A recent blog post I wrote received some comments from ‘Brad’, at The Mosaic Initiative, a grassroots organization based in the US. Although Brad seems to think that what I wrote accords in some way with what he believes, it is quite clear to me that we both think very different things about HIV.
For a start, I believe that HIV epidemics in African countries are NOT like HIV epidemics in the US and other Western countries. The bulk of HIV transmission in Western countries is a result of either male to male sex or injected drug use. The bulk of HIV transmission in African countries is not a result of either of these, in any country.
The very point of the Don’t Get Stuck With HIV website and blog is that no African country has made a convincing estimate of the proportion of HIV transmission that is a result of sexual, as opposed to non-sexual transmission. It is just assumed that about 80% is a result of heterosexual sex and most of the remaining 20% is accounted for by mother to child transmission; these assumptions have been held for more than 20 years and emanate from WHO, the World Bank, UNAIDS and other institutions that control HIV funding, globally and in African countries.
I also disagree with Brad that it is merely “important to know how HIV is spreading”; it is vital to know whether someone was infected through sex, through unsafe healthcare, through some traditional practice or in a tattoo studio. There is no “generalized pandemic” that Brad speaks of. In Western countries, the vast majority of people are not at risk of being infected with HIV. Even in African countries some people are more likely to be infected than others; in Burundi HIV prevalence is low, but in Botswana it is high. In cities, even Bujumbura, prevalence tends to be high.
Prevalence is almost always higher among women than men in high prevalence African countries, higher among employed people than unemployed people, higher among wealthier people than poor people, etc. There is a huge level of heterogeneity, between and within countries. This heterogeneity does not seem to correlate very much with sexual behavior, though you may believe otherwise if you have immersed yourself in HIV industry literature.
For example, birth rates are high in Kenya’s Northeastern Province, condom use is low, education is low, poverty is high, intergenerational marriage and sex rates are high, all things thought to relate to high HIV transmission; but HIV prevalence is the lowest in the country, lower than in some US cities.
The problem with the approach of UNAIDS and others is not that they employ ‘targeting’, as Brad suggests, but that their assumption implies that all sexually active people who engage in heterosexual sex are equally at risk in African countries. You can’t ‘target’ everyone in a population, or even half or a quarter of hundreds of millions of people.
Although UNAIDS and others claim that the bulk of HIV transmission is a result of heterosexual sex between people in long term monogamous relationships, with the implication that one or both partners must have had ‘unsafe’ sex outside of their relationships, they do not carry out contact tracing, that is, investigating ALL the possibilities for how each person was infected.
Most of the emphasis is on sexual transmission, and even then, sexual partners are usually not tested; when they are tested the HIV types are usually not matched. Therefore, it is almost always unknown how each person was infected, even though it is almost always assumed, in the absence of data to prove it, that each infection was a result of ‘unsafe’ heterosexual sex.
Effectively, UNAIDS and others in the HIV industry are not targeting any group because they don’t have a clue where to look. They assume that almost everyone who is HIV positive engages in ‘unsafe’ sex; they also assume that anyone who engages in any kind of sexual activity they consider to be ‘unsafe’ is a ‘risk group’, and that IS every sexually active heterosexual (or heterosexual who has sex with heterosexuals, or whatever nomenclature you care to adopt).
HIV status is not an indication of sexual activity, ‘safe’ or ‘unsafe’; and sexual activity is not an indication of HIV status or HIV ‘risk’. People in the US and other Western countries may object to contact tracing but in African countries it is vital. It has been avoided in African countries precisely because some have decided that it is a ‘bad thing’, that it ‘stigmatizes’ people, but as a result ALL African people in high prevalence countries have been stigmatized. The situation in Africa is not like the situation in Western countries and the sooner the HIV industry realizes that, the better.