[afro-nets] In preparation of People's Health Assembly II - part 24

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

In preparation of People's Health Assembly II - part 24
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Neoliberal ideology in the World Health Organization: Effects on
global public health policy and practice

(Part 3 of 4)

The neoliberal approach to HIV/AIDS: a colossal failure

In line with neoliberal doctrine, the international health com-
munity has 'explained' the spread of AIDS and its extremely high
prevalence in sub-Saharan Africa in terms of individual sexual
behaviour. It has exaggerated the extent to which people control
their lives and circumstances and ignored larger macroeconomic
and political factors. Above all, it has ignored poverty-
induced, population vulnerability in terms of a seriously weak-
ened immune system.

The insistence on analysing this public health catastrophe in
terms of individual behaviour has correspondingly restricted the
response to action at the individual level, usually to the pro-
motion of safer sex, condom use and education for prevention.

Average HIV prevalence in the adult population of most sub-
Saharan African countries is 25%. The figures for Europe and
most of the industrialized world are still under 0.1%, and in
many cases, under 0.01%.

Individual behaviour cannot possibly account for this enormous
difference which would imply that people in some African coun-
tries have at least 250 and even 2500 times more unprotected/
unsafe sex than people in Europe, the USA or Australia.

WHO and UNAIDS' own studies show that rates of sexual activity
do not appear to vary much between populations. Multiple, mostly
serial, casual and unprotected sex is common in Africa, Europe,
the USA and parts of Asia with most men everywhere having more
partners than most women. Furthermore, rates/types of sexual ac-
tivity do not appear to have a clear relation with prevalence of
HIV infection.

AIDS is a quintessential disease of poverty and powerlessness
and there are plausible explanations in terms of biological vul-
nerability, for the very high rates of HIV transmission among
poor populations - unrelated to individual sexual behaviour. De-
spite their common sense validity and the weight of historical
evidence in their favour, they have received very little atten-
tion.

The major biological factors of interest are malnutrition and
chronic co-infection with other diseases of poverty, notably,
parasitic infections, tuberculosis, malaria and other tropical
diseases. These factors are known to seriously impair and inter-
fere with immune function, and to be responsible for the bulk of
infectious disease, whether bacterial, viral or parasitic.

There is no shortage of evidence on the adverse, even devastat-
ing effects of malnutrition, under-nutrition and specific nutri-
ent deficiencies on the immune function, susceptibility to in-
fection and capacity to cope, once infected. Co-infections not
only interfere with immune function, but also increase viremia -
the level of HIV circulating in the blood. High viremia, unsur-
prisingly, is associated with increased risk of transmission.

Let us recall that many African households are caught in a pov-
erty cycle of low food production/consumption, low income, poor
health, malnutrition, poor environmental sanitation and infec-
tious disease. Populations in Asia, where an AIDS epidemic of
similar or major proportions is developing, survive in similar
conditions of misery.

Food, water, sanitation, basic education, health care, security
-- and decent work in non-exploitative employment -- are a good
part of the solution to AIDS in Africa -- as everywhere else for
all the diseases of poverty. Making populations resistant to in-
fection -- which is what the rich countries all did -- is pri-
mary prevention, far more 'primary' than condoms or safer sex.
AK