Tuesday, July 12, 2011

Abstinence is just a Distraction and Will Not Eradicate HIV

Sexually transmitted infections (STI) are not highest in countries where the people are most promiscuous. According to figures on the 'Barking up the wrong tree' blog, Finland is number one in the promiscuity charts, followed by New Zealand, Slovenia and Lithuania. None of the countries in the top ten are in Africa and they are all likely to be relatively low on the STI charts.

In fact, high rates of STIs are more closely associated with crumbling health services than 'promiscuity' levels. If any avoidable and treatable disease, whether sexually transmitted or not, reaches endemic proportions in a country, that says a lot about its health services and the conditions in which people live.

But that doesn't stop journalists writing about promiscuity, immorality and groups of people who need to be targeted by whatever HIV prevention program happens to be hitting the headlines. Usually it's immoral men who are the target, even though far more women than men are infected with HIV in high prevalence countries.

Ironically, the South African health minister, Aaron Motsoaledi recommends male circumcision and public confidence in state run hospitals. Yet, elsewhere we read about the conditions in SA hospitals, which would not encourage anyone to have any kind of invasive treatment there, let alone circumcision. One of the biggest fears would be HIV and other blood borne diseases.

Some of the most popular punchbags have been truckers and other long distance drivers and sex workers. These two groups may well be promiscuous but articles about their behavior never seem to enquire into the whole range of HIV related risks they face. For example, both groups have been targeted by STI reduction programs. But HIV prevalence among sex workers in Tanzania and Kenya rocketed long before it was common in the general population. So did the STI programs inadvertently spread HIV?

In response to the motion "Can we treat our way out of the HIV epidemic?", a professor chairing the debate asked "what would happen if we targeted key populations such as sex workers, truck drivers and fishermen?" Well it depends on what they are targeted with. If it's more of the usual finger-wagging, I think the result will also be more of the same - nothing. But if some effort is made to find out why these groups are infected in such large numbers we might find our way out of the entire pandemic.

The First Ladies referred to in a recent article make a common mistake: they claim that "if the youth shun pre-marital sex and married partners are faithful to each other, Africa will get a generation of children free of AIDS". They are talking about a world where HIV is almost always transmitted sexually. This is not such a world. They may have a point about reducing sexual risk but that has never translated into reduced HIV transmission.

Despite all the talk about 'risky' sexual behavior leading to high rates of HIV transmission, research from Tanzania shows that high levels of risky behavior (multiple sexual partners and low condom use) often don't result in high HIV rates. None of the areas studied have especially high HIV rates, unless that's about to change.

The association of HIV with sex, morality, religion, etc, is not based on any evidence about how HIV is transmitted or about how transmission could be reduced. Efforts to reduce transmission in high prevalence countries have long been in vain. And as long as these ridiculous and stigmatizing claims continue to be made, HIV will not be eradicated. Abstinence is not the answer, no matter how much the HIV industry may love the concept.


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