http://www.workingforchange.com/article.cfm?itemid=15137&CFID=7809904&CFTOKEN=18116784

Why do Africans get AIDS?

Discover Magazine makes questionable case blaming unclean health care

Alexander Cockburn - Creators Syndicate

06.11.03 - Initially I was much taken with an interesting piece in
the latest issue of Discover magazine, Vol. 24 No. 6, dated June
2003, containing an article, "Why Do So Many Africans Get AIDS?" by
Josie Glausiusz.

Every major campaign against AIDS in Africa, Glausiusz writes, has
been based on the premise that heterosexual sex accounts for 90
percent of transmission in adults, Yet safe-sex efforts have not
stopped the spread of the epidemic, which now affects 30 million
people. Economic anthropologist David Gisselquist therefore suspected
that HIV might be spreading primarily by another route.

After analyzing 20 years of epidemiological studies, he and his
colleagues concluded that unsafe injections, blood transfusions and
other medical procedures may account for most of the AIDS
transmission in African adults. Their analysis indicates that no more
than 35 percent of HIV in that population is spread through sex.

Gisselquist's interest in AIDS was stimulated by the guidance he
received while traveling through Africa as a World Bank consultant.
"They give you a syringe and say, 'Carry this with you, and avoid all
the health care that you can.' We've been paying for third-world
health care while advising ourselves to avoid it," he says.

When Gisselquist examined hundreds of papers on AIDS in Africa, he
found evidence to back up his concerns. A study in the Democratic
Republic of the Congo, for instance, found that 39 percent of
HIV-positive, vaccinated infants had uninfected mothers. In contrast,
Gisselquist could not uncover any clear data proving that sexual
intercourse dominates the spread of African AIDS. In Zimbabwe, HIV
incidence rose by 12 percent per year during the 1990s, even as
sexually transmitted diseases sank by 25 percent overall, and condom
use rose among high-risk groups.

Gisselquist recently reported his findings in four papers published
in the International Journal of STD & AIDS. Medical researchers may
have overemphasized sexual transmission of African AIDS in part
because condom-use campaigns dovetail with their concerns about
overpopulation, Gisselquist says. They also fear that people in
Africa will lose faith in modern health care. Gisselquist urges new
efforts to halt the spread of AIDS: "Aid programs need to push
infection control in health care. And we need to give the public the
advice and the tools for protecting themselves in medical
situations," such as new syringes and single-dose vials.

I liked Gisselquist's noting of Malthusian concerns about
overpopulation, but then I talked to Cindra Feuer, who worked on the
AIDS-oriented New York magazine POZ and has also spent considerable
time in Africa. Feuer points out that the argument of noxious health
care doesn't look so good if one recalls that most poor Africans
don't have access to health care.

The core problem is that safer sex advisories and programs fare badly
in poor regions in large part because people don't have the safe sex
option.

*       A woman can't negotiate a condom with her husband. Being
married confers one of the highest risks of getting HIV in Africa.
(I'd previously regarded the theory as a piece of rather racist
myth-making, but in certain regions, Feuer confirms, African women
have higher exposure to risk because of a male liking for "dry sex,"
which can easily cause lesions because of the lack of lubrication.)
*       A sex worker gets more money from her trick if she doesn't
use a condom.
*       No condoms are available.
*       They can't afford a condom.

Safer sex tactics don't work when people are poor, and indeed safer
sex interventions are failing in industrialized nations.

Treatment, a strategy that had to overcome furious opposition from
the keep-your-legs-together crowd), is the best course. If you have
treatment, people will then get AIDS drugs, and they'll get tested.
If they get tested, they're not as likely to have unprotected sex
with their partners. If they test positive, they're not as likely to
go have unprotected sex. If they test negative, they have more
incentive to stay that way.

So treatment helps to boost prevention. If you don't have treatment,
there's no incentive to get tested, and rates will remain high.

© 2003 Creators Syndicate