Are anti-AIDS programs based on a false premise?

The public radio show This American life has a fascinating story on how counterintuitive behavior sometimes save lives and how many AIDS prevention programs in Africa are based on flawed conventional wisdom.

(Click here to access theshow... see Act One)

Shaming AIDS victims

A story broke recently whereby authorities in Tanzania will require all students with AIDS to wear an identifying red ribbon. Officials claim that it's for the students' own benefit: they will not have to do physical tasks. However, the move was quickly denounced by AIDS activists in the country and abroad who complained that the move would stigmatize the children. They also denounced it as a grotesque invasion of privacy.

'Has HIV/AIDS Destroyed Its First Nation-State?'

Chris Albion's fascinating Conflict Health blog asks the provocative question: Has HIV/AIDS Destroyed Its First Nation-State?

He reports that there's a growing movement in the mountain kingdom of Lesotho to have the country annexed by South Africa. Lesotho, which is entirely surrounded by its giant neighbor, has one of the highest rates of HIV in the world.

"Doctor" Jammeh scapegoats gays again

Yahya Jammeh, the megalomaniac in charge of The Gambia, has reportedly threatened to execute practicing gays who are HIV positive. In 2007, Jammeh claimed to have cured Gambians of HIV and AIDS. So if "Doctor" Jammeh "cured" those afflicted with HIV, then how can there be anyone left for him to murder?

World AIDS Day and Guinea

From Friends of Guinea blog (reprinted with permission)

In the run up to International AIDS day, the UN's IRIN news service had several articles related to AIDS in Guinea and West Africa.

IRIN reports that Guinea's mining sector is stepping up its anti-AIDS efforts. With an HIV infection rate of 5.2 per cent, the lucrative mining sector in Guinea is particularly at risk from the epidemic. Some mining companies have begun setting up their own programmes to make up for the lack of HIV/AIDS services on offer. But they say a public-private partnership is essential if local residents are not to be excluded. This is important as HIV services now tend to be concentrated in the capital Conakry, some distance away from the main mining regions.

Another piece points out that antiretroviral treatments are now free in Guinean hospitals. This is an important step in Guinea, such treatments cost patients $100 a month or sufferers were forced to travel to Dakar, Senegal. However, the article warns that bureaucratic difficulties may hamper the campaign's efficiency.

IRIN also had a fascinating piece on how national legislation designed to slow the spread of AIDS in West Africa is a double-edged sword.

In places like Guinea, Guinea-Bissau, Mali and Niger, a woman can be criminally charged with not taking the steps necessary to prevent HIV transmission to her unborn baby, such as taking antiretroviral (ARV) drugs during pregnancy. Sierra Leone recently changed a legal provision that explicitly referred to a mother passing on the virus to her baby as a crime.

In Togo, people who do not use male or female condoms in "all risky sexual relations" are considered to be breaking the law; HIV-positive people are prohibited from having unprotected sex, regardless of whether they have disclosed their status to their partner.

Guinean law requires mandatory HIV testing before marriage, while Togolese law provides for periodic mandatory testing of sex workers for HIV and sexually transmitted diseases.

Circumcision undermines anti-AIDS efforts?

As I blogged about earlier, there is some scientific evidence that male circumcision can significantly reduce the risk of contracting HIV-AIDS.

However, part of the medical community in Rwanda is concerned that the country's current circumcision campaign could actually harm anti-AIDS efforts. They fear that the campaign could lull people into believing that the procedure is tantamount to a vaccine against the disease, particularly in a country where knowledge of sexual health issues is low.

"Most of the difficulties relate to convincing men that circumcision does not exclude the use of condoms during sex," notes one general practitioner in the capital Kigali.

While circumcision may reduce the chances of the man contracting HIV by one half, a risk still remains. And obviously it does nothing for the women.

Anti-HIV efforts in Africa: two approaches that work

The Washington Post has a good article on the 'Best-Kept Secret' for reducing HIV in Africa: birth control.

President Bush banned funded to groups that provided or 'promoted' abortion shortly after he took office in 2001. But the article noted that the effects went well-beyond those organizations.

Two of the largest distributors of contraception [in Kenya], Family Health Options Kenya and Marie Stopes Kenya, did not provide abortions, which are illegal in Kenya, but were subsidiaries of London-based parent organizations whose members helped provide them in other countries. Together, the two groups closed five family planning clinics after losing U.S. funding.

In 2003, Bush created something called The President's Emergency Plan for AIDS Relief (PEPFAR), as a way to circumvent UNAIDS, an organization which it could not sufficiently manipulate. Even if PEPFAR weren't working cross-purposes with internationally coordinated AIDS relief, it hardly makes up for the assault on family planning funding.

An ounce of prevention is a lot cheaper than a pound of cure.

The paper also has a piece on Madagascar's efforts to fight HIV-AIDS. A fight which is apparently working, since the island has the lowest infection rate on the continent. But with Madagascar's economy opening to foreign workers, a situation which often leads to a rise in HIV rates, the importance of continuing these efforts can not be understated.