Monday, November 15, 2010

Is the 'War' on HIV/AIDS a War on Africans?

As in the broader field of development, who gets what in HIV funding depends more on their relationship with Western powers than on relative need. Certainly what is wanted, what is requested or what is appropriate are not considered. You might say that the market is supply driven, whether you are talking about HIV programs, services, commodities or even research.

A country run by a pretty undemocratic regime, like Uganda, is vaguely listened to and receives a lot of funding. Zimbabwe, which may also have questionable levels of democracy, is not considered particularly credible and receives a lot less funding. Yet it's hard to know which country is the better or worse off. The populations of both countries are infantilized, manipulated and patronized.

But both countries have little say in how HIV, people infected with HIV or people at risk of being infected with HIV are treated. The myth of 'individual responsibility' is pushed by vested interests, political, commercial and religious. All Africans are vilified by the HIV dogma, in particular, women. At best, women are seen as helpless victims of the reckless male, who is seen as violent, greedy and lazy. At worst, women are seen as sexually promiscuous, ignorant and unconcerned about their health or the health and welfare of their children.

Social problems are, rather tautologically, undesirable. Persecution, rape, poverty, disease, discrimination, deprivation and many other social problems are exacerbated in developing countries by poor health services, low levels of education, underdeveloped infrastructure, high unemployment, etc.

But many social problems in African countries have been associated with the spread of HIV. The truth is, no social problem is, on its own, responsible. HIV is not driven by any particular social problem, though many social problems may play some part in HIV transmission. HIV is a virus and, in common with other viruses, its spread relates to the nature of the virus itself, the virus host and the environments in which the hosts live.

Sometimes, the ostensible driver of HIV in African countries is given the name 'African culture', sometimes 'African sexuality' (assumed to be a subset of human sexuality, but very different), sometimes the 'African male psyche' (in the case of the Zimbabwean male). All the undesirable characteristics assumed to spread HIV are also assumed to make up whatever culture, sexuality or psyche is being described.

The fact that HIV epidemics vary considerably within and between countries, along with culture and sexuality, is generally ignored. As for psyche, the notion is woolly even by pop anthropological standards.

Kenya even had a special profile for members of the Luo tribe, who were historically deemed to be incapable of leadership for various reasons, including lack of male circumcision. And when HIV was recognized and found to infect far more Luo than members of any other tribe, this was conveniently added to the set of prejudices. Exactly why HIV prevalence is higher among the Luo population is not yet clear. Nor do the HIV research community seem particularly interested. Following the various prejudices, HIV policies are painted with broad brush strokes.

Zimbabwe may not receive the same level of Western favor as Uganda, but they (and a number of other African countries) are being 'favored' with a similar mass male circumcision program, funded by USAID. This program is not based on any demonstrated need for mass male circumcision, nor any demonstrated effectiveness of such a program in Zimbabwe (or any other African country). It simply assumes that the country is dominated by African males who conform to the stereotype, whatever set of undesirable characteristics that currently comprises.

One of the most studied HIV epidemics in Africa is in Uganda, where early HIV prevention campaigns have gained mythical status. But Uganda still has a serious HIV epidemic. If it was overstated in the 80s and 90s, it is probably understated right now. HIV has not been shown to relate to sexual behavior alone, and certainly not to any particular 'psyche', culture or sexuality. On the contrary, no single 'driver' has been identified in Uganda. It's almost as if the epidemic struck, increased, decreased and then increased again, independent of any prevention effort, national or global.

There may be people doing undesirable things in Zimbabwe, Uganda, Luo populated areas and certain other African countries. But this is true of every country in the world. Similarly, HIV may well be spread by sexual behavior, especially certain forms of sexual behavior. But sexual behavior, including sexual behavior considered to be 'unsafe', is universal.

On the other hand, in every country in the world, HIV is also known to be spread by certain non-sexual modes, such as through unsafe medical and cosmetic procedures. When virgins, people who are not sexually active, people who have only had 'safe' sex, infants whose mothers are not HIV positive and others in non-African countries are found to be HIV positive, the cause of their status is investigated. But in Africa, it is merely assumed that personal testimony is less reliable than it would be in non-African countries.

UNAIDS and the rest of the HIV community refuse to countenance suggestions that HIV in Africa has anything to do with, for example, medical facilities. This is despite the fact that medical facilities in some African countries are among the worst in the world. Nosocomial transmissions of HIV have probably been found (and investigated) in all wealthy countries, where health facilities are far better. But where such transmissions may have occurred in African countries, the authorities close ranks.

Zimbabwe, along with several other high HIV prevalence countries, is exceptional. These countries, including Botswana, South Africa, Swaziland, Lesotho, Zambia and perhaps others, have relatively good medical facilities, with high levels of access. And that may turn out to be one of the decisive factors in high HIV prevalence countries. Health facilities are better than in Uganda, Kenya, Tanzania and other medium prevalence countries, where access to health facilities is low.

If HIV programming is, as I have suggested above, supply driven, it seems like the Western countries who dominate development, health and HIV agenda are not really interested in any of those issues. Perhaps it's even naive to expect that Western countries would have interests that go beyond their own welfare. But HIV programming is often referred to as a 'war', or in similar terms, when it looks a lot more like a war against Africans. I'm not saying the West created HIV, just that they seem intent on making sure it is not going to be eradicated too soon.


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