beds and you’ll never need to think about latex again. I’m looking forward to hearing from the venture capitalists among you…

Thanks to Babe for pointing me in the direction of this great business opportunity.

Epidemiologists don’t often hit the headlines. While forensic scientists are celebrated in endless mini-series, the bug hunters merit just the occasional, mercifully long forgotten film (anyone remember Dustin Hoffman in Outbreak? I thought not). As a job, it’s just not very sexy, and most of us who plod away at it keep our wild sides to ourselves. How delightful, then, to discover that Belle de Jour, a sex icon for our times, is actually a practicing researcher with a PhD in epidemiology.

Needless to say there’s been a big kerfuffle about this. The “all prostitution is explotation crowd” are banging the drum again, anxious to entrench the image of the sex tade as nothing but tawdry. But as Catherine Stephens of the International Union of Sex Workers eloquently points out in this segment on Channel 4 News, those sterotypes are unhelpful.

(For those who are confused by Cath saying she doesn’t think practicing hookers should go public, it’s amazing how Channel 4′s hair and makeup team can nerd a girl down.)

The University of Bristol, where Brooke Magnanti PhD works, has very sensibly said that the way she chose to finance her studies does not have any bearing on the quality of her work. The university doesn’t mention that there are many other similarities between being a hooker and a research scientist. We all provide the services that the people who put down the cash demand, whether they are punters or science funding bodies.

I’ve always been curious to know what a random investigator would make of my in-box. Lots of people find theirs clogged with offers of penis extensions and tireless nights of love; I have the added joy of getting soft-peddalled syphilis diagnostic kits. I also get alerted when medical journals publish papers on a variety of sexual practices. I’ve never thought to restrict the papers to “Humans only” (an option in PubMed). And so it is that I can belatedly bring you the oral sex lives of fruit bats.

The paper, in the (wonderful, open access Public Library of Science), even includes a little cartoon video. Bat porn. In essence, scientists in China have found that a female fruit bat will go down on her partner while he’s taking her from behind. Apparently, the extra stimulation helps him keep it up longer (not a universal observation among females of our species, I venture to guess). The researchers come up with a number of reasons why a lady bat might go to this trouble, among them that it might give his sperm more oomph, might make him less likely to roam, might clean up nasty infections before he passes them to her. But I particularly like their closing shot:

“The behaviour presumably favours the donor, although it may also benefit both partners especially if fertilization success is increased. It is conceivable that the female manipulates the male by increasing sexual stimulation, so that she ultimately benefits.”

I think that’s known as the Pleasure Principle.

Thanks to Klaus for stimulating me to post on this.

As promised, a note on the UK’s latest data on HIV among drug injectors. Some of the US’s battalions of Drug Warriors have been crowing that the new figures show a rise in infection rates among junkies in the UK: clear evidence that the nation’s policy of making sterile needles and injecting equipment available to people who need them doesn’t work.

Unlike the United States, the UK has bothered to track HIV infection among large, representative samples of drug injectors (both current injectors and those in methadone and other treatment programmes) since close to the start of the epidemic. Part of this effort involved testing anonymous samples of left over blood for HIV — the samples were usually taken from treatment or diagnostic purposes and are stripped of all but the most basic demographic and risk information (age, sex, length of time injecting, recent needle sharing) before being tested with HIV. The results, shown separately for London and the rest of England and Wales are shown below.

(Click to enlarge)

Yes, prevalence for the whole of England and Wales (including London — Scotland has its own system and reports separately) has risen by over 77% in the last decade. But still, fewer than one injector in 60 is infected with HIV. If you draw the graph using a normal percentage scale, you’ll see something close to the true level of infection — still too high, of course, but not exactly an overwhelming prevention failure when compared with data from any city or country that doesn’t have needle exchanges. The graph compares what happened in the UK with what happened in Jakarta, just because I happened to have the Indonesian data handy. But it would look just the same with data from Bangkok or Moscow or even New York in the years before the city (with no help from the federal government) began to hand out needles.

(Click to enlarge)

Since I’m just a numbers nerd and obviously don’t have a great visual imagination, perhaps someone could help me out here: how can you conclude from these pictures that safe injecting programmes fail to prevent HIV?

Yesterday the US finally dropped its absolutely senseless law forbidding people with HIV from visiting the Land of the Free. (While Saint Obama is getting patted on the back for ending the ban, he was actually signing off on something that George Bush put in motion last year). That’s unmitigated good news for people with HIV, their lovers, friends and families, as well as for a lot of US employers who can’t import some of the best and the brightest simply because they have a not-very infectious virus that can only be transmitted in a tiny number of well-known ways which we can protect against with safe, cheap technologies.

Does this signal a new wave of common sense in HIV prevention in the United States? That’s certainly what we expected when Obama was elected. During his campaign, for example, he recognised that sterile needle programmes cut HIV infection among injectors, saving lives and money, and pledged to end a ban on funding those programmes from federal coffers. So cities such as his home town of Chicago, pictured in the map below, will now be able to use central money to provide clean needles to the inner city injectors that need them most. As long as they set up in one of the grey spaces. In the cemetary, in other words.

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On this fantastic map, which comes from Yale University’s Dr. Russell Barbour by way of Stop the Drug War, the red areas are the parts of town where it would be illegal to operate a federally funded needle exchange under new rules proposed by Congress. The Drug War Chronicle provides an interesting history of the needle exchange shenannigans. Essentially, Obama did not remove the ban from a budget bill because he thinks policy shouldn’t be made through sub-clauses in budget bills. Democrats on the committee discussing the bill disagreed, and dropped the ban. Then Republicans, not willing to give up the idea that the availability of clean needles would have us all racing to start shooting up smack, decided to protect the innocent by forbidding needle programmes within 1,000 feet of “a public or private day care centre, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth centre, or an event sponsored by any such entity”. That’s the red bits on the map of Chicago above. Here’s Dr, Barbour’s map of needle exchange exclusion zones in San Francisco:

This is clearly just a way of pulling the rug from under any effort to increase access to clean needles. We’ve come to expect this kind of implaccable opposition from conservative Drug Warriors in the United States. We used to expect the Brits to be more rational about their drug policy, and the UK has, thank God, held on to its policy of providing clean fits for anyone that needs them. But with the sacking of the government’s independent advisor on drugs David Nutt for repeating his independent advice after the government chose to ignore it, I’m not so sure.

I’m not even going to wade in here about whether or not idependent scientific advisers to government should shut up after their advice is ignored, but I will commend to you a wonderful paper by Dr Nutt on the dangers of Equasy, (pdf) an irrational addiction to horse riding. This has been seized on by many who have not read it as an example of his inappropriate analyses. Irony, where art thou?

The US Drug Warriors also joyously seized on the latest round of anonymous surveillance of HIV among drug injectors in Britain, sending out an e-mail crowing about rising rates of HIV and drawing a link between that and the fact that the UK was the first country in the world to have national injection safety programmes. My next post will put those rather one-eyed claims into perspective.