Thursday, June 3, 2010

UNAIDS Set to Score Own Goal in South Africa

Many people who follow the HIV pandemic will be looking with interest at the soccer in South Africa or rather, reports about possible HIV transmission there. There are claims that tens of thousands of women from around the world are flocking to South Africa to work in the sex industry and that a lot of soccer fans will be availing of these services. Whether these claims are true or not is anyone's guess, I've seen no evidence to back them up.

It seems likely that even if people visiting South Africa don't know how to protect themselves, those working in the sex industry will. One hopes so, after decades of warnings about the dangers of sex and HIV. If these warnings haven't worked by now, perhaps those spending public money on them should rethink their HIV strategy.

But what about the dangers of non-sexual infection with HIV? Neither those in the West coming over to South Africa nor those living in South Africa are likely to have had so many warnings. Tourists may well be aware of non-sexual risks, such as tattoo parlours, cosmetic outlets like barber shops and, perhaps most importantly, medical facilities. Go into a travel shop in many European countries and you will find medical equipment that you can bring with you on your trip, such as needles, syringes and sutures. Some of the well known guide books warn against some of the non-sexual dangers of HIV infection in addition to sexual behaviour.

Africans are not granted the benefits of access to affordable medical equipment or even of information about non-sexual HIV risk and how to protect themselves. It seems they are just not as important as tourists and others visiting the continent.

Perhaps Westerners visiting South Africa have some chance of protecting themselves against these risks, although the media coverage of the issue is (as usual) concentrating on sexual risk. In a typical article covering the soccer, we can read about sporting stars and what they have to say about HIV and sexual violence, especially against women and girls. I assume they are saying what they are told to say, perhaps what they are paid to say, but none of them appear to be talking abut non-sexual transmission of HIV. Or perhaps the press just doesn't bother covering that issue.

My guess is that people's heads, wherever they come from, have been so filled with information about condoms, casual sex, multiple partners and the rest, non-sexual risks will have little impact. And conflating gender based violence with HIV risk is not very helpful either. Gender based violence, whoever the victims, is wrong, it's not just wrong because victims may be infected with HIV. In fact, the majority of victims are not infected with HIV, but gender based violence is none the less abhorrent.

In a similar vein, an article about the singer Annie Lennox becoming a Goodwill Ambassador for UNAIDS also conflates the need to reduce HIV transmission with the need to fight against gender based violence. I admire Annie Lennox and I hope she gets through to people in a way that UNAIDS has completely failed to do. But being supported by UNAIDS would tend to suggest otherwise. Still, Lennox is an intelligent and sincere woman. We may see her shaking off the shackles of UNAIDS patronage and speaking the truth about HIV.

The truth is that the mainstream HIV industry has concentrated on sexual transmission of HIV to the exclusion of medical or cosmetic transmission. This was not so much the case in the early days, before the interference of massive levels of funding, commercial, political and religious interests. But now, the industry is all but silent on anything but sexual HIV transmission.

This is not because UNAIDS, the UN, WHO, CDC and other big players don't know about non-sexual HIV transmission. They have just chosen to ignore it. It's not quite clear why and I'd really like to hear their explanation. However, they simply spew out their guesswork figures, which already presuppose that heterosexual transmission accounts for most HIV transmission in African countries. They assume sexual transmission to be so high that there is not much scope for estimating anything more than a few percent for non-sexual transmission, unless the number of transmissions is higher than 100%, which wouldn't be beyond those clever UNAIDS epidemiologists. They can do anything with figures, it appears, except tell the truth.

Even campaigns about sexual transmission of HIV have been unconvincing, to date. But they are better than the complete silence that non-sexual transmission receives. People just don't realize the number of risks they face in their day to day lives. And people in African countries face more of those risks than those in Western countries. For a start, HIV prevalence is already very high in many Sub-Saharan countries. But medical facilities are often understaffed, underfunded, underequipped and oversubscribed. This is a disasterous combination if you consider how efficient medical transmission of HIV is, compared to sexual transmission.

Whatever happens during the World Cup, there will be little point in investigating what went wrong with the campaigns afterwards. The World Cup itself is irrelevant to the fact that millions of Africans face etremely high risk of contracting HIV every day and this has little or nothing to do with their sexual behaviour. The evidence for that is available now. It's time international health institutions stopped ignoring it.


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