Tuesday, April 21, 2009


AIDS Prevention in Africa

It seems strange that 30 years later we are still having a conversation about a disease that is easily preventable. And yet, due largely to a wholly inadequate response to the problem of AIDS, more people have died and many more have contacted AIDS than is necessary. It seems that sin does indeed make one stupid.

Dale O'Leary has written a provocative paper, provided by the blog Feminine Genius here that brings us up to date with the situation in Africa, and the picture isn't pretty.

In the wake of Pope Benedict XVI's visit to Africa and the attendant brouhaha over O'Leary updated a 2005 paper, providing an overview of the various strategies for dealing with AIDS.

The HIV/AIDS pandemic has caused immeasurable suffering, but prevention is possible. The disease does not strike randomly – we have identified the virus that causes AIDS, and we know the pathways the virus can take. The question for the people of Africa is: What is the most effective strategy for preventing transmission?

The protection of public health in the face of deadly epidemics has always required a balance between respecting freedom and saving lives. Governments are given three options from which to build a strategic response: risk elimination, risk avoidance, and risk reduction. Even the most devastating epidemics can be stopped if the government is willing to abridge its citizens' freedom by employing draconian risk elimination strategies such as mandatory testing and quarantine. Such strategies are normally only employed for deadly, fast-moving epidemics. Risk avoidance strategies prevent infection by motivating the public to avoid all possible sources of infection and enforcing public health regulations. Risk reduction strategies allow people to continue to engage in behaviors that could expose them to infection while encouraging a reduction – but not elimination – of the risk of infection.

Early in the epidemic, various nations made different choices with differing results. When Cuban soldiers returned from fighting in Angola, the government realized that some were infected with HIV. The regime responded with mandatory testing and quarantine. The epidemic was blunted.

The U.S. opted for risk reduction. Mandatory testing and quarantine were suggested but ruled unacceptable. Standard public health measures that were used to control sexually transmitted infections (STIs) such as syphilis and gonorrhea were also rejected. Instead, prevention focused on educating people on the ways in which they could protect themselves by using condoms. The result: twenty-five years after the threat was identified, over a half million citizens have died of AIDS and three times that many are living with HIV. In 2006 in the U.S. 56,300 people were newly infected – the majority of them being men who have sex with men. The U.S. strategy with some modifications has been exported to other countries as the preferred method for controlling the epidemic.

Africa’s leaders and those who fund AIDS prevention programs in Africa need to consider the full range of options available. The following is a review of what is known about how HIV is transmitted, standard public health strategies, the prevention strategy presented to Africa as the "scientific consensus," the agendas of those who created this consensus, the challenges to that consensus, alternative strategies, and the effect of the choice of prevention strategy on the culture.

Be sure to read the full report.

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