Thursday, July 15, 2010

HIV Programs That Never Happened

A steaming pile with hundreds of flies buzzing around it surely means a fresh press release has been issued. And putting '2.0' after the word 'treatment' has ensured that every big news agency repeats the press release so that if repetition makes something true, there really is a new approach to HIV treatment. And treatment is prevention, that's been repeated a lot too. And young people are leading the prevention revolution, because a press release saying so has been passed in advance of the Vienna Aids Conference, which involves those in the HIV industry meeting up and patting each other on the back. Predictably, the 'free' press has picked up that one as well.

Meanwhile in South Africa, a piece of research gives an idea of what people really think about condoms, which are an important aspect of preventing HIV transmission through sexual contact. In many African countries condoms are used by young people, but only by some young people and only some of the time. A point that has been entirely missed by UNAIDS is that male condoms need to be worn on penises, preferably erect ones, before and during sexual intercourse. They can be removed afterwards. But waving them around conference halls, writing policy papers about them, filling up storage space with them, putting lots of pretty pictures of them on your website and issuing press releases about them has little impact on sexually transmitted HIV.

This paper finds that most women and girls are not in a position of power in a relationship and do not usually get to decide or even discuss whether to use a condom. Also, some people have negative beliefs about condoms, such as that they decrease sexual pleasure. Others feel that if condoms are discussed, there must be a lack of trust in the relationship, although that lack of trust may be quite justified. A lot of people just don't talk about condoms, HIV or risks like pregnancy or infection with a sexually transmitted infection (STI).

But what is probably one of the biggest obstacles to reducing HIV transmission is the association of HIV with sexual promiscuity and casual sex. Many people, under such circumstances, would think twice before buying condoms in a pharmacy where there are lots of other people or even being seen with condoms, even by their most intimate friends. Young people are unlikely to be sold condoms by pharmacists or given them by health workers because of the stigma that HIV has been surrounded with. Given that HIV transmission is not just a matter of sexual behaviour, why all the stigma?

Well, the HIV industry itself plays a big part in fuelling the stigma that surrounds HIV transmission. The big players in the industry (and they are big) maintain that HIV in developing countries is almost always transmitted through heterosexual sex. They deny that there is any significant risk from unsafe healthcare or cosmetic practices, despite many questions about this claim. The fact that there are young children and infants with HIV whose mothers' are HIV negative should set off alarms and give rise to investigations. But in African countries, no such investigations have been carried out. Many women are infected, often after they become pregnant, even though they have only had sex with their HIV negative husband. Again, no investigations.

Colluding with the HIV industry are the many political interests, African and non-African, commercial interests, generally non-African, and the hoards of religious groups, who can't open their mouths without spreading stigma. And the above research uncovers some of the lies that church leaders spread about HIV, about condoms and about sex education. It's not as if church leaders are above reproach themselves and I'm not just talking about the Catholic Church.

You can accept the plethora of 'good news' HIV press releases or not but it would be very surprising if young people were 'leading the way' in HIV reduction when they are surrounded by a complete absence of accurate information about HIV and a whole lot of lies, often contradictory lies. While UNAIDS tells them that 'safe sex' will protect them from HIV, the churches tell them that condoms are not safe. Many young people are told little or nothing by their parents or teachers, who probably know little more than their children do. If HIV transmission among young people is falling, this is unlikely to have much to do with HIV prevention programs.


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