Radical Needs to be More Radical Than This

The Global Citizen Summit on HIV and AIDS, which took place in Nairobi in May came to some interesting conclusions. The conference called for a more radical plan to prevent HIV and treat those who are HIV positive.

They endorsed universal testing, for a start, which is particularly commendable because it is not part of the much hyped plan to test everyone and treat everyone found to be HIV positive. Not that I think that would be a bad thing to do, I just doubt the feasibility of such a huge and expensive undertaking at a time when fewer than 20% of people know their HIV status and the 30% of so HIV positive people on treatment may not be on treatment for long because of funding shortages.

But the more people tested, the better, whether there is treatment available or not. At least if people know their status they can take some measures to avoid infecting others.

The Summit also concluded that the Abstain, Be faithful, use a Condom strategy (ABC) is now obsolete, that it was a great strategy but that it had failed. I'm not sure what was so great about it if it failed but better late than never.

More worryingly, they came up with a strategy called SAVE or safer sexual practices, access to medication, VCT and Empowerment.

It's all very well to conclude that a strategy has failed and needs to be replaced but I wonder about the wisdom of replacing one costly slogan with another? Not that there is anything wrong with any of these aims, they are all good. But one of the problems with ABC was the dogmatism that went with it and the way it was indiscriminately shoved down the throats of everyone for so many years when it was clearly wrongheaded.

A single slogan with however many sub slogans is not what is needed. There are many conditions surrounding the transmission of HIV and they vary from place to place. Trotting out some slogan, no matter how enlightened it may seem in comparison to the moribund ABC campaigns, will simply not be appropriate for most contexts.

HIV is just one disease but its transmission is assisted by many different circumstances. People in a Nairobi or Mombasa slum have different vulnerabilities from commercial sex workers in smart clubs and tourist resorts. Men who have sex with men and women who have sex with women have different needs from long distance drivers, orphans and vulnerable children, single mothers in isolated rural areas, people on slave wages in export processing zones (EPZ) and underpaid workers on sugar or tea plantations.

The unwillingness to accept that HIV is transmitted in so many different contexts is one of the reasons why attempts to reduce its spread have been so unsuccessful. HIV is not just about sex, it's not just about commercial sex workers, intravenous drug users or same sex relationships, it's about so many different things. There is no single slogan that can be used and there is no single slogan needed. Marketing is to persuade people that they need something they may not need, good health and safe sex are not like that.

Some things do not work on commercial or economic principles and a really radical approach to HIV would reject the use of these failed approaches. A lot of money has been spent on expensive campaigns when what people need is good information and education. Marketing and the patronising slogans that go with it are no substitute for these.