Saturday, December 4, 2010

Sexism, Racism, Homophobia and Individual Responsibility

The Kenyan Prime Minister, Raila Odinga, has called for the arrest of people involved in same sex relationships. Why he thinks that this will help anyone living in Kenya is a complete mystery. But he will probably gain the support of various 'christian' groups, right wing political interests and, of course, the police themselves.

There is a widespread belief that same sex relationships, especially men having sex with men (MSM), play a significant part in transmitting HIV. It is true that anal sex, whether among MSM or heterosexual couples, is a very efficient transmitter of HIV. But this is not, by any stretch, the biggest contributor to any high prevalence epidemics in Africa, if official figures are to be believed.

Official figures claim that the biggest contributor to the highest prevalence African HIV epidemics is heterosexual sex between married or cohabiting couples. In Kenya, low risk heterosexual sex accounts for 44% of all transmission. In other words, low risk sex is the biggest contributor, while whole populations are being warned against high risk sex.

Another 20% is said to be accounted for by casual heterosexual sex and the figures are similar in Uganda. Again, casual heterosexual sex is not exactly high risk when transmission probabilities can be as low as 1 in 500 male to female and 1 in 1000 female to male. Many factors can increase or decrease the transmission probability but casual heterosexual sex is not nearly as dangerous as many would have us believe.

But a word of caution about these figures. UNAIDS estimate that only 2.5% of transmission results from unsafe health care. This figure clearly came to someone in a dream and was found to be so attractive that the entire HIV mainstream have accepted it ever since. However, WHO estimates HIV transmission from unsafe injections alone to be 14% or higher. And various other medical procedures make a contribution that has yet to be fully investigated.

So, sex workers and their clients are thought to contribute 14% to Kenya's epidemic. But sex workers, like pregnant women, often have to put up with numerous injections, which means that sex is the least of their worries when it comes to serious diseases such as HIV, hepetitis and various other blood borne infections. Even sex work on its own may not carry as high a risk of HIV transmission as we are told.

Then we come to MSM. But the Kenyan Modes of Transmission Analysis doesn't even have an exact figure for this. Instead, we are given a figure for MSM plus prison populations. There are many ways prisoners could be infected with HIV, including unsafe health care, tattooing, sharing shaving equipment and various other routes.

This makes it quite unclear how much men having sex with men contributes to the country's epidemic. The figure is likely to be considerably lower than that for unsafe injections and probably half that from unsafe health care as a whole. And it's only a fraction of the contribution from heterosexual sex among married people and people in regular partnerships.

Personally, I think all of the figures in the Kenya Modes of Transmission Analysis are in need of careful review. They may be the official figures, the ones that policy is based on, the ostensible basis for funding allocations, etc. I just don't accept that sexual transmission is as high as these figures claim, nor that non-sexual transmission is so low.

But there is nothing in these figures that justifies punishing people who are at high risk of being infected with HIV, whether they are MSM, sex workers or intravenous drug users. In Uganda's Modes of Transmission Survey, sex workers account for less than 1% of transmissions while intravenous drug users account for even fewer. Added together, these three groups are estimated to contribute far less than unsafe medical injections.

Odinga has since denied that he made such a statement about gays and said that "gays have rights". But he was only playing to the gallery. What one politician says is unlikely to have much impact unless it resonates strongly with what people already believe. I would suggest that he made the initial statement because he had a fair idea what people believe about MSM. He can whip up a bit of righteous indignation but I doubt if he can significantly influence the views of large groups of people. Therefore, his retraction is futile.

There are several major prejudices at work here. The first is homophobia, the belief that heterosexual sex is the only kind of sexual relationship that is acceptable to humanity. The second is anti-African racism, the belief that Africans have too much sex, mostly 'unsafe' sex, and that they care little about their own health or the health of those around them.

A third major prejudice, perhaps the most prevalent one on every continent, is the belief that women are less capable of making decisions that affect their lives and the lives of those they care for. HIV in Africa is a virus that infects women in far higher numbers than men. It is women who face the highest risks from unsafe medical practices, in addition to the exaggerated risk of heterosexual sex. The claim that HIV transmission is a matter of individual responsibility is the main source of the stigma that has had such horrrifying results in African countries.


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