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.

Shout Outs

Alayna’s Favorites has consistently linked to the stuff we post here, so time to shower a little attention on her. Her site provides links to other sites. Here’s one that I found through her favorites: a nice reflection on the absurdity of the summer mini-mester, one semester supposedly crammed into two weeks.

Erkan’s Field Diary, run by an anthropologist who covers both anthro blogs and European and Middle East politics and culture, has consistently included us in some of his round ups. Here’s his most recent anthro one, which covers a lot of excellent ground and also provides us an introduction to some of his own work. You can also download his paper, Blogging as a Research Tool for Ethnography.

Dr. X’s Free Associations. Where else can you get vintage photos and psychology in one place? Plus a little politics too. The recent man with hyena photo really struck me. And he has a fun take on Jerry Springer speaking at Northwesetern’s commencement.

And of course the biggie for last. Greg and I both appreciate how Vaughan at MindHacks helps promote so many mind-related blogs, including our own. And where else can you find out about the brains of dead Russian geniuses and electronic lovers with fake online identities?

There are other places that have mentioned us over the last months, such as Neurophilosophy and Purposive Drift. And if you dig into some of our archives, you’ll find links to places we like. Or check out our blogroll. So this is just today’s shout out. But if you really like us, well then, feel free to comment with a link! We’d love to hear from you.

Wired on imaging ‘neurohype’

Wired magazine has a good piece on recent attempts to market neuroimaging services to individual consumers, Brain Scans as Mind Readers? Don’t Believe the Hype, by psychiatrist Daniel Carlat. Vaughan at Mind Hacks has a good discussion of the piece, Don’t believe the neurohype (thanks to Vaughan, also, for alerting me to the original piece). The Wired article, in addition to sharing Carlat’s adventures with the pay-per-scan industry, has a nice table of ‘neurologisms’ as well to help out the less-neurohip among us (myself included).

(I was a bit chastened by the line: ‘Add the prefix neuro to a discipline and you get a new field with instant cred. But the science can be less than compelling.’ uhhh… we at Neuroanthropology hope that our readers will judge us by our results; we plan to earn our ‘cred.’)

As Vaughan discusses, some people have a financial interest in over-interpreting brain scans and exaggerating what they can do:

Scientists and responsible clinicians will know about these shortcomings and make sure they don’t oversell their findings, but commercial companies are not selling you the data, they’re selling you a way of make you feel better about your insecurities, whether they be commercial concerns or health worries.

All I would add to this is ‘most‘ scientists know about these shortcoming and don’t paper over them when describing their research (and we’re happy to heap scorn on those who don’t have the proper humility).

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The human ‘super-organism’

The New York Times has just run a story by Nicholas Wade, 6 Tribes of Bacteria Found to Be at Home in Inner Elbow. The piece discusses new views on commensal bacteria, types of bacteria that live benignly on the body of a host. As the article points out, DNA culturing has really expanded our ability to study these bacteria because they are so difficult to sample and culture normally (in part because they need their host to live very long). The research is part of the federally funded human microbiome project, an attempt to catalogue all of the bacterial DNA that makes up the human ‘microbiome’ or what some call the human ‘super-organism’ (not because it can leap tall buildings but because a human ‘being’ turns out to be a walking system with staggering numbers of bacterial ‘beings’ as part of it).

Usually, articles like this make the point that, ‘no matter how hard you wash, every square inch of you is still covered in millions of bacteria…’ This article is no exception. But the article is also working with a lot more interesting data. For example: ‘The project is in its early stages but has already established that the bacteria in the human microbiome collectively possess at least 100 times as many genes as the mere 20,000 or so in the human genome.’ Bacteria cells outnumber the cells of the body itself as they are often quite a bit smaller than human cells.

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