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 have been doing for decades – focusing HIV prevention messages almost exclusively on sex.
This focus 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 infected despite never having had a non-marital sexual partner.
Will 90-90-90 empower people to reject stigma?
The focus on sex hurts HIV-positive people and their families:
Will 90-90-90 empower people to demand balanced prevention messages?
WHO’s almost exclusive focus on sex and silence about blood-borne risks undermines HIV prevention. Surveys in 16 countries show that HIV prevalence is lower in countries where more people are aware of blood-borne risks.
Can we expect any benefit from messages that continue to focus on sexual risks? During the last several decades, a number of studies provided special warnings about sexual risks to selected people and then looked to see if they were less likely to get HIV. Significantly, there was no impact (see table 3 in this link). In other words: people already know sex is a risk for HIV – banging again and again on that point does not help.
Let’s ask experts to be honest about the evidence: WHO’s focus on sex could be defended if almost all infections in African 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).
Moreover, if one looks at what is different about Africa that explain how so many more people are infected in Africa than anywhere else, what jumps out is not any difference related to sex, but rather differences in healthcare safety. Large percentages of clinics and hospitals in Africa do not have equipment to sterilize instruments.
Will 90-90-90 empower people to ask health experts to be ethical?
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.” 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 does not give similar warnings to the African public.
Why 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 professionals – including notably experts in international agencies and foreign aid programs – have a conflict of interest in telling Africans risks in healthcare.
1. 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.
2. 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
3. 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/
4. 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