Sunday, March 13, 2011

Africans Slowly Start to Question the Popular View of 'African' Sexuality

It's nothing new for a Kenyan minister to opt for foreign medical services rather than settle for the best their own country has to offer. Never mind that non-whites in the US currently get the worst medical services their country has to offer, if they get anything at all. Kenya has some high quality, private facilities, but the country's political elite are not tempted.

However, when the Minister for Medical Services, Professor Anyang' Nyong'o, heads to the US for prostate work, people may do well to sit up and take notice. Does the Minister know something about Kenyan health services that leads to those in the best position to judge their quality choosing to head off elsewhere? Of course, he is hardly going to face the sort of hazards faced by non-white Americans, but there surely must be something available in Kenya for those able to pay, or for those who don't have to pay?

Well, in early October of last year, the same minister pointed out that there are many problems with health care provision in the country. Quite an understatement. I blogged about it at the time and there are a couple of links to some further information.

But Nyong'o is remarkable in drawing attention also to the possible contribution that unsafe health services could make to the HIV epidemic and various other blood borne viruses. Politicians normally don't even come close to considering this possibility, that at least some HIV transmission in countries with appalling health services may result from unsafe health care practices.

The closest I have heard has come from former South African President Thabo Mbeki, who pointed out that Africans face numerous health risks that could just as easily explain what the rest of the world calls the HIV epidemic. Mbeki infamously went a lot further than that and refused to accept that there was a HIV epidemic. He made the biggest blunder possible, despite his valuable insights into the plight of Africans and other developing peoples.

But people like Mbeki, and even Nyong'o, are shedding more light on the drivers of HIV than whole teams of highly qualified scientists from the Johns Hopkins School of Medicine and various other elite academic institutions. There are some Africans who sense that the deeply racist explanation of HIV being driven by some notional African sexuality is not going to help eradicate the virus.

Nyong'o also raises other interesting points, such as the lower quality of health care found in rural areas, compared to urban areas. But he doesn't go far enough. Most rural areas have no health care facilities whatsoever, the majority of facilities being located close to or in urban centres, or at least close to surfaced roads, another thing that is in short supply in Kenya.

And he could have gone further still: in areas of Kenya where access to health facilities is lowest, HIV prevalence is also lowest. Yet, it is clear that people don't have less sex, or less unprotected sex, in these areas. In the North Eastern province, where health and other social services are lowest, birth rates are highest, early marriages are most common, female genital mutilation is most common, intergenerational marriages are most common, etc.

Mbeki was wrong in concluding that HIV affects the poorest disproportionately; it affects those who are just rich enough to access what are very poor health services. Of course, many such people are poor and suffer from numerous other health hazards, but the richest of the poor suffer the highest rates of HIV. And that probably means that even the best health facilities are not too reliable and Nyong'o is better off taking his chances with the health facilities of a country that would normally discriminate against him.


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