Tuesday, March 24, 2009

A Role for the Christian Churches in Africa?

Those who refuse to accept that condoms have a role to play in reducing transmission of HIV should take note of the following findings from a study carried out in Hlabisa district, South Africa. It was found that HIV incidence (the number of new infections per year) was high and remained unchanged over a five year period, despite large scale prevention work being carried out over the same period.

HIV prevention needs to pull out all the stops. Abstinence is great if it works, being faithful is great too. Using condoms is vital where the first two don’t happen, but there are still many other things that need to be taken care of. People need education, health services, social services, they need jobs, economic security and a viable future. There are multiple vulnerabilities that allow HIV to spread and no single intervention or single set of interventions will be enough to cut transmission significantly. Transmission should be reduced by every means possible.

The South African research found that half of all new infections occurred in people who had already received a negative test result. Those who have been tested have also been counselled and thus could be expected to change their behaviour, but clearly testing and counselling are not enough.

This and other studies show that people’s behaviour is only likely to change if they are found to be HIV positive. It’s good to know that people who find they are HIV positive reduce their risky behaviour but the aim of HIV prevention should be to prevent new infections. Too much money and emphasis has gone into spectacularly unsuccessful finger wagging exercises about abstinence and Christian morality, other ill informed ‘moral’ pronouncements and downright lies and misinformation.

Most of the people who became infected during the study period were young people. Many interventions, especially school based interventions, have been shown to have little effect. They have some influence on people’s knowledge about sex, even some influence on their self-reported sexual behaviour. But most have had little or no influence on transmission of HIV or other sexually transmitted infections or even unwanted pregnancies.

In Uganda and later in Kenya, it is possible that the effect of so many people becoming visibly ill and dying resulted in behaviour change speeding up. Sadly, the pace of behaviour change may be slowing down now as a result of death rates going down. But even this doesn’t seem to have happened in the South African area in question. There are many families with several HIV positive people, some already on antiretroviral therapy (ART). Others hadn’t even heard of ART (so their behaviour could not have been affected by ‘disinhibition’, thinking that one doesn’t need to take precautions against HIV infection because treatment is available).

It is noted that Hlabisa has little employment and is mainly agricultural. Many areas of Kenya, Tanzania and other African countries are like that, the majority of people living in rural areas and living at subsistence levels. Even many of the urban dwellers live in slums and are as badly off or even worse off than rural dwellers. Most people are denied basic health, education and other social services.

It is not surprising that people receiving small amounts of schooling, or even large amounts of schooling, learn very little. Educational standards are low and those who get through school have little to look forward to. Developing countries have high disease burdens but very few health services, which are of poor quality anyhow. Water and sanitation, communications networks, transport infrastructure and other utilities have been run down for decades in Kenya and other African countries. These areas of underdevelopment need to be part of any programme intended to reduce transmission of HIV.

Given the huge following that Christian churches have in African countries, perhaps Christian leaders could preach to the as yet unconverted political leaders, business people and financiers in Africa and beyond. Perhaps they could preach abstinence from greed, dictatorship, imperialism and exploitation (although some may say these leaders are guilty of these themselves). After all, I assume they come not to call the righteous, but sinners, to repent.


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