The ABC of HIV

HIV / AIDS is a modern scourge, having been with us for almost three decades. Despite significant progress in the developed world there is still an overwhelming problem in the developing world especially in Africa where 64% of infected people live with only 1 in 5 getting treatment. Here in the UK with complex antiretroviral therapy doctors talk in terms of almost normal life expectancy. That is far, far from the case in Sub-Saharan Africa. There are, however, suggestions that significant reductions in the number of new HIV infections could be achieved in low and middle income countries.Previously some on the religious right have advocated the ABC campaign of “Abstinence, Be faithful and Condoms” viewing condoms as a last resort. As the, New England Journal of Medicine article I quoted earlier observes this view has been less heavily promoted recently.

There remain vast challenges in the fight against HIV in Africa. A number of problems of AIDS denialism have been stopped recently with Thabo Mbeki now supporting the view that HIV is indeed the cause of AIDS; though leading politician Jacob Zuma has made bizarre remarks about showering reducing the risk of HIV transmission. Also (though nothing to do with Zuma) the myth continues that sex with a virgin can cure the virus.

Whilst no one solution apart possibly from a vaccine (though recent results have been disappointing) will be effective; simple strategies such as treatment of other sexually transmitted infections, increased condom usage and increased anti retroviral availability are likely to be effective as noted above (link 4). One issue which would probably be helpful but is extremely difficult to address is the place of women in society. There is some scientific evidence that intimate partner violence and high levels of male control in a relationship are associated with HIV infection. In addition some medical researchers who are by no means associated with the religious right are advocating not merely ABC but a lot more letters including E for Empowerment of women in sexual decision making.

Of course the cost and potential distribution problems with condoms may at times present problems with their availability. There is of course also a much more basic problem. Let us be frank about this; men prefer not to wear condoms during sex and empowering women to demand such whilst extremely difficult in view of societal structure and sexual taboos would be useful; let alone empowering women to demand abstinence or faithfulness. As such the ABC approach might have had some merit but by moralising on sexual behaviour and its religious message it seems to have been relatively ineffective (even in societies with high levels of religious observance). On the other hand, however, one could at least in part regard it as an issue of women’s empowerment. The idea of women’s empowerment is not, however, closely associated with the religious right; and fear of cultural insensitivity may at times result in not equipping women (frequently the forgotten people in “culture”) with the ability to demand safer sexual practices. It may be time for groups other than the religious right to talk about ABCDEF etc.

Of course our own society with its rising levels of rape, and woefully low conviction rate, let alone the tendancy for women to be viewed as sex objects is hardly in much of a position to lecture others on the position of women. In terms of AIDS, however, we have the extreme good fortune that HIV is relatively rare and of course, as noted earlier, we have fairly effective drugs for its treatment.

  • joeCanuck

    It’s all rather depressing in the case of South Africa.
    I was looking forward to denier MBeki going but now his likely successor thinks you just need a shower, as you point out.
    Empowerment for women is likely far off. It’s not that long since we (western men), “gave” the vote to women.
    Still, must try to be optimistic and contribute what we can.

  • Pete Baker

    “There is some scientific evidence that intimate partner violence and high levels of male control in a relationship are associated with HIV infection.”

    Turgon

    Important to emphasise that any such correlation in that South African study is not evidence of causation.

    In fact that linked study is highly speculative

    FINDINGS: After adjustment for age and current relationship status and women’s risk behaviour, intimate partner violence (odds ratio 1.48, 95% CI 1.15-1.89) and high levels of male control in a woman’s current relationship as measured by the SRPS (1.52, 1.13-2.04) were associated with HIV seropositivity. Child sexual assault, forced first intercourse, and adult sexual assault by non-partners were not associated with HIV serostatus. INTERPRETATION: Women with violent or controlling male partners are at increased risk of HIV infection. We postulate that abusive men are more likely to have HIV and impose risky sexual practices on partners.

    Even without the detail of the adjusted findings, there are some very subjective measurements being taken into account there and that’s a very big final leap in logic to take.

    More likely that there is a correlation between abusive behaviour in men and their HIV risk behaviour.

    As their remaining point gets around to making

    Research on connections between social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviours in men, as well as effective interventions, are urgently needed.

    But I suspect that assumption was there at the beginning.

  • Turgon

    Pete,
    I think you are correct. There does, however, seem to be a problem with the position of women in some societies and I think frequently people skirt round admitting that this is one of the major problems in HIV prevention. The other articles such as the NEJM one also comment on this; that particular taboo may be beginning to be addressed. The fear is always cultural imperialism which is a legitimate concern but as I say there is sometimes a danger that culture equals what men think is important. I agree that research on this is difficult but I very much doubt that the position of women in society is not highly relevant.

  • Pete Baker

    Turgon

    How women are viewed generally within society is undoubtedly a factor in the behaviour of some men towards them.

    But the key factor in HIV incidence, and its spread, is HIV risk behaviour.

    The attempt to use suspect scientific analysis to support attempted social engineering is repellent to me.

  • Rory

    I am at a loss, Turgon, to understand where your argument is going.

    Pete has already touched above on a possible confusion with causation you may have been experiencing. My time working with the major AIDS charity in England has given me some insight into, and understanding of, how so easily such confusion can arise.

    However, we all get a bit lost at times and really all we want is to know how best to move forward – to address the problem.

    I am intrigued by this idea you have that women should be “empowered” in order to protect themselves against the potential of acquiring this virus.

    Tell me again, in simple words, if you please, how best we might all work together in order to achieve this?

    Should we tell the women, do you think?

  • Turgon

    I think Rory that the problem you percieve is common amongst people in the West. The epidemology of the infection is fundamentally different in the Africa.

    The medical professionals in this field such as those mentioned in the NEJM are begining to accept that the role of women in society is a huge problem in a number of African societies. I worry that the message about empowerment etc. is not discussed by the development community because of fear of insulting cultural sensitivities. In reality some of the positions of women are really very unacceptable and it is not racist to point this out; yet fear of percieved racism keeps people back from saying this.

    Of course telling women is critical but I fear people sometimes fail to understand the position of women in some African societies. That also needs to be said.

  • Maybe Aids is spread by people (men and women) having sex with other men and women outside of marriage. Could there be a link? Maybe some expert can do some research.

  • Intelligence Insider

    Well personally I think that promoting the use of condoms would help in this. Unfortunately the roman catholic church won’t support this in areas where they have any sort of control. For example, in Mozambique where approximately 1 in 6 of the population have HIV, and 500 new people acquire it daily, this is what the RC Archbishop Francisco Chimoi had to say;

    “I know that there are two countries in Europe … making condoms with the virus, on purpose,”

    So the RC church advice there is that you get HIV by using condoms!!!!!!

  • The problem with encouraging the use of condoms, aside from encouraging bad behaviour in itself, is that the failure rate in practice is relatively high.

  • joeCanuck

    You wouldn’t happen to have a link to a source on that, would you, Smasher?