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.
Gisselquist takes up the narrative once more. When he examined
hundreds of papers on AIDS in Africa, he found evidence to back up those
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.
Alexander Cockburn is coeditor with Jeffrey St. Clair of the
muckraking newsletter CounterPunch. To find out more about Alexander
Cockburn and read features by other columnists and cartoonists, visit the
Creators Syndicate Web page at
www.creators.com.
COPYRIGHT 2003 CREATORS SYNDICATE, INC.
