Call for Change in HIV Prevention in Africa

Daniel Halperin, a medical anthropologist at Harvard, is leading the call for a change in HIV prevention. As a recent BBC article reports, “Substantial investment in condom promotion, HIV testing and vaccine research has had limited success in Africa, [Halperin and others] argue in Science. Instead male circumcision and reducing multiple sexual partners should become the ‘cornerstone’ of prevention.”

Their overall argument actually takes aim at one of the biggest sacred cows in current anthropology—the role of inequality. In Reassessing HIV Prevention, Potts, Halperin et al. write, “Such devastating epidemics [of HIV/AIDS] have frequently been attributed to poverty, limited health services, illiteracy, war, and gender inequity. Although these grave problems demand an effective response in their own right, they do not appear to be the immediate causes of generalized epidemics.”

The immediate causes, and thus the immediate foci for prevention, are more concrete:

Where multiple sexual partnerships, especially concurrent ones, are uncommon, and particularly where male circumcision (MC) is common, HIV infection has remained concentrated in high-risk populations (7). Niger, a Muslim country where sexual behavior is relatively constrained and MC is universal, has an adult HIV prevalence of 0.7% (1), despite being the lowest ranking country in the Human Development Index. Botswana, the second wealthiest country in Sub-Saharan Africa, has high levels of multiple concurrent partnerships among both sexes and lack of MC (8), with an HIV prevalence of 25%.

I would also add mother-to-child prevention, given work I help guide in Lesotho. That research, in affiliation with the Touching Tiny Lives project which helps children, shows the importance of access to preventive drugs during pregnancy and breastfeeding, while also addressing the stigmas and sociocultural limitations that often keep women from having access to these drugs.

And for those larger causes? Halperin wrote a powerful editorial back in January, Putting A Plague in Perspective. There he wrote:

Many other public health needs in developing countries are being ignored. The fact is, spending $50 billion or more on foreign health assistance does make sense, but only if it is not limited to H.I.V.-AIDS programs… Many millions of African children and adults die of malnutrition, pneumonia, motor vehicle accidents and other largely preventable, if not headline-grabbing, conditions. One-fifth of all global deaths from diarrhea occur in just three African countries — Congo, Ethiopia and Nigeria — that have relatively low H.I.V. prevalence. Yet this condition, which is not particularly difficult to cure or prevent, gets scant attention from the donors that invest nearly $1 billion annually on AIDS programs in those countries.

One thought on “Call for Change in HIV Prevention in Africa

  1. For anyone wondering about the explanation for the link between circumsion and AIDs (as I did) see http://news.bbc.co.uk/2/hi/health/background_briefings/aids/434880.stm

    “Although the reason for the extra protection has not been proved, the research team suspects that the skin on the glans of the circumcised penis is tougher than that of the foreskin.

    It is therefore less likely to suffer small abrasions which increase the chances of HIV being transmitted. “

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