Tuesday, October 26, 2010

HIV, Individual Responsibility and Blame in a Neoliberal Agenda

Yesterday, I argued that there can be a tendency to make diseases of poverty seem like matters of personal responsibility, lifestyle decision and behavior. Some diseases, such as diabetes, may occur in poor and rich countries. Whether people in rich countries suffer from diabetes because of their irresponsible dietary choices may or may not be true. But people in developing countries usually do not have a great deal of choice about what to eat. High starch staples may fill a person up as cheaply as possible, but they can also contribute to chronic health conditions.

Similarly, poverty and unemployment can be painted in terms of individual responsibility. An article about the Grameen Bank and its founder, Mohammad Yunus, traces the desire to attribute development problems to individual responsibility back to neoliberal rhetoric.

In the past, I have also argued that HIV is not solely transmitted through individual sexual behavior. Sexual behavior can be relevant, but so is individual susceptibility, the health environment in which people live, levels of equality and empowerment, etc. Indeed, HIV is not solely transmitted through sexual behavior, either. It can also be transmitted through unsafe medical and cosmetic practices.

The fact that health seeking behavior can often be elective and that cosmetic practices may almost always be elective does not mean that HIV transmission through these routes is avoidable. Many people are unaware of the risks involved and know little about how to reduce their exposure to them. Others are just not in a position to ensure that medical and cosmetic instruments and processes are hygienic and risk free. They may be too sick, very young or otherwise unable to do anything about it.

The country that spends more per head on health, the US, sometimes experiences nosocomial outbreaks of certain diseases, that's outbreaks that are caused by medical treatment or processes. Actual HIV transmission is now rare, though it does still happen. But many people have, on several recent occasions, been exposed to risk of infection with HIV, hepatitis and perhaps other diseases. And other recent instances of infection have occurred.

In contrast, African countries only spend a few dollars per head of population. Out of 450 HIV positive children in Mozambique, 22 (nearly 5%) were found to have HIV negative mothersUnsafe healthcare is 'suspected'. The fact that many of the children were infected with the same strain of HIV as their mothers does not mean they were infected through the usual mother to child routes. In other words, the number infected through unsafe healthcare could be a lot higher. But, despite many such findings in African countries, investigations are few and far between.

An article that mentions the outbreak in Mozambique concludes:

These neglected routes of HIV acquisition need due attention urgently. Education of staff in health-care services must be continuously pursued to reduce nosocomial risk, and a sufficient supply of disposable needles and syringes and maintenance of high-quality screening of blood donors must be top priorities.

You may think that it's a straightforward matter to reduce nosocomial risks. However, the typical allocation of funding to this area of HIV prevention is about 1%. Given how poor and inaccessible health services are in African countries, even this 1% is unlikely to have any noticeable impact on nosocomial transmission.

So, where HIV is transmitted sexually, there are many reasons why this is not just a matter of 'individual responsibility'. We have long been aware that many people don't know their HIV status or their partner's status and that even when risks could be avoided in theory, it is not always possible in practice. But we must also recognize the fact that many HIV positive people, perhaps a substantial proportion, are not infected with HIV through sexual intercourse. If people don't recognize the possibility they will not see the need to protect themselves.

The HIV industry has gorged itself on HIV prevention programs that, predominantly, assume individual responsibility. There is, and always has been, plenty of evidence to show that this assumption is wrong. The pitifully low success rates of these programs over many years should have been taken as a warning sign. Like poverty and poverty related diseases, HIV is probably very rarely a matter of individual responsibility. HIV prevention programing needs to be developed accordingly.


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