HIV Prevention Programs that Focus on Sexual Behavior Will Fail, The Nation Contributor Says
AIDS prevention programs, particularly those in Africa, that focus on HIV transmission as an issue of sexual behavior instead of considering "biological factors that result from poverty" have failed and led to the "perpetuation of racial stereotypes," Gettysburg College economics professor Ellen Stillwaggon writes in The Nation. Instead, what is needed is an "interdisciplinary approach that incorporates biological and social data into an analysis of the social context of HIV disease in Africa," according to Stillwaggon, author of Stunted Lives, Stagnant Economies: Poverty, Disease, and Underdevelopment. She asserts that "sexual behavior alone cannot explain HIV prevalence as high as 25% of the adult population in some African countries and less than 1% in the United States." Further, there are "significant levels of unprotected, multipartnered sex in the United States and Europe," but no corresponding "heterosexual epidemic of AIDS" like that in African nations, Stillwaggon says. "Treating African AIDS as a special case caused by a hypersexualized culture obviously reinforces racist stereotypes and pessimism over Africa's future," she adds. Such a focus also "pushes AIDS policy to an almost exclusive reliance on behavior modification and condom use and away from general health and nutrition, and it gives us little preparation for similar epidemics that are now incubating in South Asia and Latin America."
Focus Prevention on Poverty
Instead, Stillwaggon proposes that prevention programs examine the culture of impoverished nations and praises South African President Thabo Mbeki for questioning how poverty in Africa affects the development of HIV/AIDS there. She says that "pre-existing health conditions play a key role in susceptibility to disease," adding, "We should expect HIV/AIDS to develop differently in rich and poor countries, just as do tuberculosis, pneumonia, measles and nearly all other infectious diseases." Populations in poverty are "characterized by malnutrition, parasite infection and lack of access to medical care and antibiotics for bacterial STDS" -- the "biological conditions for greater susceptibility to infectious diseases," Stillwaggon says. HIV prevalence is "strongly correlated with falling protein consumption, falling calorie consumption, unequal distribution of national income and ... labor migration," she adds. Stillwaggon notes that prevention programs that focus on the "synergistic relationship among malnutrition, parasite infestation and infectious disease" do not deny that HIV is an STD or that it causes AIDS. She concludes, "Strengthening immune systems will help to protect people from some of the consequences of unsafe sex and from other infectious diseases as well" (Stillwaggon, The Nation, 5/21).