Shaming people for their alleged sexual behavior has deadly consequences for everyone infected with HIV and anyone engaged in behaviors said to result in HIV transmission, or claimed to be so engaged. Given the weight of evidence against the sexual behavior paradigm of HIV transmission (which, mysteriously, only operates in high prevalence African countries), why does the industry still use it to prop up every campaign?
When HIV was identified in several US cities in the 1980s, it was mainly found among men who had sex with men (MSM), injecting drug users (IDU) and people who received blood products or transfusions that contained the virus. Now, 40 years later, the largest proportion of people in those same US cities with HIV are MSM, with IDUs a distant second.
A few years later, when HIV started to spread rapidly in African countries, such ‘high risk groups’ did not account for the highest proportion of HIV transmissions. Rather, prevalence was higher among people who were not MSM or IDUs. Prevalence was high among a group often referred to as commercial sex workers (CSW), or just as sex workers. But it’s not clear that these were coherent groups of people who self-identified as sex workers, or if they were assumed to be sex workers by those collecting data, on the basis of their HIV status.
In fact, many of the people infected with HIV early on in the epidemic in African countries which subsequently experienced the highest prevalence rates in the world were more closely associated with healthcare than with high levels of ‘risky’ sexual behavior. Women who gave birth in health facilities, even clients of STI facilities, were infected in very large numbers. And that is still the case. Most people infected do not engage in any kind of risky behavior. Their infections are unexplained by the prevailing paradigm.
From the 1980s onwards, very high transmission rates in African countries tended to be found in cities, within the compounds of employers of large numbers of people, such as mines and other labor-intensive industries, close to well-developed infrastructures, in the vicinity of large hospitals, and in areas and countries where healthcare was accessible to all or most people. Examples of this are South Africa, Botswana, Zimbabwe, Zambia, Swaziland and Lesotho, mostly in Southern or Eastern Africa.
In contrast, most countries, even on the African continent, experienced lower transmission rates. Transmission rates in countries in the north of the continent, especially those on or overlapping with the Sahara, were, and still are, lower than in many US cities. Isolated areas, places where healthcare facilities didn’t exist, or were not used by most people, remained relatively free of HIV. Even in countries where HIV prevalence was very high in some areas, it remained low in isolated areas. Examples are Kenya, Tanzania, Uganda and others, where there are only a few high prevalence hostpots.
So why did the HIV industry play the LGBTQ and promiscuity cards in countries where neither MSM nor sexual behavior seemed to be the biggest risk for HIV transmission? If the industry wanted people in African countries to reduce transmission, they would have had more success if they had encouraged healthcare facilities to figure out why they seemed to be the source of a lot of infections, perhaps a majority. The funders of healthcare (and HIV) would have been ideally placed to insist that an appropriate proportion of funding be spent on healthcare safety, or to withdraw the funding if it was not.
Some transmission may have been a result of sexual behavior, although probably not the sexual behavior of most people, which tended to be conservative. And MSM sex does occur, despite western ‘experts’ initially claiming that it was rare in ‘African’ countries. But successive Modes of Transmission Surveys have shown that infections among these higher risk groups make up only a small proportion of total infections.
All people infected with HIV, young women, men, married or single, those engaged in sex work, or alleged to be so engaged, every MSM, including those alleged to be gay, prisoners and almost everyone else in high HIV prevalence countries suffer the consequences of the continued association of high HIV prevalence with promiscuity and with MSM.
An article in SciDev.net trots out the tired old fictoids, about homophobia threatening ‘HIV progress’, about HIV prevalence being "higher in countries with laws that criminalize homosexuality", and the insinuation that this “could impact foreign aid to Uganda”.
The deep homophobia that we see in Uganda and other high HIV prevalence countries didn’t exist in the 1980s. The bill (the ‘Bahati Bill’) that initially proposed lengthy sentences and even the death penalty was supported by US evangelical Christians. The spite towards ‘sex workers’ and people who were perceived as being promiscuous was a continuation of long-held prejudices about ‘African’ promiscuity, dating back to the Eugenicists, and beyond.
The worst HIV epidemic in the world is in South Africa, where as much as 20% of the global population of HIV positive people live. Yet, homosexuality is not criminalized there. In contrast, HIV prevalence in most North African countries is lower than that found in many western countries and in US cities where HIV prevalence has been high since the 1980s, although homosexuality is criminalized in most North African countries. Many countries where homosexuality is criminalized are also countries with low or very low HIV prevalence, such as those in the Middle East, Central Asia and elsewhere.
Numerous Aids Indicator Surveys and Demographic and Health Surveys show that most people in all countries, on every continent, engage in relatively low levels of sex, ‘risky’ or otherwise. Some people engage in high levels of sex, sometimes ‘risky’ sex, in every country. Among MSM, only some are ‘promiscuous’ and many take precautions to avoid infecting others or being infected with HIV. Outside of sub-Saharan Africa, people engaged in sex work are unlikely to be infected with HIV unless they are also IDUs or have some other, non-sexual risk.
Playing the promiscuity and LBGTQ cards is what drives the increasing homophobia seen in countries like Uganda. Obama and Cameron threatened to reconsider HIV funding after the Bahati Bill was proposed and Museveni, predictably, said they could keep their funding. This SciDev.net article seems to be reiterating that threat. It was the HIV industry that built itself up around prejudices and issues that the legacy and trade media will always report assiduously.
If SciDev.net and the HIV industry in general are genuinely interested in addressing HIV transmission, after dithering for 4 decades, they could start asking some of these questions that have long demanded an answer. If only some HIV transmission is accounted for by sexual behavior, including MSM sex, how is the rest to be accounted for? If that question is not answered then HIV transmission will continue through the industry’s next ‘target’, 2030.