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.

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