Lack of funds and misused thereof are the two main causes of a failing HIV prevention. As noted by Emily Geminder, HIV prevention does not attract as much financial attention as a quest for an HIV treatment, and when funds are committed to prevention, they end up financing interventions that are more dogmatic than evidence-based and whose results are hardly quantifiable and rarely quantified.

This USAID-sponsored poster promoting abstinence in Zambia as part of an HIV prevention campaign is a good illustration of what William Easterly describes as “the native people of Africa” having “to acknowledge Western Truth against native error” (in The White Man’s Burden, OUP, paperback 2007, p207).

In a few words this campaign succeeds bringing to life a vision of Africa where lewd and short-sighted women succumb to the charm of powerful men driving daunting cars, putting the short term retribution of sex before their future. But thanks to the West and its (christian) values of chastity and fidelity, real women, that is women who can wait, will succeed in life and get a career (as PA). But then, do real men real (have to) wait?

Emily Geminder quoted Susan Watkins a research scientist and sociologist who has long studied the response to AIDS in rural sub-Saharan Africa:

“I think there are a lot of misconceptions about AIDS in Africa – including misconceptions among the agencies of the United Nations”. Too often, she told MediaGlobal, “depictions of gender and HIV in international and national policy documents do not reflect the reality on the ground.”

She also quoted Catherine Campbell, who has studied prevention strategies in South Africa:

“HIV prevention strategies are informed by the assumptions of Western science and policy, with insufficient assessment of whether these are appropriate for local conditions. Proposals for projects funded by overseas bodies may be written by external consultants and presented to local groups for implementation. Local people may therefore have little sense of ‘ownership’ of the proposals.”

And concluded that “In many ways, it’s the archetypal tale of modern times. Western interventions fail to accommodate the nuances and complexities of local topographies. Too often, they rely on outdated conceptions and over-simplified conclusions. Out-of-place values get in the way of real solutions.”

There are a lot questions being raised currently within the scientific community about where the money should be invested and it seems that there is a lot of questions starting to be raised regarding how prevention has been and should be conducted where it is most needed. These are interesting times that may introduce a long needed sense of accountability to intervention and therefore results on the ground.

In Thailand a survey conducted by Fritz van Griensven and colleagues found that HIV prevalence among MSM in Bangkok has increased from 17 percent in 2003 to 30 percent in 2007. In Chiang Mai, prevalence increased from 15.3 percent in 2005 to 16.9 percent last year. In Phuket, prevalence leapt from 5.5 percent in 2005 to 20 percent in 2007.

Commenting in The Nation, Chatwut Wangwon, a member of a joint Thai Public Health Ministry and US CDC program said that “The best means of preventing HIV among MSM is providing free condoms and lubricant and raising awareness about health checks to diagnose HIV early.”

Would one be vindicated asking why with such prevalence being known since 2003, prevention interventions have failed to decrease incidence amongst MSM?

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