If WHO’s AIDS experts and bureaucrats had set out to generate stigma against Africans with HIV and to ensure tens of millions of new infections in low risk adults, they couldn’t have done much better than what they have done for decades – focus HIV prevention messages almost exclusively on sex.
The focus on sex by WHO and other non-African organizations has – distressingly – been accepted and implemented by NGOs, churches, African governments, and others who should know better. They should know better because they see HIV-positive children with HIV-negative mothers, and couples where one or both are HIV-positive despite never having a non-marital sexual partner.
The almost exclusive focus on sex stigmatizes and harms HIV-positive people and their families:
WHO’s almost exclusive focus on sex and silence about bloodborne risks undermines HIV prevention. Evidence suggests that the best way to slow HIV transmission is to give people more warnings about bloodborne risks:
WHO’s focus on sex could be defended if almost all infections in African youth and adults come from sex. But the best available evidence as of 1988 – about the time WHO’s experts agreed to blame Africa’s epidemics almost exclusively on sex – shows blood contacts to account for at least as many HIV infections as sex. A review of evidence through 2011 shows the same thing: blood exposures account for as many infections as sex (see especially tables 5-7 in this link).
WHO’s silence about bloodborne risks violates medical ethics. The World Medical Association’s Declaration of Lisbon on the Rights of the Patient states: “Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services.” The Joint United Nations Program on AIDS (UNAIDS) warns UN employees working in Africa that “unsafe blood collection and transfusion practices and the use of contaminated syringes account for a notable share of new infections,” but WHO does not give similar warnings to the African public.
Why do WHO bureaucrats and experts and so many other health professionals give Africans incomplete, stigmatizing, and dangerous misinformation about HIV/AIDS risks? Reasons include: ignorance, fear the African public will avoid health care, fear of losing one’s job, and no doubt others. What is clear is that health care professionals – including notably bureaucrats and experts in international agencies and foreign aid programs – have a conflict of interest in telling Africans about risks to get HIV, Ebola, and other communicable diseases in health care settings.
1. Gisselquist. Break the silence: stop HIV through health care and cosmetic procedures. Available at: https://dontgetstuck.org/2012/10/15/3-in-african-countries-where-more-people-are-aware-of-blood-borne-risks-fewer-people-have-hiv-part-2-of-3/
2. Brewer DD. Knowledge of blood-borne transmission risk is inversely associated with HIV infection in sub-Saharan Africa. J Infect Dev Ctries 2011; 5: 182-198. Available at: http://jidc.org/index.php/journal/article/view/1308/518 (accessed 7 July 2011).
3. Gisselquist. Randomized controlled trials for HIV/AIDS prevention among men and women in Africa: untraced infections, unasked questions, and unreported data. SSRN 2013. Available at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1940999
4. Gisselquist, Potterat, Brody, Vachon. Let it be sexual: how health care transmission of AIDS in Africa was ignored. Int J STD AIDS 2003. Available at: http://www.cirp.org/library/disease/HIV/gisselquist1/gisselquist1.pdf
5. Clause 9, World Medical Association Declaration of Lisbon on the Rights of the Patient, reaffirmed April 2015. Available at: http://www.wma.net/en/30publications/10policies/l4/
6. Page 9 in UNAIDS, 2004, Living in a World with HIV and AIDS. Available at: http://data.unaids.org/publications/irc-pub06/jc975-livinginworldaids_en.pdf