Good news on the global AIDS front. The UN announced at the International AIDS Conference in Vienna that the prevalence of AIDS has been waning in the hardest hit areas of sub-Saharan Africa. The reason: people are taking the matter into their own hands by having fewer partners and putting off sexual activity. This is a great cause for hope—even if news this week of a partially protective gel gets vastly more attention.
The bottom line is that every instance of HIV prevalence decline in Africa is most attributable to behavior change. The converse is also true: relying on the technical fix has just not paid off. These broad trends have been known for some time, if—sad to say – not well received by the AIDS Establishment.
So, what now? Reporting these trends is one thing—and long overdue; acting upon them is another.
Former UNAIDS employee Elizabeth Pisani’s account of the inner working of the agency in her book, The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, does not inspire confidence. UNAIDS has an abysmal track record of manipulating data, suppressing inconvenient findings, and resisting sensible behavior change measures.
I have been advised that at least one of the most affected countries (in southern Africa) has—despite all the epidemiological evidence—recently dropped, from their overall HIV control strategies, any explicit reference to the behavior change that has been most instrumental in bringing about AIDS reductions. It is hard to imagine that this is a purely internal, African decision.
This is not an academic debate: according to one reliable estimate, South Africa alone could have prevented over 3 million infections over the past decade if they had implemented a prevention policy which took behavior seriously.
It’s certainly good that this report has been released—even surprisingly so at an International AIDS Conference. President Museveni of Uganda, architect of the world’s most dramatic AIDS reduction, was hectored rather than celebrated at a previous conference in Bangkok, because he dared to use common sense and prioritize behavior change.
So check back to see if UNAIDS and the Western agencies who wield such influence are ready to respond to the evidence and elevate behavior change to the center of their prevention strategies—where it deserves to be—or if they find a way to “justify” business as usual.
July 22nd, 2010 | 9:38 am
But if we tell people in Africa to clean up their sex lives, then what’ll we tell westerners? If millions of African lives have to be sacrificed to justify whorish western lifestyles, then so be it!
July 22nd, 2010 | 12:13 pm
Good point Sean…but don’t we basically export the same precise ideas that the cultural elites have long been imposing here as well.
July 22nd, 2010 | 12:54 pm
Ryan,
Maybe that’s why so many Americans dislike the idea of christian missionaries to Africa and Asia while having no problem exporting American movies, tv, technology, porn, etc. Missionaries preach an ethic of self-restraint.
July 22nd, 2010 | 3:26 pm
It looks like Tutu is not happy with Obama for cutting AIDS spending. But of course condoms will not be cut under Obama. No way.
July 22nd, 2010 | 10:23 pm
Which are worse – these International AIDS conferences or the G-8 summits? Anarchists and militants crash one but organize the other.
July 23rd, 2010 | 12:45 am
In Thailand, behavior change was certainly a big part of slowing the growth of HIV: twenty years ago, large numbers of Thai men were having unprotected sex with prostitutes while women generally stayed virgins until getting married — and would then get infected by their husbands. Now, fewer men visit prostitutes because more are having sex with their girlfriends and more are using condoms. New HIV infections have fallen by 90% and in 2003 there were only 19,000 recorded new cases.
I should follow the AIDS in Africa issue more closely than I do but I’m not aware of anyone ever saying that people do not need to change their behaviors.
July 23rd, 2010 | 7:37 pm
We have to really sit down and wonder what is being promoted here.
UNAIDS Head Michel Sidibe and Deputy President of South Africa Kgalema Motlanthe are very heavily promoting genital mutilation as HIV “prevention” and no one at the conference seems to be raising an eyebrow?
Has the whole world gone MAD???
First of all, the VERY idea. Would the WHO, UNAIDS etc. ever recommend FEMALE circumcision as a way to curb AIDS, if it were shown in “studies” that it “might” prevent HIV transmission by 60%? What about 100%?
The answer is, no, they wouldn’t. Forcefully circumcising a girl or woman would be immediately recognized as a basic human rights violation. When something is a basic human rights violation, it doesn’t matter how many studies are written for it. All the “studies” in the world would not be enough to promote female circumcision. How is it that we have allowed this to happen with male circumcision?
Why can’t researchers seem to focus on something else? What research is being done to move past circumcision? What studies are being made on alternative medicine? Usually, medicine tries to ABOLISH the use of surgery, not seek its preservation. This “lets circumcise everybody” idea is MADNESS. I’m surprised no opposition was raised at the conference.
But secondly, the claim that circumcision prevents HIV isn’t entirely solid. There are a few realities that “researchers” have failed to explain.
In America, for example, 80% of men are already circumcised from birth. The rates of infant circumcision are dropping, but at large, the population remains circumcised. These rates are at their highest in the East Coast, where cities such as Philadelphia and Washington DC rival HIV hotspots in South Africa. In the 1980s, when the AIDS epidemic first hit, the rate of circumcised men in America was at 90%. One needs to question how something that never worked here in our own country is suddenly going to start working wonders in Africa.
In other countries, the “protection” remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On Wednesday, July 7th, two weeks ago, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (in other words CIRCUMCISED). The Muslim, circumcised population accounts for 70% of the incidence of HIV, but only 60% of the population, which would mean that the circumcised population is getting HIV at a much higher rate than the non-circumcised population.
Millions are being spent on a “prevention method” with dubious benefits, when they could be spent on other modes of prevention that have been conclusively proven to work. Condoms and education for example. Some people say “that hasn’t worked,” but that’s not the reality. In some parts of Africa, it has worked so well that people wanting to “study” circumcision there have no cases to work with. Behavior change IS possible, and reports are coming in that African youth are having less sex partners, using condoms etc.
Circumcision is going to COST more money in the long run. A recent issue of the WHO Bulletin noted that African ritual circumcisions have a 35% complication rate, while clinical circumcisions have an 18% complication rate. A neonatal circumcision complication rate of 20.2% was found in Nigeria. As you may know, Annie, funds for the fight against AIDS are scarce. Dealing with these complications is going to divert resources away from other more-needed programs, such as mother-to-child transmission reduction, and treatment of people who are already infected.
Not to mention that men are using their circumcisions as an excuse not to wear condoms, putting themselves and their partners in danger. That’s MORE money, because now you have more people infected, and more people on drugs. But that’s what this whole thing in Vienna was about, wasn’t it; drugs.
Tribal groups are using the WHO’s stance to go ahead with traditional circumcision rituals, where men, if they want to be called “real men,” are ostracised if they want to go to a hospital to have a “safe” circumcision. 47 men have already died this year, and a lot more have lost their penises to gangrene.
This is already being used to carry out circumcisions in healthy, non-consenting CHILDREN. “Rights here, right now” was the slogan at this year’s conference. Where is human rights HERE? How is it that circumcision is being pushed on children who aren’t even sexually active and therefore at ZERO risk? Shouldn’t circumcision be for those who WANT it, and they KNOW they’re going to be engaging in risky behavior? Why are men being coerced in KwaZulu Natal? This is MADNESS.
This is an UNACCEPTABLE form of “prevention.” Leaders need to find something else.
I cannot get behind a movement that endorses genital mutilation as “prevention.” They’ll just have to get their money and my signature for their precious “Vienna Declaration” from elsewhere. And I’m notifying all my friends too. As long as this madness continues, UNAIDS, UNICEF etc. should NOT be getting our money. This is absolute MADNESS.
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