Sunday, January 23, 2011

Global HIV Policy Too Prejudiced to End Pandemic in Africa

In an article in AlterNet, Jessi Fischer asks "Why Do We Vilify Male Sexuality"? But it's not just male sexuality that is vilified, it's sexuality in general. As a result of people's apparent desire to vilify sex, they seem anxious to seek out targets, people whose sexuality is perceived as most deserving of vilification, as opposed to their own sexuality, which is not.

When HIV was identified and thought to be exclusive to homosexual populations, many were happy to vilify men who have sex with men. Doing so was nothing new, after all. And when it was recognised that HIV also infected heterosexuals, sex workers, injecting drug users and 'promiscuous people' were vilified. They still are.

Sex was considered so important in the transmission of HIV that almost all large-scale HIV 'prevention' campaigns since the 1980s have concentrated on sex. In countries where it was possible to remove the threat of medical and other transmission of HIV, this was done, with a high level of success in rich countries. Less wealthy countries have had varying levels of success, some failing altogether.

As for poor countries, they didn't have a hope. Health services in the poorest countries were bad enough in the 60s and 70s but those countries who fell for the World Bank and IMF's 'structural adjustment' policies of the 80s, 90s and 2000s reduced health and other public services till most of their population hardly ever see a nurse, let alone a doctor or any kind of specialist.

Under international 'development' policies, health services, social services, education, infrastructure and anything else that could allow developing countries to develop were reduced, often to zero. Independently of HIV, although overlapping substantially with the pandemic, levels of health, education and overall development had already started to decline from the 1980s onwards.

It was very convenient to blame HIV for this, but the damage had already done. By the time HIV transmission rates had peaked and slowed down in the 90s and 2000s, structural adjustment and other policies, policies that continue to punish the poorest people in the world, had already destroyed whole populations.

Early on in the pandemic, it became obvious that HIV was not easily spread through sexual intercourse alone, especially not penile-vaginal sex. But those who had jumped on various political, religious and commercial bandwaggons weren't prepared to let go. The association of HIV with sex, especially promiscuous sex, was like a gift from the heavens.

HIV was, in a sense, just what development theorists had been looking for. They had been messing around with population control for decades, billions had been spent on persuading people in developing countries to use contraception, have fewer children, plan their families, etc. None of these attempts had been particularly productive, but the suggestion that they could hawk condoms as a means of protecting people from HIV, not just from unplanned pregnancies, was more than they could resist.

Billions more was spent on the same organizations which had done such a mediocre job for several decades, FHI, PSI, TFGI, and others (I assume there were some non-American institutions involved?). Unsurprisingly, they had even less effect on sexual behavior, maternal health and family planning than they had had in the past. But then, these weren't really the issues, were they?

The whole global HIV prevention effort was sidetracked by sex and has still to find its way back. This is not for lack of scientific evidence. The evidence has always pointed to the impossibility that serious HIV epidemics could be driven by sex alone. Serious levels of transmission only occur when the transmission route is highly efficient, such as through blood transfusions, mass vaccination campaigns, injecting drug use, etc.

But the international community was so enthralled by the apparent vindication of their view of Africans as animalistic, as not quite human, their policies are still completely skewed by such prejudices. African males are sexually incontinent and females are primarily victims, but also they have an insatiatable appetite for being pregnant, regardless of any danger to their own health or the health of their children. That's the story, anyhow.

And so the pinnacle of scientific endevour in HIV prevention is that we know how to prevent it; we just don't want to let go of our prejudices. Our prejudices are far more important than academic progress and, as for the lives, health and livelihood of generations of Africans, that has never been our major concern. And it probably never will be.


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