The Integrated Regional Information Networks (IRIN) is a humanitarian news agency, part of the vast United Nations network of offices doing all sorts of things that are not always very clear. 'Bridging the Information Gap', as IRIN like to say. I was reminded about some of their stories when I was asked to do one of those online surveys that they use to show how wonderful they are. I happened to check through my blog and found I had cited an IRIN source over 20 times and it was almost always accompanied by some expression of disagreement. For example, IRIN is probably the source of the 'HIV positive Swazis eating cow dung because they don't have any other food to take with their antiretroviral drugs' story.
If the Wikipedia entry for 'Jaboya' is anything to go by, IRIN is also the main source for that story too: "an economic system common in the fishing towns of Kenya, on Lake Victoria. It is a system where the fishermen in the region form relationships (commonly sexual) with women in the communities who wish to purchase the fish to take to the market to sell. It is not uncommon for both the fishermen and the women to have multiple partners. As a result of the vast web of these relationships, the Jaboya system is said to account for the rampant increase in the HIV prevalence in the region. It has also caused the mortality rate in the region to increase." All 11 references come from IRIN.
So I wasn't surprised to hear about the jaboya system when I went to places near Lake Victoria to ask why so many people there are infected with HIV, a sexually transmitted infection, even though people all over the country have sex, yet prevalence is far lower almost everywhere else. IRIN's film 'Deadly Catch', is cited all over the web, in mainstream and less mainstream media sources. Like the story about eating cow dung, the story of women having sex with fishermen, bus drivers and market traders really captures journalists' 'imagination', a ready-made story about how Africans are easily different enough for a difficult to transmit virus like HIV to infect up to a quarter of adults in some areas around Lake Victoria.
I'm not saying IRIN made up the whole thing, I'm sure at least part of the film is based on something that happens in the area where they made the film. But I think the phenomenon is in need of a bit more research and analysis. For example, how many people, exactly, are involved in this practice? Saying this or that is 'common' doesn't really tell you anything. It is vital to know what other health risks people face, sexual and non-sexual, in order to understand the exact role this phenomenon plays in HIV transmission. Are there other diseases involved, sexually transmitted and otherwise? A brief film is great for grabbing headlines, but short on analysis. It came out seven years ago and has been widely cited, but what do we know about the practice now?
It could also be expected that jaboya or something similar would be practiced in other fishing communities, at least around Lake Victoria. But recent figures from Uganda show that HIV prevalence among fishing folk is about the same as the national average. Prevalence among long distance drivers is only a bit higher than average. In fact, the highest prevalence is found among civil servants, at more than twice the national average. Of course, news agencies like IRIN now have to go into overdrive trying to explain how civil servants face such high risks, forgetting to explain how the terrible risks faced by fishermen and transport workers appear to have magically dissipated.
The IRIN correspondent blusters about civil servants: "These people [civil servants] are always in workshops, where they meet and interact with many people. They have little time to spend with their families. This gives them enough time to have 'side dishes' [extra-marital relationships]," said Samuel Lyomoki, a member of parliament representing workers, told IRIN. "They are involved in reckless behaviours. There is a need to sensitize and take services like counselling and voluntary testing to them." I wonder how many of the workshops 'these people' attend are about HIV. Note also the mention of 'side dishes', another term that appeals to journalists.
Another beloved explanation, repeated by many when asked about high HIV prevalence among Luos, is polygamy. Some Luos do practice polygamy but there is no evidence that levels are higher in Luo areas than in other places where HIV prevalence is a lot lower. Why would it result in higher rates in just some areas? And, as the IRIN film notes, some women are 'inherited' by a relative of their husband if he dies. Of course, there is nothing about how common widow inheritance is, just the assertion that it occurs, or is 'common'. Some people will tell you that it is no longer common; but it fits in well with the story about 'traditional' practices, which are 'bad', compared to modern practices expounded by forces of good, such as the UN and it's multitude of agencies and sub-agencies.
Years of this kind of propaganda by IRIN, the UN, the US Center for Disease Control (CDC), the WHO and others means that you will hear exactly what you expect to hear if you ask people. Luos wheel out the usual about promiscuity, lack of condom use and a handful of other phenomena that have been dug out to make HIV prevention more appealing from a publicity point of view. And people have been persuaded to give their consent (arguably 'informed' consent) for their teenagers to be circumcised. Most sexually active people are saying no to circumcision, but those running the program don't really care, they get paid anyway.
Something that comes across clearly in the IRIN film, though it is not a particular focus, is that many people around Lake Victoria live in great poverty, receive very little education, live in appalling housing and dreadful environmental conditions. Health services are minimal, not particularly accessible and the disease burden is very high. There are few employment opportunities and there is little in the way of entertainment. There may be brief references to these circumstances, but the thrust of the film is that people have a lot of unsafe sex a lot of the time with a lot of people.
IRIN know how to put together a tear jerker and the entire film is shamelessly exploitative, both of the respondents and the audience. But analyzing evidence of HIV in terms of what kind of sexual behavior must have caused it, then analyzing evidence of any kind of sexual behavior in terms of what levels of HIV transmission will result, leads to a lot of circular reasoning. IRIN's claims about jaboya may now require some further research (as may their claims about dung-eating Swazis), and they should make more effort to find out why civil servants face such high risks of being infected with HIV, aside from spending a lot of time in workshops.
There are questions to be answered, truthfully this time. It's very likely that we were wrong about fishermen, sex workers, long distance drivers, 'housegirls', teachers, people who live close to Lake Victoria and various other groups who have had the collective finger pointed at them. It seems we were also wrong about civil servants. However, though high HIV prevalence among them could indicate sexual risk, it could also indicate non-sexual risks, such as through unsafe healthcare, to which they have far better access than unemployed people and those in informal employment (the majority).
We have not shown that HIV is always or almost always transmitted sexually, so we can not go from HIV infection to inferring levels of unsafe sex; nor can we go from evidence of unsafe sex to predict that HIV prevalence is high or that it will become high in the near future. We must know that by now, but we still keep on doing it. IRIN is famous for it and if they really want to do research to 'improve' their services, they should have a look back through their own disgraceful record when it comes to honest research and analysis.