Friday, August 6, 2010

Deal With Your Anger Wisely, Obama

Obama is 'angry' over the spread of HIV/Aids. It appears he's angry with African governments for not doing anything about the epidemic and perhaps with Africans for doing the spreading. That seems to be the direction his thinking takes. He says "treating patients while others are catching the virus is untenable."

"We are never going to have enough money to simply treat people who are constantly getting infected," he said. "We've got to have a mechanism to stop the transmission rate."

I couldn't agree more. That's why I believe some of the main actors in the HIV industry should find out why HIV transmission is so high in some African countries and in some sectors in some African countries, yet it is low in other countries and other sectors. These actors include UNAIDS, the WHO, the UN as a whole, the US Center for Disease Control, universities such as Johns Hopkins and various other extremely well funded institutions. I assume Obama has some influence with them. (That he has influence in Africa is not in question but how that influence works or how legitimate it is are less clear.)

And while we're on the subject of money, my guess is that the amount of money made out of HIV dwarfs the amount spent on it, it's a good investment. Institutions like the ones mentioned, various commercial interests and other big NGOs have done very well out of funding over the years. So let's not pretend that money is leaking out of the US and the country gets nothing in return. And the absolute amount of HIV money coming from the US may be high, as Obama claims, but as a percentage of GDP, the US is nowhere near the highest contributor.

The “retrogressive culture that makes females satisfy the pleasure of men” that Obama says is responsible for the “upswing in new HIV/Aids infections in Africa” is, presumably, the same culture that gave rise to a Black American politician who won the last US presidential elections. Has he anything to say about the retrogressive culture that allows billions of dollars to be spent enriching rich people and institutions while Africans die?

"In Africa, empowering women is going to be critical to reducing the transmission rate because so often women, not having any control over sexual practices and their own body, end up having extremely high transmission rates”.

Women all over the world have little control over sexual practices and their own body but nowhere in the world are HIV rates as high as they are in some Southern African countries. The entire cash-rich industry has failed to explain what is behind the source of their wealth and power: HIV epidemics in certain African countries.

It's great to hear that the "US has a huge interest in public health systems in Africa" because health systems have been ignored for several decades, with all the attention being concentrated on a handful of diseases considered newsworthy enough to attract funding. Let’s get on with it.

It's hard to believe that such statements as the ones found in this article could really emanate from one of the most powerful politicians in the world. Doesn't he have anyone to do his publicity or to provide him with up to date information? It is not true that in Uganda "infection rate was about 30 per cent in the late 1980s". Prevalence in certain sectors of the population may have reached that level but there was never a time when 30% of sexually active people in Uganda were HIV positive. HIV prevalence did reach such levels some time later, but not in Uganda.

There was no "politically-led three-themed campaign - for Abstinence, Being faithful and Condom use or ABC model - [that] helped drive down the rate to an average six per cent." ABC didn't exist till the late 1990s and it was not dreamed up in Uganda. The abstinence only campaigns imposed by his predecessor on Africa in the early 2000s have had little or no effect in Uganda, just as they had little or no effect in the US. They may have been confusing but most behavior change programs failed, so any damage they could have done may have been similarly limited.

If Obama wants to "explore workable preventive programmes" he needs to challenge the behavioral paradigm, the view that most HIV is transmitted sexually in African countries. He needs to question the view that Africans have unbelievable amounts of ('unsafe')sex with incredible numbers of partners.

If he wants to "build greater public health infrastructure", he needs to be informed about basic distinctions between vertical approaches to health, which target individual diseases and horizontal approaches, which concentrate more on primary healthcare. And he shouldn't be distracted by nice distinctions like 'diagonal' approaches, which claim to be some kind of 'third way'.

And if he wants to "institutionalise country-specific interventions", he needs to campaign for the abolition of UNAIDS and perhaps other big players in the HIV industry. Their programs to date have painted whole continents with the same brush, failing to identify all the ways that HIV is being transmitted and ignoring some of the most vulnerable groups. Buzzwords like 'global health' seem to lead, inexorably, to this sort of broad brush policy.

Massive rates of HIV transmission in African countries can not be explained by resort to myths about the great sexual appetite Africans have. And no research has yet demonstrated that Africans have more appetite for sex than people who live in other continents.

Rapid rates of HIV transmission can partly be explained by very low standards of healthcare, where the majority of injections given in healthcare settings are not necessary and are unsafe, very likely to transmit HIV, hepatitis and various other infections. The extent to which unsafe healthcare could explain high rates of HIV transmission in African countries is unclear, because the HIV industry, in all its splendor, wealth, power and wisdom, has never seen fit to investigate.

Please Mr Obama, before you consider punishing anyone, try to establish what wrong has been perpetrated and who has perpetrated it. The important thing is to reduce HIV transmission, not to apportion blame, despite what the Christian Right may tell you. But unless we are clear about how HIV is being transmitted, and you seem very unclear, we will never reduce transmission enough to eradicate the disease.


No comments: