Monday, June 7, 2010

Unmixed Messages Could Scupper World Cup ‘Opportunity’

It's all about taking part, not winning, right? It’s certainly not about corporate domination, making money or anything so sordid. The World Cup probably means different things to those who care, can afford it or have something to gain from it. But there seems to be a worry that warnings about public safety could detract from people’s enjoyment of the football. According to the British Guardian, Fifa are blocking attempts to distribute condoms at venues. Fifa deny this and say no attempts have been made to set up condom distribution facilities. But even safe sex information has been banned, apparently.

I imagine people from Western countries travelling to South Africa will receive plenty of information about safe sex before they leave their own safe countries. Many will probably have their own supply of condoms or be able to buy them on arrival. They may even receive information on other HIV risks, such as from medical and cosmetic treatment.

They may be told that some health providers have a shortage of equipment and trained personnel, so they have to make sure that needles, syringes, suture needles and other equipment are properly sterilised if they haven’t taken a supply of medical equipment with them. It’s possible that visitors will also be warned to avoid getting tattoos, body or ear piercings or any cosmetic treatment that breaks the skin. (I’ve seen a warning about avoiding tattoos because they may be regretted later but none about the risk of HIV or any other disease.) Condoms are great for preventing sexual transmission, but I think people will need information about more than just basic safe sex.

Some Aids organizations are said to see the World Cup as a good opportunity to give out messages about HIV. But which messages are they trying to give out? That HIV is sexually transmitted? Report after report has shown that most people in African countries already know that. Whether people from Western countries know that or see that as relevant to them is another matter. But when will Aids organizations start to warn people about non-sexual risk of HIV? Non-sexual risks, especially from medical treatment, have been recognised since the early 1980s, almost since HIV was identified as the virus that caused Aids. But since early on in the epidemic, international health institutions have remained relatively silent about this important mode of infection. It is rarely discussed and every year these institutions publish figures purporting to show that medical transmission is very low and hardly worth worrying about.

Hospitals in South Africa are generally in poor condition, places you would not visit for treatment unless you really had to. Most South Africans really have to put up with these conditions, but rich South Africans (and rich visitors) don’t. They can opt for the expensive and hopefully safer hospitals, such as the ones that are looking for health tourists during the World Cup. Even those World Cup fans who need routine accident and emergency treatment will probably opt for something a bit better than the facilities available to poor South Africans. If Aids organisations see the World Cup as an opportunity to get a message across, that message should be relevant to everyone, regardless of their race, economic circumstances or any other criterion.

It is clear that HIV is transmitted by routes other than sexual behaviour. It is also clear than non-sexual transmission is far higher than UNAIDS and others will admit. Just how high non-sexual transmission goes in African countries is unclear because outbreaks of medically transmitted HIV have, so far, been entirely uninvestigated. UNAIDS is happy to warn UN employees to avoid medical treatment in African countries, except in UN approved hospitals. But they don’t seem to want Africans to know about the risks of medically (and cosmetically) transmitted HIV. This is the message that needs to be broadcast during the World Cup. Why the sudden worry that a few Westerners will become infected with HIV when Africans are being infected every day and much of this transmission could be avoided?

A brief article about preparations for medical emergencies during the World Cup mentions the ‘beleaguered health system’ and the huge HIV epidemic, but says nothing about the risk of medical transmission of HIV. The country is not suddenly going to acquire the capacity to provide adequate and safe medical treatment for everyone, no matter how important the World Cup is perceived to be. But that is part of the important message that Aids organizations should be concentrating on: that people should be aware of all the risks and how to protect themselves in order to avoid HIV and other diseases. The warnings should no longer be just about sexual risk but should include non-sexual risks too, especially risks of medical transmission.

The sort of racism that gives rise to UNAIDS and other institutions claiming that HIV is mostly transmitted by heterosexual sex in African countries results in an overemphasis on sexual risk and little or no emphasis on medical transmission. But another instance of racism seems to come out in the run up to the World Cup. There seems to be a lot more concern about non-Africans becoming infected with HIV than about Africans, who face risks, sexual and non-sexual, every day. They have faced these risks for decades and it looks as if they will continue to do so for decades. Apartheid may have ended, nominally. But every African, as well as every non-African, needs to be aware of how to avoid HIV infection and everyone needs access to information and facilities that will protect them. These are not yet available: that is why around 1,400 South Africans become infected with HIV ever day. HIV risk didn’t start with the World Cup and it won’t end with there. But it looks as if the usual Aids organisations will waste the opportunity by talking exclusively about sexual risk, yet again.


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