Thursday, March 17, 2011

Are Racism and Sexism Lessened by Being Passive-Aggressively Pursued?

Following yesterday's blog post I had a brief email conversation with Dr David Gisselquist during which he pointed out that higher levels of education, to some extent, and greater wealth, to a large extent, tend to correlate with higher HIV prevalence in African countries. Researchers are not sure what to make of these correlations, though they are well attested.

Anyhow, neither of us find the World Bank claims particularly credible and they seem to go hand in hand with a purely sexual view of African HIV transmission, the so called 'behavioral paradigm'. The view is both racist and sexist. Imagine a similar handing out of money to Western women aimed at influencing their sexual behavior, and particularly their reproductive intentions.

Anyhow, giving girls money and paying their school fees could be expected to result in higher HIV prevalence among the recipients, unless transmission patterns have changed substantially, and only since all previous population based surveys of the last 15 or 20 years have been carried out.

The same article refers briefly to a Tanzanian study, which gave cash incentives to adults who tested negative for certain sexually transmitted infections (STI). But public health experts are well aware that STIs are more than just a reflection of sexual behavior. They also reflect broaderhealth conditions in a country, that's why certain STI rates are very high in some US and other Western populations.

The idea of handing out money to people in an attempt to influence their behavior or lifestyle is not confined to sexual behavior, nor even to young people in developing countries. Money has also been used to persuade women (and some men) to use birth control of some kind, or even to be sterilized, because an institution called 'Project Prevention' has wished to intervene for one of several reasons.

Project Prevention aims at female drug users in Western countries, because they are said to play a significant part in HIV transmission there. But it is HIV positive women who are targeted in Africa (Kenya, specifically). The aim is not really prevention because if HIV transmission had been prevented in the first place, there would be no need to prevent the possible vertical transmission of HIV from the mother to their children. And Project Prevention aim to eliminate the child, hence, no prevention if they achieve that aim.

Ironically, one of the favored methods of birth control employed by Project Prevention is the intrauterine device (IUD). If Project Prevention gave a damn about the safety of women at all, they would check out the sort of conditions found in health facilities in Kenya and other high HIV prevalence countries. Getting an IUD inserted in Kenya will carry many risks, including the risk of infection with diseases such as HIV.

And that's only if things go reasonably well. If women have any future problems with an IUD they will face further, similar risks and perhaps some additional ones. Many will continue to have little access to adequate health care after Project Prevention have handed over their few dollars a head and, in common with most African women, will probably just have to put up with whatever injury that results.

Whether it is right or even effective to hand over a few dollars to influence people's behavior is one thing. And there is a lot of discussion about these questions. But even if the answer is that it is both right and effective, it will not work, because HIV is not, and never has been, purely a matter of individual behavior, sexual or otherwise.

Some commentators are correct in referring to Project Prevention's agenda as pure eugenics or 'racial hygiene'. But then, so is the bulk of prevention work carried out by the big players in HIV prevention, including Population Services International, Family Health International, The Futures Group International, the Guttemacher Institute, the Rockefeller Foundation, the Gates Foundation and many others.

Most of the billions contributed to the multi-billion dollar HIV industry has gone to treating HIV positive people. But most of the considerable fraction that has gone into prevention, very unsuccessful too, has been frittered away on trying to influence people's sexual and reproductive behavior. Project Prevention's strategy is extreme, but that's really only a matter of degree.

The various commentators abhorring the work of Project Prevention are all rightly concerned about preventing HIV transmission from mothers to their babies and they are also right in pointing out that this is a well developed and relatively successful area of HIV prevention. The problem is that too few women who are about to become pregnant, or are already pregnant, or even who have just given birth, are in any way protected from HIV infection.

It is the very assumption that HIV is almost always sexually transmitted that results in the stigma that these commentators also abhor. Project Prevention is contributing to the stigma, but so are these well-meaning critics. If the HIV industry could lose its obsession with the sexual and reproductive behavior of people in developing countries, they would be able to prevent HIV transmission that is clearly not coming from heterosexual sex.

HIV in poor countries is commonly associated with pregnancy. But this does not mean it is therefore also caused by sexual behavior. Many women are infected when they are in the later stages of pregnancy, or even after they give birth. And this is often the case when they have a HIV negative partner and they have only had sex with this HIV negative partner. At least some of these women were infected non-sexually.

Some HIV negative women have HIV positive babies and, despite the excuses of UNAIDS and others, all of these babies were infected non-sexually, probably through unsafe healthcare of some kind. HIV positive babies can even infect their mothers during breastfeeding.

Project Prevention may be racist and sexist bullies, who prey on vulnerable people in developing countries. But what they are doing is not that different from the more passive aggressive forms of racism and sexism that constitute global HIV prevention policy. HIV is not just another sexually transmitted infection, though it may sometimes be transmitted sexually. Eradicating the virus depends on accepting that and investigating the extent to which it is transmitted sexually and non-sexually.


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