New Evidence Suggests 'Safe Sex' Is the Wrong Medicine for Africa

GUMARE, Botswana — In Botswana, almost 40% of adults are infected with HIV, the virus that causes AIDS — a devastating statistic that sadly is close to the norm in other countries in sub-Sarahan Africa.

In early March, Western news media expressed shock at reports of a public-health nurse in the village of Gumare in northwestern Botswana using the same needle to vaccinate 83 children, apparently unconcerned or unaware about the risk of transmitting HIV in this way. But new scientific studies indicate that Botswana, too, might not be so different from the rest of Africa.

In the March issue of the International Journal of STD and AIDS, researchers claim dominant organizations such as UNAIDS (the U.N. program on HIV/AIDS) have grossly underestimated the role of unsafe vaccinations in the spread of the disease in Africa and have overestimated the role of sexual transmission.

Since 1988, AIDS organizations have held that 90% of HIV infections in Africa are caused by heterosexual transmission, but the new studies indicate the correct figure is approximately 30%.

“The finding has major ramifications for current and future HIV-control programs in Africa, whose focus has been almost exclusively on sexual risk reduction and condom use,” say the researchers, led by Pennsylvania anthropologist David Gisselquist.

The leading organizations in international AIDS prevention are heavily invested in promoting so-called safer-sex strategies, chiefly the aggressive promotion of condom use. Their assumptions about Africa are crucial, because it is home to more than 70% of HIV/AIDS cases worldwide, and nearly 30 million Africans are infected.

They were quick to dismiss the new studies and defend the status quo.

In a statement March 14, UNAIDS and the World Health Organization “reaffirmed that unsafe sexual practices are responsible for the vast majority of HIV infections in sub-Saharan Africa and that safer-sex promotion must remain the primary feature of prevention programs in the region.”

Distorted Picture?

Critics say these groups have a distorted picture of AIDS in Africa because they are driven by the liberal sexual ideology that dominates most wealthy nations.

“In the late 1980s, the interpretation that 90% of HIV infections among African adults was from heterosexual transmission was used in the United States and Europe to make the case that everyone was at risk, not only gay men and injection drug users,” Gisselquist said. “However, the idea that heterosexual transmission explains almost all of what happens in Africa unfortunately obscured other risks in Africa.”

Catholic author Dale O'Leary, who has written extensively on AIDS and the prejudices of the AIDS establishment, said that in responding to AIDS in Africa, “the pro-homosexual lobby's first priority was to do nothing that would stop their sexual revolution, and [they] pressured those working on the problem to see things their way.”

Gisselquist said since AIDS programs are now well established in wealthy countries, “it's no longer necessary to overemphasize the proportion [of HIV infections due to] heterosexual transmission to ensure enough attention to HIV/AIDS.”

The population-control ideology might also have been a factor.

Gisselquist's team said “there may have been an inclination to emphasize sexual transmission as an argument for condom promotion, coinciding with pre-existing programs and efforts to curb Africa's rapid population growth.”

The team suggests “preconceptions about African sexuality” — the assumption that Africans engage in a lot of sexual activity with a lot of partners — also played a role in overestimating the sexual transmission rate.

The new studies point to many facts about AIDS in Africa that are at odds with the 90% figure for sexual transmission. In Zimbabwe in the 1990s, for example, HIV infections rose by 12% while condom use increased and sexually transmitted diseases as a whole fell by 25%.

A study in Kinshasa found 40% of HIV-positive infants had mothers who did not have the virus. These infants had received an average of 44 vaccinations, while uninfected infants averaged only 23.

Another study found that some places with the highest rates of risky sexual activity, such as Yaounde, Cameroon, had relatively low and stable rates of HIV infection.

But UNAIDS and the World Health Organization say “age-specific infection rates among young women and men strongly follow patterns of sexual behavior and those of other sexually transmitted infections,” and “there is no consistent association between higher HIV rates and lower injection safety standards.”

Chastity Works

If the AIDS establishment is proved wrong on this point, it will not be the first time it has let ideology get in the way of actually fighting the disease.

Groups such as UNAIDS have consistently scorned efforts to reduce sexual transmission of HIV through chastity education. But the first country to make that strategy the centerpiece of its AIDS prevention efforts, Uganda, has also had the most outstanding success in reducing infection rates.

Uganda's approach — known as ABC, for abstinence, be faithful or use condoms — has strongly emphasized saving sex for marriage and staying faithful to marriage vows while targeting condom use primarily at prostitutes and other specific high-risk groups less likely to respond to behavior-change messages.

This approach has been widely credited for a dramatic decline in Uganda's HIV rate since the early 1990s. The U.S. Agency for International Development, the foreign aid agency of the U.S. government, says the rate peaked at 12.4% in 1995 and will reach 8.23% by 2010.

A study by Cambridge University researchers in 2001 found the infection rate in the 15-to-19 age group — an important predictor of future overall rates — declined by approximately 75% between 1990 and 1998.

Some might wonder whether the success of chastity programs in Uganda is not an argument in support of the usual 90% estimate of sexual transmission of HIV. If a change in sexual behavior can have such a dramatic effect on HIV rates, it stands to reason that a large number of infections are due to sexual transmission.

But researchers note it is possible Uganda has had a relatively low rate of transmission from unsterile vaccinations and sexual transmission might play a larger role in that country.

“From the late 1980s,” Gisselquist said, “Ugandan health authorities and the general public have been very aware and concerned about health care transmission. The government provided special training in infection control for health care workers. Private radio talk programs raised public consciousness about injection risks.”

David Curtin writes from Toronto.

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