'ULTRA-LIBERAL' ECONOMICS IN REDESIGN OF GLOBAL HEALTH GOVERNANCE

Nance Upham,

Change @ WHO is the title of a WHO newsletter intended to present the deep reform in governance and
structure of the World Health Organization (which has laid off a third of its staff last year) in a fun
'marketing' mood.
Difficult, even impossible to understand the reform process without looking at the global change in economic
policy and the associated ultra-liberal free market approach to the three components of health: national health
services disease and epidemic control social and environmental determinants.

The drift of the leading United Nations organisation in charge of health guidance for the world, the WHO,
has occurred over a 30 years period, from an organisation responsible to give guidance to health and
epidemic control for the world, to a bizarre and at times incoherent organisation. The turmoil is manifest.
Like a loose sail boat in the tormented seas of the dominant economic policy of 'State shrinking', the WHO
has lost its rudder and its budget.
Core funding for activities supposedly scientifically grounded and decided upon by State representatives
during the Executive Board and World Health Assembly (EB/WHA) governance body process has shrank to
13% of total, peanuts.
Over the years semi private organizations have been set up which channels health related funding bypassing
the WHO in every way, including policy guidance: typical of these is the Global Fund for AIDS which was
expended to include Tuberculosis and Malaria, the GFATM, a Swiss Foundation, a typical PPP - Public
Private Partnerships which have mushroomed over the past two decades.
The bulk of funding that goes to the WHO is decided by individual (powerful) countries or group of
countries, and, more and more, by private funders, such as the Bill and Melinda Gates Foundation, on the
basis of 'preferred' diseases or topics.
The outcome is that the most important Resolutions passed by the WHA, held every year in May and
governing body of the WHO, responding to the world population's main health problems, the most
UNIVERSAL, are the most neglected, ill-funded, 'paper' resolutions!
Rational Use of Medicine first concept elaborated in 1985, (Resolution.WHA 39.27) took several years of
lobbying to pass. Rational Use is left for one single person to handle implementation.
Present day 'ultraliberal' input to health policy takes the form of 'deliverables' which could be 'measured' and
'accounted for' (specific drugs, condoms, bed nets).

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The relative power of PPP versus national health expenditures.

The argument for reform is that WHO is now 'crowded out' by the multiplicity of Global Health Initiatives
and Public Private Partnerships in Health.
So let's look at a few random figures to compare the best known 'big' PPP, the Global Fund:
Global Fund for AIDS, TB, Malaria

$3 bill in 2010.

World Health Organization

$4.2 billion in 2008-2009 (voluntary 80%)

NIGERIA 2003 - annual health expenditures

$6.7 billion

BRAZIL 2008 - Social Security, annual budget

$198.7 billion (expenditures)

FRANCE 2011 - Social Security, annual budget

170 billion (health related expenditures)

Even 'big' PPPs contribute pebbles compared with States budgets! Which means that the argument to the
effect that WHO must be reformed because PPP are dominant in global funding has no substance, in fact.
Funding for Health is primarily public expenses on a national level, and PPPs represent less than a microbe
on the elephant's tail.
From that reality, it should be obvious that WHO as a Member State led technical organization has a rle
which is growing in importance with the growth of the world population, or urbanization, or environmental
issues, not a diminishing one.
But the wonder landscape presented (marketed) by private interests is one of 'competition' for stockholders
(not stakeholders) to place their money for highest return (profits) on investments...
Here is how the reform of Global Health governance is presented:
Ad Hoc Advisory meeting Report 03/11, 2011 on WHO governance reform:
Global health governance is important because the stakes are high. The landscape is fragmented and
health has to compete for attention with other priorities such as food security and climate change.
Demonstrating impact is critical (emphasis added)
This sentence makes no sense: what 'stakes' are we writing about? What 'landscape'? What does it mean to
say that health is 'competing' with climate change? And who needs to demonstrate what to whom? What
impact?
Let us translate this Orwellian phrasing to make it understandable:
Global health governance is important because the FINANCIAL stakes are high. The landscape (of
funding sources) is fragmented and health (funding) has to compete for attention with other (funders)
priorities such as food security and climate change. Demonstrating impact is critical - Value for money is
critical.

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Before Man there was 'cash': the ultraliberals are very religious: First was the dollar bill and it must be well
spent. It is as if health was dependant on Northern charities!
The desire is for command and control. The B&M Gates Foundation spokesperson addressing ministers of
finance and health at the Macroeconomic Commission organized Summit in WHO headquarters insisted ten
years ago already: Donors want donor ownership!
As the Director General of the WHO herself, Dr Margaret Chan once complained:
Rwanda has to report annually on 890 health indicators to various donors, with nearly 600 relating to
HIV and malaria alone. (2010- World Health Report, Berlin).
This extravagant 'donor ownership' mechanism of 'accountability-measurement' (value for money) was
denounced at the Geneva meeting of ECOSOC on health four years ago.
Behind the scenes, the World Bank has risen to pre-eminence in global health policy making.
The April 2013 issue of 'Change WHO' refers to a new Chatham House report on The role of the WHO in the
International System).
It says the following:
The entry of the World Bank as a major health funder in the 1980s and a proponent of market-based health
policies challenged WHO's pre-eminent position in the field.
Indeed! As we will see later the rise of the Bank in health was correlated with the AIDS pandemic.
The drift towards making the World Bank the main player in health was accelerated by Director General, Gro
Harlem Bruntland (1998-2003) as she created the Kitchen Cabinet, as the World Bank representative to
the UN in Geneva once publicly named it, a reference to the behind the scene executive group Churchill had
created during WWII to organize the war effort. 'The 'Kitchen Cabinet', the Bank representative explained
'is composed of the four major players: IMF- World Bank- WTO-WHO.' All major health decisions are
discussed first in the Kitchen Cabinet, he said.
The new architecture proposed and being installed in 2013 for global health management brings in
multinational corporations not just the pharmaceutical industry but also agro-food, internet and mobile
phone industries, marketing, transport, and so forth, into the 'kitchen cabinet' type of governance structure.

The New WHO

Dr Julio Frenk is the former Minister of Health of Mexico, known for his pro-US very 'ultra liberal' views is
now Dean of the Harvard School of Public Health. Under his pen, a major piece on 'governance' was just
published in the BMJ
there is widespread consensus that the current institutional architecture, now more than 60 years old, is
unable to respond effectively to contemporary global health threats. Today, the WHO stands on a crowded

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stage; though once seen as the sole authority on global health, the WHO is now surrounded by many diverse
actors. (emphasis added)
The argument is that PPP are 'crowding out' WHO and making it irrelevant.
() we prefer the term global governance for health, rather than the more restrictive notion of global
health governance, which tends to focus only on entities specializing in health matters.
Dr Frenk then speaks of this transformation of what the UN system is about as a sovereignty challenge
National governments are viewed as 'obstacle to be overcome'
As the WEF Senior Director for Global Health and Healthcare Sector, Dr Olivier Raynaud, told the audience
how much he appreciated the work of the Commission on the Social Determinants of Health :
We are really in agreement with the outcome of the Commission on the social determinants of health, indeed,
water and nutrition, drinks and food fortifier have a place in health, this is why we at the Davos World
Economic Forum believe that the drink and food industry must be involved in global health governance...
and this will be discussed in Dubai for the launch of the Global Redesign Initiative.
(Speaking at a public round table on PPPs during the Geneva Health Forum, 2010, approximate quote from
live memory)

The Global Redesign Initiative.

As had been announced by DAVOS' Dr Raynaud, the announcement and the multiplicity of documents
issued as the Global Redesign Initiative (GRI) of the World Economic Forum proposes a re-think of
national and international institutions away from the UN model and sets the founding stones of global
governance in health, environment and so forth.
It is critical to rethink the worlds 20th century institutions and redesign them to meet 21st century
demands.
The GRI comes at a crucial moment in the aftermath of the global economic crisis, which puts in stark
relief the deficiencies of the global system of governance.
The WEF paper: Ensuring Health for all places great importance on 'measurement' and 'accountability'
(exactly as the reforms in the WHO itself)
It speaks of the:
Need for Significant Strengthening of Measurement and Accountability:
The provision of relevant, accurate and timely performance metrics is central to improving the performance
of all aspects of health systems. The transparency offered by measuring performance is an essential element
in securing accountability for health system performance
Performance Metrics and Evaluation is a sub sector:

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The role of performance metrics and evaluation becomes even more crucial as health systems become
more global and more local. International cooperation requires that donors, regulators, lawmakers, funders
and industry obtain improved assurance that funds are being spent wisely (emphasis added)
Measurement (of what?), Accountability (to whom?). As the typical example of Rwanda illustrates, more
accountability to donors not only distorts national priorities, it can go a long way towards destroying national
capacities and aims at 'command and control'.
It means a financial-managerial-cost efficiency approach to health that may be intrinsically opposed the
function of the United Nations Organization. It is in line with the sausage slicing approach to health, the silo
approach: delivery of drug or vaccine x via enterprise for a concrete example, the recent agreement
between the CocaCola corporation and the GFATM for the delivery and logistics of drugs supply.

Most health systems in the world are a combination of public and private. In the post war Western European
systems, it is the public the State which decides and the private can contribute within the public
framework. Here the GRI and the entire 'Health Governance' proposals are geared to place national
governments under obligations to open up, follow and service health policies managed by private
corporations, and not just the pharmaceutical industry.
Further, the notion of health as part of 'crisis management' shows that health is understood as a remarkable
tool for manipulation and to bend public opinion.
Chapter entitled : Ensuring Health for All (pp347-381) in GRI's Report, uses the report on the
Commission on the Social Determinants of Health and turns it on its head:
Health as a multi determinant and multi stakeholder issue: the recognition that much of health is dependent
on water and sanitation systems, transportation, communication, education and information, food and
individual behaviours, not on hospitals or health workers (emphasis added)
Governance adapted to new realities, including stronger community and patient involvement, with new
international governance including NGO and business involvement, the drafting of binding health treaties
Rather than trying to rally other sectors around an agenda entirely conceived and driven by health
professionals, the time has come to involve other sectors (e.g. transport, environment, agriculture,
education, law) from the planning stage (...) to realize co-benefits.
Then, having set that the business of health is unrelated to the medical profession (epidemiologists, doctors,
nurses etc.) but very relevant to the drinks, agro-food, communication internet industries and other
business interests, the GRI decided on a Commission a First Assessment of Leading Health Risks
All available evidence should be taken into consideration when selecting the set of 10 risks for this initial
assessment.
The risks selected for this first analysis should be based on two criteria: magnitude of the burden of disease
related to each risk and the potential for modification through actions by different actors in society.

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The Commission launched a Partnership for Health Risk Accountability (PHRA) to develop a metrix to
identify health risks... which demonstrated the need for... a New Governance.!!
Basically, the simple idea is to take the ultra liberal approach used for AIDS: focus on individual behavior
and fund large media, and marketing campaign, leaving aside regular health systems couple that with a
'parallel' structure for drugs- (Global Fund GFATM) and, notably, apply that to NCD (diabetes, heart
strokes, can also be resumed to some drugs and individual behavior modification). New technologies are
understood as only fitting within this matrix (cell phones etc).
Articulate Key Principles for PHRA to Be Effective:
The preliminary 18-months phase is intended to demonstrate the importance of bringing together diverse
stakeholders to address health risks. It is expected to lead to widespread acceptance that a new approach to
global health governance is needed, in which the nature and extent of health risks is exposed to public
scrutiny, and practical actions to address them can be developed. Long-term success will require designing
the PHRA with certain key principles in mind. These principles include:
a) Ensuring independence accountability for health risks requires that the metrics of progress be
sheltered from vested interests or political interference. This principle of independence has important
implications for the ultimate institutional home for the PHRA once it has been effectively incubated by the
World Economic Forum.
Multiples 'initiatives' and projects regarding health are undertaken as part of the GRI as this summary
indicates. We mention a last one:
The Global Agenda Council on Global Healthcare Systems & Cooperation (which) proposes
that : the World Economic Forum put in place a process to create an institutional architecture, tools and
practical implementation to address the lack of global accountability for health risks. (emphasis added)
All this is situated within a framework where health is located as a shock absorber for 'crisis' and 'risks
management' and the documents leave out healthcare systems workforce.
The target is on the individual level: the person/patient is considered as a consumer to be influenced via mass
marketing for risk reducing behavior and appropriate purchase of services or pills. And to be 'monitored'
for his good behavior (there is talk of implanting chips to monitor that patients are really taking their
medicines as decided by Big Brother) this is the new 'Patient Engagement' framework.
Add to that their GRI comment that:
The food and beverage industries have a crucial role to play in selling healthier alternatives, at a minimum
starting in schools (for example, PepsiCo stopped selling high-sugar drinks in schools).
(PepsiCo organized a breakfast at the NCD Summit in New York!)
Contemporary marketing and behaviour influencing methods are undervalued in public health and should be
fully incorporated into prevention programmes.

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Hence Marketing Agencies and Mobile Phones are brought in in a direct to consumers (patients / would be
clients) approach.
Since this document was issued two successive United Nations extraordinary summits, Moscow and New
York have been held (an exceptional occurrence in itself) on what is presumed to be the new heaviest burden
of disease: NCDs. Non Communicable Diseases.
A Global Platform on NCDs has been created with tripartite composition of UN- WHO, large private
corporations, 'Charitable' foundations that are mostly linked to large private corporations, and a sampling of
NGOs.
But is it really as new as it sounds?
The approach to health recommended by the GRI/DAVOS main features are:
- bypass health services notably the public sector role in prevention and promotion, including epidemics
control
- bypass health manpower and pharmacies for drug deliveries (CocaCola's agreement with the GFATM to
deliver drugs is a harbinger of things to come.
- use marketing on a grand scale in a 'direct to consumer/patient' approach
- 'de-medicalise health.
And of course, it goes hand in hand with a full privatization of curative services for those who can pay,
accompanied by State vouchers for the poor to 'buy' care from private providers (as experimented in parts of
India today).
The issue is not that 'private corporations' are inherently bad, the issue is that viruses in real life, in nature, do
not respond to marketing, and such an approach is un-scientific, unsound and dangerous for the human race,
and it has been already tried experimentally. Importantly, it aims at a very private elaboration of health goals,
risks and methods and wishes States to be used for obeying and implementing objectives (example of the
flue scare).
The army of the dead
April 2013, former British Prime Minister Margaret Thatcher had a lavishly noisy funeral. Her type of ideas
came to power in the late seventies in more than one country, and among the consequences : the funeral of 35
million mostly young men and women. Since 1979, Human Immuno-Deficiency Virus (HIV) has infected 70
millions persons, half of whom have died of AIDS so far.
These were crucial years, those of the shift from industrial capitalism to financial capitalism, it all
started in the mid-seventies and took control over most of Europe and the USA as well as development
policy towards the very poor developing sector.
Unnoticed during the same three decades was the rise of ultra-liberal experiments in health policy
making in the face of a serious epidemic threats : HIV.

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The pre-Great Depression best known progressive reference in economic thinking was Thorstein Veblen,
who, as no other, understood the ingrained conflict between industrial capitalism and rentier financial
capitalism. Here is typical Veblen wits on the assumptions regarding man in the 'free market' under financial
ultra -liberal dogma.
The hedonistic conception of man is that of a lightening calculator of pleasures and pains who oscillates
like a homogeneous globule of desire and happiness under the impulse of stimuli that shifts him about the
area, but leave him intact. He has neither antecedents nor consequent.
He is an isolated, definitive human datum, in stable equilibrium except for the buffets of the impinging forces
that displace him in one direction or another. Self imposed in elemental space, he spins symmetrically about
his own spiritual axis until the parallelogram of forces bears down upon him, whereupon he follows the line
of the resultant. When the force of the impact is spent, he comes to rest, a self-contained globule of desire as
before. (Thorstein Veblen, The Place of Science in Modern Civilization)
Think of the way a person is targeted by marketing in the AIDS 'prevention' campaigns, for safe sex,
abstinence or safer use of narcotics? That person is considered as an 'homogenous globule of desire and
happiness' in the 'formula' applied to populations, especially youth by marketing agencies.
The underlying assumption regarding human individual behavior in response to the emergence of a new
dangerous virus, notably HIV, are all contained in that sentence: a calculator of pleasures and pains.
As defined by the first architects of the global response to HIV: to wear or not to wear a condom, that is the
question! As Maggie said There is no such a thing as society. Each and every individual was alone in space
vis vis HIV, to get contaminated or not was his choice. And if he decided to be 'unsafe', he was a victim of
his own ignorance and stupidity. (the incredibly racist assumption of that statement are conveniently ignored)
Peter Piot proclaimed it : HIV has nothing to do with poverty! Peter is now one of the expert authors of
Davos' GRI. And, because individuals, and even more so individuals who rose to a position in the elite
themselves, do not get their consciousness or understanding from a magic source but rather think as a 'group',
practically all very well meaning persons committed themselves to that fraudulent idea. Once an erroneous
concept has been successfully marketed in a society, it is extremely difficult to change course. Dissidents will
be burned, condemned to death, threatened, demolished.
The containment policy usually applied in the face of the emergence of a new and very deadly viral epidemic
was exploded: testing was labelled infringement of human rights, closing sex shops and saunas:
'homophobia', isolation as 'criminal'. It took 25 years to lift the ban on HIV testing within health care.
It became a policy of 'free market laissez faire' but the marketing under a 'human right' sexual freedom
wrapping was so brilliantly and lavishly done that the overtly racist, murderous neglect of poor population
was 'sold' to the masses worldwide, and notably to youth, with such exuberance of means that the ultraliberal hoax passed unnoticed. The drive for AIDS prevention and the drive for sexual liberation became so
intricately interwoven thanks to the tremendous power of the marketing agencies, that they became
undistinguishable. People did not realize the approach to combat AIDS was a shame because they were so

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enthusiastically recruited into the drive against stigmatization. People fought to defend the right of a 100
individual allowing for 1000 to become contaminated and die, for the right of the 1000, allowing 10 000 to
become infected... and so forth. 35 million people are dead today and the farce continues and, in many ways,
has become unstoppable. Youth fought against discrimination of homosexuals and the policy killed several
millions homosexuals!
The course of engaged health governance reform all partake of the same lunacy.
1979-1990 were the years of the Iron Lady Margaret Thatcher in power they were the overlapping period
of Reaganomics and of the French Barre-economics. Thatcher was the first politician in Europe to rely on a
marketing agency for her election (Saatchi and Saatchi). The rise of marketing agencies in elections was
accompanied with the emergence of marketing in health issues.
AIDS was the first time in modern history that a major emerging epidemic soon a pandemic was dealt
with marketing as the main instrument of belief and control.
Today the 'AIDS model' is the reference for NCDs, explicitly so, and by implication for all health and
epidemic problems tomorrow.
When AIDS claimed its first victims, a marked shift in world health policy occurred which went unnoticed
and yet was a mirror image of the Hayek-Friedman brand of experiments in political economy: the
individualistic-marketing-branding-shrinking of State functions in the face of epidemics.
It fitted specific private interests- it coincided with the incoming World Bank dominance over health and it
first applied its new doctrine with the stern mentality of zealots towards HIV.
The fall of the Berlin Wall marked the acceleration of the shift.
What did we know of HIV/AIDS scientifically when it emerged:
Scientifically HIV is a 'blood-borne- retrovirus', a virus most easily transmitted through blood contact
as it is present in greater quantity in the blood. Yet HIV was re-branded an STD, a Sexually Transmitted
Disease.
Of course HIV could be transmitted sexually, it was and still is, but strictly defined as a health category an
STD is a disease which affects the sexual organs, HIV does not.
HIV is present in all secretions: tears, sweat, breast milk, urine, faeces, sputum, sexual secretions, and in
proportionally much greater quantities in the blood, why privilege sexual secretions and near total silence on
the risks of faecal contamination, for example? The risk of transmission is proportional to the viral load
(quantity of viral particles in secretions, especially blood) which is dependant on treatment (ARV decrease
viral load) and dependant on co-infections (the presence of many bacterial and parasitic infections increase
HIV viral load)
The risk of sexual transmission in a discordant heterosexual couple (discordant= one is HIV infected, the
other not) is 1/1000 intercourse. But transmission by even tiny blood transfusion is extremely efficient.

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After 'branding' HIV an STD, any attempt at HIV control was argued (marketed) to be an attack on sexual
liberty!
Epidemic control became entrapped into a discourse on stigmatization, sexual freedom, human rights, and a
non-effective control practice was 'sold' to youth, to governments and the public much as a product is 'sold'
massively on the market with today's marketing experts using human psychology.
It is ironic to note that marketing agencies use deeply engrained religious ideas such as that of 'guilt'
associated with disease. Thus when 'conservatives' expressed disagreement, it was to advocate repression,
and more victim blaming, as they considered the AIDS patient 'guilty' of 'bad behavior' and HIV was God's
punishment. Having this Orwellian choice, no doubt youth choose the approach branded as 'human rights'.
But a virus is a real thing and HIV became pandemic as no real world control measures, or so little, were in
fact taken.
- The extreme dangerousness of blood contact the high efficiency of blood to blood transmission was
neglected, and along with it the need for safe blood banks, safe tattooting, safe injections in health
care... This cornerstone of an AIDS prevention policy which limited the spread of the epidemic in OECD
countries or Brazil with the implementation of 'universal precautions - went out of the window for the
developing sector when HIV was decreed not to be not a medical but a behavioral issue. British Tax Payer
wants Value for Money - HIV is not a medical problem but a behavior modification problem, thus
spoke head UK representatives to the Board of GPA (the Global Program on AIDS, then still in WHO).
The 'behavior modification' orientation of the control policy was the justification for taking HIV out of WHO
altogether and creating UNAIDS in 1996.
Provocative Q & A might be the best way to grasp some essential elements of the issues at hand:
Q: When the AIDS epidemic first surfaced in the USA in 1980, it was called the 'four H disease' what do the
four H stand for?
A : H for Heroine addicts H for Homosexuals H for Haemophiliacs, and H for Haitians.
Q: What do the four H have in common?
A. : Blood. Heroine addicts contaminated each other by sharing syringes as minute quantities of infected
blood will pass the virus (or HIV contaminated liquid drugs). Haemophiliacs were killed in mass due to
irresponsible State policies in many countries with contaminated blood derived products. Haitians? Poor
Haitians who came to the USA as rural migrants workers first came down with the AIDS mystery disease in
1979-80. Haiti was one of the key places where the like of vampire king Somoza engaged in their private
blood collecting empire business. Poor Haitians were making a few bucks by selling their blood and were
getting contaminated through that route as blood donors (because of dirty plasma collecting practices not
via transfusion). Mexico and many years later China had well documented epidemics among blood donors.
These Haitians first come down with AIDS by having tuberculosis. Tuberculosis acts as a facilitator for HIV
uptake, as an accelerator of HIV disease and is as well an opportunistic disease of HIV. Homosexuals? Direct

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blood contact is easier in anal sex because the anal membrane is very thin and likely to have minor tears
permitting HIV easy crossing into the blood stream during sex, is one of the reasons.
Q.: What has a poor African woman caring for the sick may have in common with a California upper class
homosexual, in terms of HIV contamination risks?
A.: Faecal contact, maybe? The fact that HIV can be easily found in faeces is never mentioned in relation
with the diarrhoea prevalent among 'slim disease' as AIDS was called. Yet there are several cases of women
and nurses getting contaminated 'horizontally', notably through caring for babies, or caring for adults with
AIDS. A well documented horizontal intra-family transmission was scientifically proven by well known
researcher Laurent Blec. (a scientific study so well done that it was co-signed by Franoise Barr Sinoussi!)
That African women can get contaminated by home care is a taboo subject 30 years into this epidemic.
Q.: What does an intravenous drug user have in common with an average poor patient in a poor country?
A.: Exposure to dirty needle and syringes? Approximately half of the 19 billion injections administered in
health care globally each year are dirty! 8 billion dirty shots for patients! Why this silence? The
contamination with HIV of liquid drugs (medicines vials or nacrcotics drug liquid mix)
Q.: What does a middle class homosexual in France have in common with a poor child in some ghetto town
in Southern Africa?
A.: Exposure to intestinal parasites ? Intestinal parasites (as bacteria) are HIV enhancers. The role of
intestinal parasites was first indicated by Pr Luc Montagner, South African and other researchers called in the
Lancet for a global effort to eradicate Helminthic infections which are co-factors for HIV as well as clinical
tuberculosis especially in Africa.
The suspicion that the TB bacilli enhanced HIV and played a part in the rapidity of HIV spread, was first put
forth by Anthony Fauci head of the NIAID (1996 research), and Nulda Beyers of the South African TB
committee.
Q.: What does a female prostitute have in common as an HIV risk with a baby getting breast fed?
A. : Oral contamination. Dendritic cells in the back of the throat pick up HIV. Cases of babies are well
demonstrated. Monkeys are more easily contaminated by the oral route (SIV model) than the anal route,
itself more efficient than the vaginal route. Research of Ruth Ruprecht.
Q.: What does a youth getting a tattoo in the street have in common with a patient undergoing surgery?
A.: Contamination via multidoses-reused vials. As late as 1997, over 50% of anaesthetists in North America
still changed needles and not the whole syringe when taking more anaesthesia product from a vial, thus
contamination the container and putting the next patient at risk (even if a whole new syringe is then used).
This unsafe type of practice was exposed in the Nevada Hepatitis epidemic in the USA again 3 years ago.
These poor practices are common in Sub Saharan African health centers where over 50% of patients are
already HIV carriers.
Q.: What does a man in a barber shop may have in common with a new born babe in a maternity ward?

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A. : Risk of contamination through a dirty razor blade (with microscopic traces of HIV containing blood
from a previous customer/mother. Contrary to common beliefs, HIV stays viable for several days even in
dried blood in the environment.
Q.: What could an African woman getting braided have in common with a Botswanian cowboy?
A.: Microscopic punctures (needles / darts of cattle flies stomoxys calcitrans known to inject their prey
with the previous meal before sucking its victims, can transmit HIV easily. Max Planck Institute research.

Can the differences between the rate of speed of HIV be explained by differences in sexual behavior between
a Black male in Africa and a White North African ? No way. Differences in sexual behavior between West
Africa and Southern Africa? None.

There's a misperception that there's a great deal of promiscuity in Africa, which is one of the potential
reasons for HIV/AIDS spreading so rapidly. But that view is not supported by the evidence commented Paul
van Look, former Director, Reproductive Health and Research, WHO.
In 1996 Dr Dominique Krouedan, a well known French physician (and international expert in development
today) working with the Ivory Coast AIDS Control Program wrote a letter to a French publication Socit
dAfrique et SIDA.
Hers is a voice of common sense, the voice of real concern of someone from within the AIDS machine. A
voice of anger. She does not pretend to have answers. She asked that the right investigations be done:
(..) I have several questions addressed to the epidemiologists who are interested in the epidemic of AIDS in
Africa, (..)
In front of the total failure of world strategy in this domain, let us accept to question ourselves.
If we were more modest, we would still be looking, and we would have other elements on which to build
interventions:
- On what studies does the WHO declare every time more loudly, than the HIV infection cases in Africa are
90 %, even 95 % of cases of heterosexual transmission?
None. Why arent you, epidemiologists, interested in measuring and estimating the importance of the
transmission through blood exposure in a country of high seroprevalence in Africa?
How we can assert so clearly that it is negligible, when we know the conditions of exercise of the health
professionals in the absence of blood banks certainly, but also deprived of equipment (when one birth
delivery kit is used for up to 60 childbirths a day, can one still consider that the risk of transmission in a
hospital environment is tiny, and why should it be tolerated here?), lacking of sterilisation equipments,
decontamination products and gloves?

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When we know the daily frequency of the traditional practices with blunt instruments and the seroprevalence
in the general population?
When we know the frequency of transfusions in the paediatric environment and the number of transfusions
made in the absence of blood banks ?
() Dont you think that it is a little bit fast and simplistic to explain this phenomenon by the inclination of
the Africans to have multiple partners and too frequent relations?
Don't you have the impression that there is something else happening and that your role would be to
investigate this other thing? (..) What do you make of unexplained cases of intrafamilial transmission?
(Kerouedan 1996)
17 years have passed and nothing has changed.

This writer remember speaking last year in 2012 to the head of the AIDS Program in Botswana: he was in
tears as he told me (side reception at the UNAIDS meeting): I am going to announce the new HIV data from
my country tomorrow, I just received them, it's terrible: 50% of the adult population of Botswana is
contaminated with HIV: What can we do?
I told him what I thought: Mainstream approaches to HIV/AIDS were empty and had always been
ineffectual. No one has the answer as to why HIV is spreading so fast in Southern Africa, what we know is
the urgency to research and seek to understand.
2013: A bloodborne epidemic already affecting 1 adult out of 2 in Botswana, 35% of young adults in
Southern Africa, and UNAIDS announces 'the End of AIDS'! It is beyond marketing, beyond the imagination
of George Orwell!

AIDS treatment problem

A second marketing fraud was the idea that treatments really cure HIV. Even in upper class middle age
heterosexual milieu, AIDS still kills in Geneva, in New York, even with the latest ARV (antiretroviral
treatments). ARV dramatically improves the lives of HIV infected persons when taken properly, when there
is food and clean water (read the late Yves Chartier -WHO on the need for water for People Living with
HIV), when there is no viral resistance or terrible side effects. It allows the victim to gain time, to gain
several years of life and it slows the epidemic (by lowering HIV viral load in the blood). But there would
need to be a real epidemic control in place to stop the spread of the virus, and strong health systems in
countries World Bank policy did the opposite. Today we have mounting viral resistance to ARV, and
increased resistance to bacterial diseases associated, Tuberculosis notably. But short of more in depth
understanding of retroviruses (and in a neo-liberal world fundamental research is downsized or strangled),
piling up new anti-retrovirals gains time for some people, but can't by itself end this pandemic.
How could Botswana treat with life long ARV 50% of its adult population?

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Yes treatment is a must. But there has to be policies to bring this devastation under control.

As Kerouedan alludes to, this scam prevention (on 'unsafe sex') was propagated with a flood of
statistics, all pretending a correlation between sex and HIV.
The big sales was 'statistics' fraudulent use of statistics as if statistical correlation meant a causal relation.
Thus all 'statistics' say that HIV transmission is 95% sexual.
Let use an image.
Statistics show :
- the first cause of death among teenage youth in district X and Y in Washington DC is bullet wounds
- the majority of youth living in districts X and Y in Wash. DC are Blacks
Conclusion: melanin in the skin is a risk factor for death from bullet wounds. ???
Widespread contamination of pregnant women was uniformly blamed on Black male promiscuity yet the
demographic surveys of their husbands showed an important percentage in Sub Saharan Africa, were not
contaminated. Similarly in India. UNAIDS concluded in one document that Indian women were more
promiscuous than previously thought. (sic). Very young women, aged 16 or less are more contaminated than
26 year old females or males... Conclusion: hidden promiscuity! Sugar Daddies! Zimbabwean pre-adolescent
females were suspected of 'lying'. Many young children are now found HIV plus, conclusion: in Africa child
sex can start as early as 5 years of age...Another story, heard everywhere, even in UK universities.
For those not making a living (having an HIV related job) in HIV in Africa, the word getting around is
hissing, hissing 'genocide'. As someone who spend 15 years in and out of Africa, I heard that word 'genocide'
spit out, in hissing tones, repeatedly.
The problem is bureaucracies in motion are extremely difficult to stop: human beings tend to act and think as
lemmings. Most 'actors' in today's AIDS policy are not at all conscious that they are perpetrating a fraud
killing millions. They really BELIEVE the piles of statistics, they really believe it when they read that The
major burden of disease falls on Africa because of HIV- HIV is due to unsafe sex the major burden of
disease is due to unsafe sex - much as the educated populations believed the earth was flat not so long ago,
and anyone disagreeing would be burned. The incredibly racist assumption in this statement is not even
seen : the assertion that Black Africans would prefer to fall sick and even die rather than give up enjoyment
of sex with multiple partners and no condoms... Serge Bil, the Ivory Coast author has well identified the
persisting 'titillating' legend of the extravagant sexual life of the 'natives', used to promote slavery (notably in
his French language book La lgende du sexe surdimensionn des Noirs.
Prostitutes and clients don't like condoms, IVDU are too silly not to share syringes, Blacks are too primitive
to control themselves... And individuals can't control themselves generally and should behave in the free
market as free inididual entities. As for sex-businesses, large drug-dealing businesses, or colonial style raw
material- natural resources exploitation and assorted financial arrangements, including banks, these are all

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very good investments and where need be, they should be legal (legalized), supported and de-criminalized)
and if this leads to reduction in population pressure, so be it.

The HIV model applied to NCDs

For the first time the Harvard School of Public Health, now headed by Julio Frenk, has issued a health
publication in collaboration with, Davos!
Non-communicable diseases have been established as a clear threat not only to human health, but also to
development and economic growth. Claiming 63% of all deaths, these diseases are currently the worlds
main killer. Eighty percent of these deaths now occur in low- and middle-income countries.
Again, statistics are used to fraudulent aims. It is 'normal' or at least not a health priority that heart attacks are
a big concern for the over 85 years of age, (and certainly not something amenable to fancy drugs- we all will
die some day! And it does not represent the same 'priority' or 'burden' as rampant under five mortality from
diarrhoeal diseases!
NCD are a chosen target because these are today implying long lasting treatment and maximum profitability
for the drug sector, which is where NCD resembles HIV/AIDS, big profits from life-long treatments.
NCDs approach is avowedly taken from HIV/AIDS (as told in many large public meetings)- it has the 3
similarities: an approach bypassing national health systems and their shrinking manpower, - ignoring the
social (and economic / environmental) determinants of health, and focussing on approaching the patient as a
potential customer with marketing.
One could think that applying marketing formulas to NCDs was less dangerous than applying them to a viral
disease like HIV, or indirectly to TB. Yet, the irony is that advanced research has began to find that bacteria
in the gut is responsible for obesity, diabetes, and research is on track to find the links with intestinal cancer.
Furthermore, the biggest huge threat on the horizon today is resistance to antibiotics by bacteria.
3 years from now, or 7 years from now, it is possible that no antibiotic will work any more. This was the
message coming out of the HAI forum of experts in 2011. Towards a world without antibiotics?
Tomorrow, a bicycle fall could mean death, surgery repair will stop, TB is already back in untreatable forms
(Totally Drug Resistant TB is seen in India and elsewhere).
Urgent action is needed (the USA has yet to forbid feeding antibiotics as growth enhancer to its animals in
husbandry!), EU husbandry gets around the ban by indiscriminate use in the name of prophylaxis.
And long term serious research is stifled in public institutions by a combination of short sightedness- the
drive for short term outcome (a saleable item) and austerity policies.
To pretend that 'non-communicable' disease is a priority when highly communicable disease are not only
affecting millions -as HIV- but also bacteria, including the TB bacilli, are becoming resistant to everything, is
not just dangerous, it is folly.

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Reclaiming strong State control over health /epidemic public policy is necessary for human life.

References
J. Frenk, Future of WHO hangs in the balance. BMJ 2012;345:e6877
DAVOS GRI download the report at http://www.weforum.org/issues/global-redesign-initiative/index.html
Ta Mre la Pub, French language paperback, by Yohan Gicquel, published by: le gnie des glaciers, 2007
La lgende du sexe surdimensionn des Noirs, by Serge Bil (French language paperback)
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Lancet, (Series: Sexual and Reproductive Health 2), vol.368, 11 November 2006
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Gisselquist March 30, 2008

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