Does the HIV Industry Despise Africans or Just Sex in Africa?

While I commend any activism that opposes the numerous ongoing national and international failures to deal with the HIV pandemic, there is an attitude that treatment for those infected is more important than maintaining the negative status of those who have not been infected. The two are equally vital and they should never be seen as being in opposition. Treatment activists have their legitimate agenda but they sometimes make it clear that they forget that health is a property of whole populations, it is not just a matter of having or not having some disease.

During the recent Vienna Aids Conference, Mark Heywood executive director of Section 27, was widely quoted as saying: "The testing campaign [in South Africa] is only a means to an end...; its intention is to give people access to treatment and to other healthcare services. However, if treatment is not actually provided, then the means cannot be justified."

Mr Heywood is quite wrong. There is talk of testing 15 million South Africans. Are we to believe that this massive number of people is to be tested and no effort made to find out how those who are infected became infected? Is South Africa going to copy the mistake made by most HIV/Aids institutions for nearly thirty years? Will everyone in the HIV industry just continue to assume that HIV is transmitted sexually in African countries, and allow sources of non-sexual infection to continue, unabated?

Testing for HIV is not just the means to one end, that of treating people. Everyone who is infected has the right to treatment, I'm in complete agreement with Heywood there. But people who are not infected have the right to stay that way. And establishing how they can achieve this is another, equally important, justification for mass testing. If we continue to ignore some routes to infection, people will continue to be infected. If campaigns for treatment for all HIV positive people fail to take account of this, the scope for treating everyone infected will start to narrow very rapidly.

Those who advocate treatment for all HIV positive people, and I am one of them, must also advocate for prevention campaigns that are based on the realities of how HIV is transmitted, whether it is transmitted through unsafe sex, unsafe healthcare, unsafe cosmetic practices, intravenous drug use, or any other way. Claiming that mass testing is only justified if those found to be positive are guaranteed treatment is disingenuous and counterproductive.

In the same article, the Nigerian activist Morolake Odetoyinbo said that testing for HIV had been scaled back and was now targeting "people considered to be at high risk, such as sex workers, injecting drug users, truck drivers and people with TB. This stigmatised testing."

Quite, it stigmatizes testing in a very specific way: it assumes the truth of the behavioral paradigm, the assumption that most HIV is transmitted sexually (in African countries) and has the corollary that all (African) people need to do is 'change their sexual behavior' in order to avoid being infected with HIV. Yes, it includes injecting drug users; they also are a stigmatized group. But the majority of people in African countries are not members of any of these groups. Even the majority of HIV positive Africans are not members of any of these groups.

If the Nigerian government wants to follow in the footsteps of other African countries, who have received all their HIV advice and funding from prejudiced Westerners (the HIV industry), all the worse for Nigerians. If you assume that most HIV is transmitted sexually, you will not be looking for non-sexual exposure, nor will you take any measures to avoid it. Nigeria could quite easily pass out South Africa and become the top country in the world for the number of people living with HIV.

Regarding stigma, Odetoyinbo goes on to say “It’s beyond access to medication”. What is the use of life if there is no quality of life? What is the use of life if you just give me pills to stay alive? I don’t want to be alive when there’s such circumstances. I still need my dignity as a human being.”

The HIV industry has set the agenda, the stigmatizing, prejudiced, sexist agenda, that HIV is just a matter of sexual behavior in African countries. With the HIV industry's view of HIV, you will never have dignity. But you can not deplore the stigma without also deploring agenda. And first, it needs to be clear what exactly is being stigmatized. It is sex, simply that. People may say it is unsafe sex or illicit sex or any number of things, but in reality, they object to sex.

Consider that in the early days of development theory, development meant no more and no less than population control. Many institutes haven't gone beyond that development paradigm. And many of the big organizations working towards the aims of that paradigm, to reduce populations in poor countries, are the same organizations claiming that they can reduce HIV transmission by influencing people's sexual behavior.

They were not very successful in reducing birth rates, they are not having much effect on HIV transmission and they will continue to fail, despite receiving the lion's share of funding. Among them are Population Services International, Family Health International, The Futures Group International, the Guttmacher Institute and the Rockefeller Institute, but there are others. A lot of institutions that use terms like 'hygiene' and 'public health' (and various other euphemisms or euphemistic uses of words that sound innocuous enough) have similar histories.

Sex is what people and institutions object to, or say they do. They don't give a damn about diseases, there are plenty of them, sexual and otherwise, but they aren't putting any of their time into reducing their transmission. Sex is what journalists like to write about and what donors like to fund and what politicians make their careers out of condemning and what the public likes to read about. But HIV is a disease, it is not sex, unsafe or otherwise. It is spread in a number of ways, sex being one of them. But the conditions under which people have sex go way beyond mere sexual behavior. Those conditions are part of what makes us human.

Sex is no more wrong than breathing, which transmits TB; drinking water, which transmits water borne diseases; standing too close to someone, which transmits many diseases; eating food, which transmits some of the biggest killers in developing countries; crossing roads, working in mines, playing football or walking home alone on a dark night.

Nor is it sexual abuse, sexual violence, female genital mutilation, male genital mutilation, gender inequality or any other forms of abuse that are responsible for HIV epidemics. They should all be outlawed, but they existed before HIV did and they will continue to exist after HIV ceases to exist, should such a time come.

Some people, who accept that there is nothing wrong with sex, make the objection that if it is recognized that HIV is not always transmitted sexually, that those who are found to have been infected sexually will still be stigmatized. But it is the sex that is being stigmatized, not the HIV. The disease (and people who are infected with it) are stigmatized because of the association with sex. If you think that there will be two tiers of HIV positive people, the sexually infected and the non-sexually infected, you too are moving the target of the stigma!

That people have objections to sex is a complex problem with a long history. It won't be solved by conflating it with something else. HIV, and many other diseases, are being transmitted rapidly when they could all be controlled, to some extent, and many could be prevented or cured. HIV testing needs to ascertain how people become infected, if at all possible, not just whether they are positive or negative. Reading humanity's sexual hang-ups into HIV transmission has allowed the disease to become a pandemic. It could get a lot worse, and it probably will if we don't take our prejudices out of our HIV prevention policies.