An Ounce of Prevention….

I feel like so much of current mainstream media reporting about HIV/AIDS in Africa focuses primarily on treatment programs:  both the importance of them and their obvious shortcomings.  The latest example is Don McNeil’s reporting for The New York Times, which draws particular attention to HIV-positive Ugandans who are unable to access treatment.  Undoubtedly there is a story in access to treatment across Africa: of the 22 million HIV-positive Africans only 2-3 million receive treatment.  Appalling, but hardly surprising when the vast majority of Africans cannot access any type of formal healthcare at all. AIDS Education

Over ten years ago I was asked by a western reporter whether the focus of US government HIV/AIDS funding should shift to treatment. I said no.  That answer felt as heretical then as it does now.  Because it seems to suggest that I believe people shouldn’t have access to treatment.  Which, of course, is not true.  It’s just that then and now I fear the consequences of focussing on treatment on efforts to contain the spread of HIV/AIDS across the continent.

I wish the media would draw our attention to one HIV/AIDS-related figure and one alone:  three million new infections a year.  That is three million new people every year who will require a lifetime of treatment. This despite over twenty-years of international prevention efforts, despite billions spent on so-called awareness campaigns, despite the fact that HIV/AIDS is entirely preventable.

Three million new infections.  That’s the most worrying figure I can imagine, far more than the number of people not receiving treatment.  Because this figure means that treatment programs will never reach all those in need.  It means that Africa governments will never have enough money to fund their own treatment programs and thus will always be dependent on international aid.  It means that the single most cost-effective way of managing Africa’s HIV/AIDS epidemic could largely be called a failure. 

I know that we like handing out medicines to needy Africans.  That we admire the “before and after” pictures of people who receive those treatments.  I also know that prevention efforts are bloody difficult to carry out, much less evaluate or quantify.  And yet I know beyond a shadow of a doubt that the only way Africa will ever be free of the scourge of HIV/AIDS is when the number of new infections decreases.  Until then, the whole world is just playing catch up.

So let’s take a hard look at current prevention programs: admit that “awareness raising” just isn’t enough and teaching people the “ABCs” often leaves them HIV/AIDS illiterate.  Let’s get real about the role of violence and alcohol in sexual activity.  Own up to de-facto polygamy, address the perceived role of witchcraft, and be plain about power relations.  Let’s hold parents accountable for the health of their children and men for the health of their wives. Let’s ditch the irrelevant Western liberal worldview that shapes so many prevention programs, emphasising the value of life and importance of choice to people whose lives are miserable and choices few.  And let’s strip away all the Christian niceties and acknowledge that sex in Africa is often drunk and dirty and dangerous, as it is in many other parts of the world.  

Let’s have an honest conversation about how current prevention efforts are largely failing to enable Africans to deal with HIV/AIDS honestly.  Because until we get the prevention piece right, there will always be a sad story to be told about HIV/AIDS treatment in Africa.

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