{"id":56,"date":"2005-11-23T12:02:21","date_gmt":"2005-11-23T17:02:21","guid":{"rendered":"http:\/\/blogs.law.harvard.edu\/politicshiv\/2005\/11\/23\/unaddressed-elements-of-the-devel"},"modified":"2005-11-23T12:02:21","modified_gmt":"2005-11-23T17:02:21","slug":"unaddressed-elements-of-the-developing-world-epidemic","status":"publish","type":"post","link":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/2005\/11\/23\/unaddressed-elements-of-the-developing-world-epidemic\/","title":{"rendered":"Unaddressed elements of the developing world epidemic"},"content":{"rendered":"

<\/a><\/p>\n

    I’ve had a couple of fairly interesting
\nconversations of late with an epidemiologist working for an NGO here
\nin the Boston area, and he’s got a bit of a hobby horse about the way
\npolicy is being implemented.<\/p>\n

    In short, much of HIV prevention policy in Africa
\nfocuses on the transmission aspects of the disease that are of
\nproportionately less risk because they are more socially acceptable to
\ntalk about than what he contends are real causes. J. points out that
\ntransmission via sources such as saliva, vaginal fluids, and other
\nbodily fluids are much less likely than transmission by blood and
\nsemen.  True.  <\/p>\n

    So it seems much less likely that HIV in
\nSSAfrica is spread by heterosexual contact of men with prostitutes,
\nespecially if we’re talking about vaginal intercourse.  The most
\neffective way to transmit the virus is through anal sex, especially
\nanal sex between men.  But most HIV prevention programs, outside
\nof the gay community in the West, do not discuss anal sex as a form of
\nsex putting people at greater risk, instead focusing on the prevention
\nof the quite proportionately lower unprotected vaginal heterosexual
\nintercourse.  Based on statistical probabilities, such policy
\nmight be problematic because it does not actually address the more
\nlikely methods of HIV transmission.  So we could be focusing on a
\nmethod of transmission that is much less likely than an unaddressed
\nalternative.<\/p>\n

    He also points out that transmission of the virus
\nhas occurred most quickly and broadly in the context of homosocial
\nenvironments.  The traditional story now is that HIV became
\nwidespread in these great gathering places far from home, where men
\nwere away from their wives and resorted to the use of prostitutes and
\nmistresses.  So along the Kinshasa highway, in mining camps, in
\nother work situations where there are high concentrations of men, and
\nin prisons, men have taken to using female prostitutes, spreading and
\nacquiring the virus from them.  But as he points out, these are
\nenvironments where there are lots of men in close and consistent
\ncontact with one another and with a general lack of women.  We
\nknow from other situations that men who want to have sex and lack the
\nopposite sex will very often turn to other men for that same sex. 
\nThe proposition boils down to this: if men want sex and the majority of
\ntheir social environment is made of men, then they will have sex with
\nthose men (and from what I have seen this is fairly well-verified where
\nit has been assessed).  If the foregoing is the case, then it
\nstands to reason that a large part of the African epidemic (and perhaps
\nthat in other countries) is driven by male-male sexual contact.<\/p>\n

    But that element of the epidemic is definitely not
\naddressed in the African context, where HIV is regarded as an (almost)
\nentirely male-female sexual intercourse disease.  Male-male sexual
\ncontact is not spoken of in most of Africa, and so we perhaps ignore a
\nlarge driver of the epidemic there.<\/p>\n

    If this is the case, what effect might this have on
\nour efforts at prevention in SSAfrica?  And how would we address
\nsuch in a political manner?  One could shift to a further
\ndiscussion of behaviors, emphasizing avoidance of anal intercourse of any sort, I guess.  But I can see problems with that.<\/p>\n

    Just seemed an interesting idea worth some consideration.<\/p>\n","protected":false},"excerpt":{"rendered":"

    I’ve had a couple of fairly interesting conversations of late with an epidemiologist working for an NGO here in the Boston area, and he’s got a bit of a hobby horse about the way policy is being implemented.     In short, much of HIV prevention policy in Africa focuses on the transmission aspects of […]<\/p>\n","protected":false},"author":709,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1107],"tags":[],"class_list":["post-56","post","type-post","status-publish","format-standard","hentry","category-politics-and-policy"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/posts\/56","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/users\/709"}],"replies":[{"embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/comments?post=56"}],"version-history":[{"count":0,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/posts\/56\/revisions"}],"wp:attachment":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/media?parent=56"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/categories?post=56"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/tags?post=56"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}