No questions are raised about the long held assumption that HIV is ‘all about sex’. The authors seem to make the same assumption themselves. They don’t question people’s right to health information and to health education, which sex education is only a part of. These rights are very clearly stated in the World Medical Association’s Lisbon Declaration on the Rights of the Patient.
What about Uganda’s ban on sex education? The Guardian could have mentioned that, if they feel that this is so relevant to HIV. The tone and content of sex and sex education articles tend to be quite different when they are about sex in a UK or non-African context. Similarly with ‘Aids and HIV’. In the UK, people have a right to privacy, for example, but not in African countries, where a HIV positive diagnosis is assumed to indicate ‘unsafe’ sex, regardless of what the person may report.
The Guardian doesn’t wag its finger at adult men who have sex with adult men and tick them off about their ‘promiscuity’. But finger-wagging at adult men and women in high HIV prevalence countries in parts of Africa is routine, as if they are behaving like disobedient children. The Guardian doesn’t seem to notice these double standards.
The question ‘Why are you having sex? You should be married’? is said to be an instance of discrimination against young females who attempt 'to access HIV prevention services from the health sector'. But the Ugandan health sector is shaped and funded by an international community that insists that HIV is all about sex. The 'stigma' to which the article alludes comes from the HIV community, from the media, from governments and international communities.
Why more young girls than young boys: "Health experts have attributed the disparity to the fact men tend to have more sexual partners, so a man with HIV would spread the infection to more people". Aside from the logistics of that 'expert' opinion, it also seems to be based on the assumption that sex is usually instigated by men, with women usually being unwilling victims, that men are ‘more promiscuous’ than women, etc. Or perhaps those assumptions are totally absent?
While we are questioning differing prevalence rates by gender, what about some of the other figures gathered for Uganda and elsewhere (see Uganda Aids Indicator Survey, 2011 and others)? For example, why are there often large numbers of HIV positive virgins, who were not infected vertically? There have been cases of babies who seroconverted even though their mother were not infected. Some babies have infected their mothers, through breastfeeding. Many HIV positive women have one partner, who is seronegative.
There are so many discrepancies, aside from ones relating to sexual behavior, or appearing to. Why is high HIV prevalence clustered in just a few places in most countries (Kenya is a good example)? Why are rich people more likely than poor people to be infected? Why are employed people more likely to be infected than unemployed people? What difference does religious belief system make?
What is it about location, environment, economic circumstances, employment status and other factors that results in very high HIV prevalence in some countries, but not in others? The stock response from UNAIDS tends to be about differing ‘sexual mores’, differing sexual ‘mixing’ behavior in urban and rural areas, wealth inequalities (which result in more rich people paying for sex and more poor people engaging in paid sex, apparently), etc. It’s as if sexual behavior is the only determinant of HIV exposure and status, uniquely so among diseases, a complete epidemiological anomaly, and only in (some) African countries.
Instead of concentrating on sex alone, perhaps we could examine conditions in health facilities, and differing levels of access to health facilities, differing quality in health facilities, where only those with money, insurance, even transport and good infrastructure, can access? Some people are in a better position to protect themselves from non-sexual exposure to HIV, if only they also had access to accurate health information. Health funding, insurance and access will only improve health if it is high quality and safe healthcare.
The title and overall tone of the Guardian article concludes that 'it's all about sex', before anything else appears. No argument is given for their conclusion. Asia Russell of Health GAP is right to warn that the figures are for prevalence, an indication of how many people are infected with HIV in a population or group. This is not as useful a measure as incidence, which estimates how many people were newly infected with HIV, usually in a period of one year.
But neither prevalence nor incidence figures are relevant to the content of the article because the factoids are either based on opinion, or they are commonly held assumptions (some would say ‘prejudices’). These include assumptions about 'African' sexuality, attitudes towards women, underage sex, intergenerational sex, 'promiscuity', sexual practices, 'African' masculinity, the status of women, etc.
The article is about The Guardian's and its authors' prejudices, not about Uganda, HIV or 'Africans'. Presumably it contributes to, and also concurs with, the prejudices of Guardian readers, what they expect and perhaps enjoy reading about HIV, and sexual behavior in ‘Africa’.
The article does not draw attention to the fact that the health workers (ostensibly, those purveyors of (institutionalized) stigma and discrimination) make no mention of unsafe healthcare, 'informal' or unofficial healthcare, traditional healthcare and similar practices, cosmetic practices (such as tattooing) and others that could, however inadvertently, result in exposure to HIV contaminated blood.
At the end of the article we are told that the Ugandan health ministry has called for “concerted efforts from all stakeholders for scale-up of evidence-based interventions for sustainable HIV epidemic control”. But if those ‘evidence’ based interventions refer to the same prejudices and assumptions as the Guardian article, they will have no impact on transmission rates. What’s the point in scaling up interventions that have failed?
It’s the assumptions that are wrong, not the data. Prevalence rising or falling, incidence rising or falling, female rates higher or lower than male, none of these data can tell us how people are being infected with HIV. There is data suggesting that it’s not all about sex, but this is being ignored or reinterpreted.
The racism of The Guardian has disastrous consequences for people in high HIV prevalence countries. But the realization that HIV is not all about sex can only have positive consequences: people’s exposure can be reduced, perhaps totally eliminated. Accurate health information and health education, to which everyone has a right, can achieve this. Well informed, educated patients and healthcare practitioners can take action, raise awareness and change things for the better.