Wednesday, August 17, 2011

Nice Work: UNAIDS Paid to Continuously Clean up its Own Mess

Whatever about the non-HIV/AIDS portion of Tanzania's health sector, and it's likely to be a very small portion indeed, the HIV/AIDS portion is pretty much funded and controlled by a powerful cabal of international institutions, such as UNAIDS, the World Bank, the IMF, a few elite academic institutions, Big Pharma and some private foundations such as the Gates Foundation.

And yet communications about the HIV pandemic, which affects sub-Saharan Africa more than any other area in the world, always seem to talk about what 'we' (the cabal in question) have resolved to do. It's as if the circumstances surrounding the pandemic simply materialized out of nothing, as if they (the cabal) are just some disinterested but magnanamous outsiders, trying to put things right.

For instance, members of the UN General Assembly High Level Meeting on HIV/AIDS are said to be committed to “intensify national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV”.

But stigma, discrimination and violence relating to HIV are a direct result of the way the virus has been characterized by the HIV industry itself. When HIV was identified, stigma was first directed at gay men, then at various other groups, sex workers, intravenous drug users and others. But in Africa, the stigma was directed at all Africans.

And it still is. The HIV industry insists that HIV is almost always transmitted through heterosexual sex in high prevalence African countries. They don't know what proportion of HIV is transmitted through heterosexual sex, therefore they don't know what proportion is transmitted non-sexually, such as through unsafe healthcare or cosmetic practices. But nor are they in the least bit interested in finding out.

Because it's much easier to blame individuals and their promiscuity. You only need to rely on people's pre-existing prejudice about African sexuality to swallow this story. When it turns out that women are far more likely to be infected than men, you have to keep rewriting the story, but you can still depend on existing prejudices.

The prejudice is so pervasive that even many Africans seem to believe it. I have been told many times that Africans really do have lots of sex. But there remains quite a disagreement about who 'spreads' HIV. Some say it's men, some say it's women, some say it's foreigners, perhaps tourists, migrants or internal migrants, some even go with the HIV industry favorite, truckers.

But firstly, there is no evidence that Africans have inordinate amounts of sex, safe or unsafe. Secondly, there is no evidence that people in high prevalence countries have more sex, safe or unsafe, than people in low prevalence countries. And it is well known that HIV is difficult to transmit sexually.

Even in countries with relatively high HIV prevalence, the virus is not spread evenly. There are high prevalence areas, such as Iringa in Tanzania, at about 15%; and there are low prevalence areas, such Kigoma, where prevalence is less than 2%. Would anyone be stupid enough to claim that people in Iringa have more sex, or even more 'unsafe' sex, than people in Kigoma?

In Kenya, the province with the highest birth rates and the lowest rates of condom use has the lowest HIV prevalence. The North Eastern province also has the lowest figures for access to health, education and other social services. It is the poorest province in the country by a long shot, according to almost every indicator, except for HIV prevalence.

There are low prevalence areas in Kenya and Tanzania where many people have not heard of HIV, and it does not affect them greatly. Most of them do not know someone who has died of AIDS. HIV tends to infect people living in or close to cities or highly developed and densely populated areas. Like health and other social services, HIV also needs an infrastructure.

And stigma, too, needs an infrastructure. Africans do not have an interest in naming a disease, describing its modes of transmission and labelling those said to transmit it. That's a job for a cabal, like the one described above.

If the HIV cabal is interested in confronting "the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV", they could start by questioning their own prejudices and asking where Africans got the idea that HIV is 'spread' by promiscuity and other 'bad' things. It's a virus, not a magic spell.

It has taken a lot of money and work to stigmatize whole populations in high HIV prevalence countries and that money has been controlled by the HIV industry itself. Wringing their hands and wailing will not reverse the damage they have done. HIV transmission will only be significantly reduced when we establish exactly how the virus is being transmitted. And we know where to start: HIV is not only transmitted sexually.


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