Wednesday, April 18, 2012

Tanzanian Universities and HIV Risk

"Urgent and concerted effort is needed to rescue [Tanzanian] students in higher learning institutions from contracting HIV/Aids" because "most students engage in risky behaviours", according to an article in The Tanzanian Guardian. 'Risk', of course, refers to sexual risk here, as it tends to do in the mainstream media. Presumably, Tanzanian students don't go to hospitals, sexually transmitted infection clinics, hairdressers, manicurists, tattoo artists or anywhere blood-borne infections might be a risk.

Africans are almost always infected through heterosexual sex, according to UNAIDS. This is quite unique as transmission through penile-vaginal sex is the exception in Western countries, where men having sex with men and intravenous drug users who share injecting equipment face the highest risks. Indeed, Africans are also unique in that UN employees, international NGO employees and foreign tourists face non-sexual risks when travelling and working in African countries, but Africans, apparently, don't.

The article gushes on about 'multiple concurrent partnerships' (MCP), which 'most students' engage in. This means they have several partners that overlap with each other, rather than several partners one after the other. The author, one 'Correspondent', clearly hasn't followed the issue of MCPs, which Larry Sawers, Eileen Stillwaggon and others have shown does not result in increased rates of HIV transmission. MCP is not "a major driver of [the] HIV epidemic", as Correspondent would have us believe.

The correspondent goes on with the usual cliched stuff, but according to Tanzania's Malaria and AIDS Indicator Survey 2007-08 (THEMIS), HIV prevalence in 15-24 year olds is 5.5% among females with no education and 3.1% among those with an incomplete primary education. And while it is 3.8% among those with complete primary education, it drops to 1.4% among those with secondary education or higher. For males, the highest prevalence is among those with no education or those with incomplete primary education, both at 1.5%. For those with a complete primary education, prevalence is .8%, and only .7% for those with secondary education or higher.

Some of the revered 'risks' for HIV also seem a lot less threatening according to THEMIS. Prevalence among females with a partner 10 or more years older is 5.1% but it only drops to 4.9% for those whose partner was less than 10 years older, the same age or younger. HIV prevalence is higher for females who didn't have higher risk sexual intercourse in the previous 12 months than those who did. It's even higher among those who didn't have sex at all in the same period. Bear in mind, these are young people, 15-24 year olds, most of whom have not been sexually active for long. But surely it's the fact that HIV prevalence is .7% in female virgins and 1.1% in male virgins that's in need of explanation?

According to one of the author's respondents, sex is often for 'subsistence'; but he also says that "the desire for luxury material possessions was one of the key driving factors compelling girls to go for more than one sexual partner". It's hard to know how much of this sort of thing is lifted straight from poorly researched newspaper articles. But given that HIV prevalence for young people in Tanzania stands at 3.6% for females and 1.1% for males overall, prevalence for those with higher levels of education are lower than for those in all other groups.

Far from showing that "Most university students [are] at high risk of HIV infection", the title of the article, one could be led to believe that high levels of 'risky' sex do not lead to high HIV prevalence. Taking into account the figures from THEMIS, one might even suspect that when non-sexually transmitted, and perhaps non-heterosexually transmitted HIV are subtracted, we have been teaching young people the wrong things, and asking them the wrong questions when trying to pad out a rather limp article about student life.

Don't get me wrong, unprotected sex with someone about whom you know little is a mistake; sexually transmitted infections and unplanned pregnancies should be avoided. Abuse of alcohol and other drugs can also have serious consequences and students should be counselled against such behavior. It's also deplorable that anyone should have so little money that they could put their own health and life at risk. But let's tell young people about non-sexual risks for HIV and other blood-borne diseases as well, the risks they may face in health facilities and perhaps cosmetic facilities.

It would be far more instructive to know why HIV prevalence is so much lower among those with secondary education or higher, especially if 'unsafe' sex is as widespread as this and other journalists would have us believe. 1.4% prevalence among young females and .7% among males is totally unacceptable. But wagging our fingers to the bone about sex will not reduce transmission if young people, unknowingly, face easily avoidable non-sexual risks.

[For more about non-sexual HIV transmission and how to avoid it, see the Don't Get Stuck With HIV site.]


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