Prevention of HIV

Prevention of HIV

Box for anonymous questions at Diemo School, Kisumo, Kenya © Peter Armstrong

The human immunodeficiency virus, first identified in California in 1983, is transmitted by bodily fluids exchanged in sexual relations, or by contaminated blood, or through mother-to-child transmission. Despite years of creative educational initiatives costing billions of dollars, supported by many exemplary acts of political leadership, the MDG Progress Report for 2009 states that “only about 31 per cent of young men and 19 per cent of young women (aged 15-24) in developing countries have a thorough and accurate understanding of HIV.” The target for these indicators is a hopelessly impossible 95% by 2010.

Concerns about the sluggish pattern of behaviour change encouraged the World Health Organisation (WHO) to add male circumcision to its list of approved preventative measures. Research shows that the risk of infection is reduced by 60% for circumcised men. This makes no difference to the risks for women and great efforts are going into the development of HIV-resistant microbicide gels.

As results continue to lag expectations, critics question whether national strategies pay insufficient attention to the profile of new infections which varies in every country. This is particularly so in those Asian countries where the epidemic is “concentrated” within high risk groups. Many governments find it politically unappealing to direct funding into these communities.

In sub-Saharan Africa where the epidemic has become “generalised” amongst heterosexuals, it is possible that a very different form of denial is at play. The preferred behavioural code adopted in AIDS programmes is the ABC concept of Abstinence, Be faithful and use Condoms, each principle having priority over the next but not to an unrealistic extent. Many argue that this sidesteps the deeper cause which is cultural tolerance of multiple and concurrent partners for men.

President Zuma of South Africa stands at the crossroads of this debate. In decisively rejecting the disastrous policies of his predecessor, Thabo Mbeki, he has performed valuable service to his country, home to the world's largest number of people living with HIV. But Zuma’s personal lifestyle of multiple female partners, however grounded in Zulu culture, is an inappropriate role model for young Africans yearning for a new generation free of AIDS.