peripheries

INTERMEZZO: Holidaying with HIV

In a study published in Retrovirology, Dimitrios Paraskevis and his team at the University of Athens tracked how tourists got infected with HIV whilst on holiday and how HIV piggybacks on migrants traveling from one country to another.

“Specifically, Greece, Portugal, Serbia and Spain, provide sources shedding HIV-1; Austria, Belgium and Luxembourg, on the other hand, are migratory targets, while for Denmark, Germany, Italy, Israel, Norway, the Netherlands, Sweden, Switzerland and the UK we inferred significant bidirectional migration. For Poland no significant migratory pathways were inferred.”

Conclusion: Stay home, watch TV or travel to Luxembourg or … use condoms!

HIV on the rise in the Philippines: Will condoms do any good?

Since the papal comment about condoms and the HIV epidemic, there has been a flurry of articles written in support of the pontifical nonsense. These often call upon a comparison between “sinful” Thailand, awash with HIV and condoms, and the “holly” Philippines where there is not such thing as HIV or condoms (a bit like in Iran).

Does this sound slightly over the top? Not really. Kathleen Gilbert writing for the LifesSiteNews website quotes Yolly Eileen Gamutam, head of the Asia’s Catholic Association of Doctors, Nurses and Health Professionals (ACIM-Asia) saying that “Condoms are highly dangerous.” Gilbert added that “by the end of 2003, Thailand, with a population of 63 million, registered 570,000 HIV-positive adults and children. Gamutam compared the statistic to the Philippines, where only 9,000 Filipinos were HIV-positive out of a population of 80 million. 500 died of AIDS in the Philippines that year, while 58,000 perished in Thailand.”

peripheries has already addressed this misleading and inappropriate comparison but it is necessary to add that comparing two countries at one time point is rather meaningless. That the head of an association of doctors allows herself to be so unscientific is rather disappointing, if not telling that religion and science are definitively two nonoverlapping magisteria.

But let’s look at the figures available from UNAIDS and let’s compare the number of People Living with HIV and AIDS (PLWHA) at two time points:

In 2001 there was 660,000 adults and children living with HIV and AIDS and this figure dropped to 610,000 in 2007. In the Philippines, the number of PLWHA rose from less than 1,000 to 8300 and has been continuously on the rise since 2006.

Without fear or shame and against all evidences, Yolly Eileen Gamutam concluded that “the condom use program in Thailand is not effective.” Mechai Viravaidya, politician and leading Thai AIDS activist who introduced a 100% condoms policy in brothel where HIV was raging and henceforth contributed to a reduction of the number of PLWHA from 2% to 1.4% in 10 years (1997-2007) and the successful containment of the epidemic, will appreciate how his work and continuous efforts are being so promptly dismissed.

The rise in the number of HIV infections in the Philippines may not seem dramatic now but it may have some serious consequences later if not controlled. Conscious of the consequences of inaction, the Filipino government, who in the past adopted an approach to the epidemic that limited its progression in the general population, was considering a controversial bill on reproductive health at the end of 2008.

Another worrying concern about the rising HIV epidemic in the Philippines is that it is so far mostly observed amongst Men who have Sex with Men. The health departmental HIV/AIDS registry recorded 210 new infections among MSM in 2005, 309 in 2006 and 342 in 2007 and from January to September 2008, there were already 395 cases, up 96 percent since 2005.

And as we all know, before or next to condom, homosexuality is the next “abomination” that the Catholic church condemns with wrathful vehemence.

“The Catholic Church’s centuries-old doctrine, created by a bunch of celibate priests, on sex only for procreation leaves many people ignorant about sexual health. This is the sad reality.

Taking away people’s right to protect themselves, and their right to education and to responsibly manage their sex lives is certainly taking away some of their humanity.” write William Sparrow for the Asia Times.

But not all Catholics are dogmatic or blinded by credo and for example, Catholics for Choice an organisation initially founded to support women’s moral and legal right in a world led by Bishops, started an unprecedented worldwide public education effort to raise public awareness about the devastating effect of the bishops’ ban on condoms. In a recent press release the organisation wrote:

“According to a recent poll commissioned by Catholics for Choice, which interviewed Catholics in Ghana, Ireland, Mexico, the Philippines and the United States, support for condom use among Catholics is overwhelming. When asked if “using condoms is pro-life because it helps save lives by preventing the spread of AIDS,” 90% of Catholics in Mexico, 86% in Ireland, 79% in the US, 77% in the Philippines and 59% in Ghana agreed. Unfortunately, the Catholic hierarchy’s position holds the most sway in the countries least able to deal economically and medically with the disease.”

A sway leading to death. And as for the role of condoms, they certainly won’t do any harm.

Money alone is not going to treat us out of the HIV epidemic

Why HIV “prevention does not work” has been the subject of recurrent discussions during the past weeks. It all started with a thought-provoking article published online by Frontiers in LA, “a one-stop source of content for Southern California’s LGBT community” (welcome to the Ghetto) by Michael Liberatore who wrote that “if pharmaceutical companies were supplying the cash to develop [HIV/AIDS] treatments, couldn’t they just as easily stall the development of newer, less profit-friendly treatments to assure that their bank accounts continue to swell?”

The article is worth reading and raises some serious questions, and though peripheries is no friend of the “Big pharma”, one cannot always agree with the columnist. Nevertheless, the recurring conversation was about the belief that money or drugs will “make prevention work” and “treat us out of the epidemics”.

Indeed, it is not just about money or the Pharmaceutical industry but about how the money is used. PEPFAR with its numerous and often criticised ties is a good example but there are many others. For example, in an interview for the Singapore-based network Fridae.com Jan Wijngarden emphasises some very important issues on how to do prevention in the MSM population which is more vulnerable than other to HIV infection. Wijngarden’s main point is that prevention has to reach those who are supposed to be reached and I would add something often overlooked, that the target need to have a stake in the fight.

When it comes to Africa where AIDS is “hyperpandemic”, bending the arm of the Big Pharma or throwing money at African Governments or local NGOs to buy drugs is one thing, but if there is no supply chain (from road to clinics and to nurses) or even no identified people to treat,or worse, no political will, it won’t work. We often talk about corporate responsibility but what about non-profit responsibility? It is often “implied and obvious” but how accountability is there in the non-profit sector? The one that goes beyond “we have provided ARV to 3 million people” (Are these people still on ARV? Alive? How is their health? Did that change something in their community? What was the impact on a larger scale?). In a paper on the impact of PEPFAR the authors, carefully underlining their own limitations, concluded that “After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ.”

Accountability in the non-profit sector is finally being recognised and emphasised and it needs to be discussed further and translated into something real. Indeed, there are reasons to be afraid and sceptical when reading statement such as “UNAIDS estimates that the funds needed annually to deliver adequate prevention programs to sub-Saharan Africa alone would be approximately US$2 billion”. Lest we forget, several world economists (and rock stars) have been telling us that for some time that we “only” need to put X million dollars in African country Z to lift it out of poverty. 50 years and 3.5 trillion dollars later, the African people are still waiting for this to work. Meanwhile, GAP, Motorola and Armani are making profit selling (Red) branded products and rock stara are lecturing us, tax payers whose contribution to the World Bank and IMF, constitute the largest amount of money given to fight HIV/AIDS in Africa with various level of success.

We really need to think hard, look at what has been done during the last 25 year, probably throw away most of it and start again from the bottom: Who is most vulnerable ? Strikingly, MSM have just been “officially” recognized (or rediscovered) as most-at-risk at the last AIDS Conference in Mexico. What will make people practice safe sex? What will make someone vulnerable come forward to take an HIV test? What will make them accept to start treatment and adhere to it? How can treatment be delivered and patients reached, then how much will it cost, rather than blanket covering whole population with impersonal messages and dollars hoping the epidemic will treat itself out.

Re-stating the obvious, HIV prevention and treatment is a complex problem and as much as requesting more money to buy more drugs is much more appealing than requesting dollars to built roads, there is little point of shelving drugs that can be distributed or having brand new and shiny clinics in the middle of nowhere with no staff and no road leading to them.

Some governments have started to understand some of this. The UK Department for International Development (DFID) recently recognised that “Trade is critical for generating economic growth and reducing poverty. Without good quality infrastructure – roads, rail, and ports – the cost of trade and transport rises”. DFID Minister of State Gareth Thomas then announced “£100 million for the implementation of an innovative and comprehensive transport and cross-border trade reform programme along the ‘North-South Corridor’, combined with a broader package of regional trade-related reforms.” Recognizing that trade can’t happen without adequaye infrastructure comes late but is welcomed. It is regrettable that the Minister did not go one step further and recognised that the fight against HIV can’t be won without similarly good infracstructure and also aknowledge that trade development could contribute to the HIV/AIDS epidemic (both in a positive and negative way) and then implement along the North South corridor of trade a corridor of HIV prevention and treatment.

This is were mainstreaming HIV/AIDS (and the money to fight the epidemic) comes into the big picture, but we are not there yet. Money and drugs are still needed to fight AIDS, probably more than ever with increasing HIV prevalence, but what you do with it is as important if not more than as how much you get.

Uganda: Finding scapegoats for a resurgent epidemic

From Entebbe, Uganda – “A man shocked parents on Sunday when he confessed to recruiting school children into homosexuality to promote the practice in Ugandan schools.”

Hence started the opening paragraph of a front page feature of the Ugandan daily The New Vision under a 5-cm letter header: “HOMOSEXUAL ADMITS RECRUITING STUDENTS”

New Vision’s Paul Kiwuuwa writes that George Oundo has received funding and training from “abroad” and targeted children, mostly “needy” ones, because children are “easy to initiate and they like easy things”. “Conversion” was achieved through books and compact disc showing homosexuality to young boys.

So what happened that Oundo stopped converting needy children with the support of an alleged foreign Gay and Lesbian Coalition and “confessed”?

Oundo became a Born-again Christian and “got saved at Pastor Martin Sempas’ Church, the Inter-Faith Rainbow Coalition against Homosexuality, based at Makere University Kampala”. Yes, the Ugandan Pastor who burns condom on the university campus.

The story does not stop here. George had experience a “transgender transition” in the past and wanted to be a woman and was known as Georgina, all because of international human rights organisations that “spread homosexuality”. Later, eigt more men “confessed involvement in homosexuality and gay activities, which they said they had abandoned. Speaking to journalists at the Grand Imperial Hotel in Kampala, the youthful men described homosexuality as abnormal and anti-Christian, and declared war against it.”

When reading such caricature of reporting and nonsense one can only be left short of words. Such coverage does nothing but contributes to the spread of the epidemic by exonerating of their responsibility those who are really at the centre of the epidemic and its spreading: men and women who are having unprotected sex.

But there is worse. The daily reports that the Uganda Education Minister Manirembe Bitamazire announced last year an investigation into homosexuality in schools where the activity is “rampant”, and the Uganda AIDS Commission chief Kihumuro Apuuli, also observed that “schools had become a breeding ground for the vice”, the solution being that “parents had a big responsibility to inculcate African Values into their children.”

Conflating homosexuality and HIV in Uganda (or anywhere else for that matter) does not make sense but confirm that it is much easier to find a scapegoat than to face the truth. The denunciation of homosexuality as foreign to “African values” also reveals of a long tradition of denial and cultural relativism, not specific to Africa, which has obstructed and still obstruct the prevention efforts by stigmatising further people who are amongst those most vulnerable if not most affected yet and ignores the real cause of the epidemic. That such beliefs are supported by the head of the Uganda AIDS commission 25 years after the start of the epidemic is extremely worrying.

Evangelical and Pentecostal churches, in conjunction with pontifical nonsense.» are doing a great witch-hunting job, diverting resources and destroying successful HIV prevention. Such irresponsible and dangerous views are wiping out years, past and future, of HIV prevention.

Crime against humanity should apply to those who spread such nonsense.

The Madness of Pope Benedict XVI

Africa and in particular sub-Saharan Africa is the continent the most affected by the HIV epidemic. During the last 25 years more than 20 millions people have died of AIDS in Africa. There, the epidemic particularly affects women, HIV transmission is mostly through heterosexual sex, and concurrent relationships have been identified as a force driving the spread of the virus in the population. In Africa, HIV is mostly about sex. Prevention interventions have been difficult, hindered by limited political commitment, if not political denial of the cause of AIDS, religious interference and lack of resources (amongst many other factors).

Today His Holiness Pope Benedict XVI made his first papal visit in Africa and dropped a bomb on an already decimated population.

Speaking in Cameroon, the not-so-holy head of the Catholic Church argued that HIV is “a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which can even increase the problem.”

Against all common sense, against all scientific evidences, against a background of one and a half millions death a year, 12 millions of African children orphaned by HIV, 23 millions infected people, Benedict XVI believes that the answer to HIV is to be found in a “spiritual and human awakening” and “friendship for those who suffer.”

The BBC reports that “While in Africa, the pontiff is expected to talk to young people about the Aids epidemic and explain to them why the Catholic Church recommends sexual abstinence as the best way to prevent the spread of the disease.”

Let it be clear, to date there is no scientific evidence to support that condoms have increased the problem of HIV, but there is plenty of evidences supporting that abstinence, or “spiritual and human awakening” as Benedict now calls it, has failed preventing HIV transmission.

Let it also be clear that condom are not the all-in-one solution, as demonstrated -only briefly, in Uganda before Christian pastors start burning condoms in front of Makerere University, but they are not part of the problem as an old age ignorant prelate would like a vulnerable and sometimes desperate people to believe (see H. Epstein God and the Fight Against AIDS)

The pontiff wants young, energetic, hormonally-driven and sexually attractive and curious young people to sacrifice their natural attraction to the opposite sex in favour of spiritual and human awakening. Welcome to Planet Vatican, where sex is the enemy, where it must be controlled by men who know nothing about it, or so we would like to think.»

One can only supports a spiritual and human awakening, an awakening that would lead to evidences-based prevention interventions and discourses, an awakening that would lead to a reduction in HIV transmission. But it is doubtful that this is the kind of awakening the pontiff has in mind.

How can a man with so little legitimacy but so much power on other’s decisions in life be left airing such dangerous ignorance in public without a global outcry? Nobody expects the head of the Church to change his mind or the credo,  but showing a minimum of respect for human life by having the decency to remain silent on issue the pontiff knows nothing about would be a minimum.

Burning condoms literally or metaphorically does not and is not going to help fighting HIV. Burning a backward and irrelevant institution might. By the time you finish reading this post 20 people will have been infected by HIV, 17 of them in Africa. In most case, a condom, properly used could have prevented the infection.