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.
