How the war on AIDS was lost

It’s easier to focus on treatment when the Catholic Church is fighting tooth and nail against prevention.

You’re right, prevention has been ignored, so any drops in prevalence and even incidence so far have been related to the natural disease dynamics. This has been obvious for a long time so HIV will continue to spread and people will continue to suffer and die until prevention receives the attention and resources it needs. And I don’t mean half hearted prevention, like ABC, circumcision and expensive but ultimately useless marketing campaigns.

This post is all about the need for other methods when looking at development issues (in this case aids prevention). Here is a quote from a review of Epstein’s book:

(Quote) “Epstein, a public health specialist and molecular biologist who has worked on AIDS vaccine research, overturns many of our received notions about why AIDS is rampant in Africa and what to do about it. She charges that Western governments and philanthropists, though well-meaning, have been wholly misguided, and that Africans themselves, who understand their own cultures, often know best how to address HIV in their communities. Most significant is Epstein’s discussion of concurrent sexual relations in Africa. Africans often engage in two or three long-term concurrent relationships—which proves more conducive to the spread of AIDS than Western-style promiscuity. Persuade Africans to forgo concurrency for monogamy, and the infection rate plummets, as it did in Uganda in the mid-1990s. On the other hand, ad campaigns focused on condom use helped imply falsely that only prostitutes and truck drivers get AIDS. In addition, Epstein examines what she calls the “African earthquake”: social and economic upheaval that have also eased the spread of HIV. Epstein is a lucid writer, translating abstruse scientific concepts into language nonspecialists can easily grasp. Provocative, passionate and incisive, this may be the most important book on AIDS published this year—indeed, it may even save lives”

I agree. And not to beat a dead horse, but this further illustrates the root of some of the criticisms of an earlier post on the ‘resource curse’ and the shortcomings of a development economic-centric approach. That is to say, the vastly important role that culture plays and the need for qualitative/ethnographic data, as well as numbers, in ascertaining relationships not easily reducible to one-stop approaches/initiatives.

Please excuse 3 posts in a row – not trying to spam! But re Joe McLoughlin; it may be true that other illnesses can trigger a positive result and certainly there are clearly going to be issues (in some form) with pharmaceuticals as they are, in the end, there to make money. But it’s important to note that Harry H Bauer who wrote “The Origin, Persistence and Failings of HIV/AIDS Theory” also believes Aids is not sexually transmitted….a pretty substantial core failing in his overall theory wouldn’t you agree?

“In his 2007 book, The Origins, Persistence, and Failings of HIV/AIDS Theory,[19] Bauer questions whether HIV exists, claiming that HIV tests are not accurate and that AIDS death statistics are faked by a conspiracy of the media, scientists and pharmaceutical companies. Bauer claims that African Americans are more sexually promiscuous and use more illegal drugs than other groups, but says sex and drug use are not involved in AIDS since, according to him, Native Americans are also sexually promiscuous and have high drug use but do not often test positive for HIV (p. 64). Bauer hypothesises that African Americans are more likely to test HIV-positive because of supposed genetic mutations.[19] As is the case for AIDS denialism in general, Bauer’s notions on HIV/AIDS and race are rejected by the mainstream scientific community, based upon decades of research and overwhelming scientific consensus that HIV exists, is infectious, causes AIDS, and that HIV tests are accurate.”

Not sure focusing on Bono or Bill Gates here is productive or helpful ….

fact is, many women are infected by a single man for many reasons, prostitution, domestic violence, rape, or simply being trusting.

You fail to mention the known differences between male and female infections, and I think (though I may be wrong), the number is chilling.

Since men use sex for a variety of reasons — control, power, pleasure, and women remain uneducated and vulnerable to their whims, I think laying this at the feet of your usual suspects is more than a stretch.

There’s plenty of blame to go around in a man’s world …. Bill Clinton not the only one with penis (i.e. power) issues in the real “on the ground” world.

Educating women and giving them the ability to say “no” or “wear this” and providing condemns still the best answer ….

I think dragging in a bevy of educated specialists (primarily men) to pontificate in the abstract on lint in the tummy button is silly when the answer’s to be had on the ground with informed individuals (primarily women) equipped to say “over my dead body” far more effective and my guess, cost efficient.

I am of course speaking of prevention, not drug administration for those already infected.

Just this woman’s opinion …. and another dimension to the discussion.

Having worked for more than two years in Swaziland, the country infamous for the world’s highest HIV prevalence, it’s fairly clear to me why the focus has been on treatment instead of prevention: treatment is easier. As complex as ART is, it still comes in pill form with simple instructions—take three times a day with meals.

Prevention is much more difficult and met with resistance by political and religious leadership and—strikingly—by HIV positive activists who feel shamed by suggestions that others take personal responsibility for their sexual behavior.

Prevention cannot be bought with aid dollars. It cannot be solved with procurement. The problem is NOT that more financial resources have gone to treatment rather than prevention, but that no one—especially local leadership—has ever been serious about sending the necessarily blunt and uncomfortable messages it takes to get people to change their sexual behaviors.

HIV is not an issue of poverty, and in fact, we see empirically that HIV is a problem of poor countries, but not the poorest people within them and that economic collapse in Zimbabwe in fact slowed the spread of HIV. HIV is not just an issue of men cheating on their wives. In Swaziland, women were just as likely to have multiple partners as men and not just for transactional sex, but also because they are searching for love and companionship.

HIV is about unprotected sex with infected individuals. But until we are willing to speak that truth and insist that people take personal responsibility for their sexual lives, we’ll keep digging holes in our budgets for perpetual ART and holes in the African soil for more young bodies.

The issue is not so much that we overemphasize treatment over prevention: we need, and do, both, and as Gregg points out they are actually complementary. The issue is that treatment is incredibly effective everywhere, but we still don’t know how to do prevention. There is still a lot of debate over what actually accounts for the Uganda decline in infections, but even if we could narrow down the cause, it may not be generalizable to other countries becuase of different patterns and cultural practices. And even in Uganda, the trend is reversing. So we still don’t know how to do prevention.

There are only two ways the epidemic can end.
1) New infections stop.
2) A cure is found.

So of course prevention is vital. But while we wait for an answer of how to do it effectively, treatment is a bonafide way to manage the problem. Oh, and save millions of lives.

As previously noted, prevention and treatment work together – this is true in the US and sub-Saharan Africa. Poverty, malaria, TB, limited access to clean water, gender inequality, homophobia – these issues are part of the equation, too.

And nobody has mentioned the original “searchers” in the Ugandan response to HIV/AIDS – Dr. Kaleeba and The AIDS Support Organization (TASO). Learn more here: http://www.tasouganda.org

One thing that frequently gets ignored is that the transmission rate of HIV is higher in Africa than in the US for any given sexual encounter. People think prevention is so difficult because they think the issue is that people in sub-Saharan Africa are more promiscuous or have more partners than people in the US. In reality, there are a number of other risk factors that increase the probability of transmission for a given sexual encounter, including other health problems, inter-generational relationships, low rates of circumcision, and a practice known as “dry sex” where women use herbs and other means to eliminate their body’s natural lubrication (and protection!). There are multiple potential interventions to change these risk factors, and many have been proven successful, such as the work by Dupas showing that educating Kenyan teens about the dangers of intergenerational-relationships (sugar daddies) decreased their incidence. You can read more about dry sex here.