AIDS prevention programs, particularly
those in Africa, that focus on HIV transmission as an issue of sexual behavior
instead of considering "biological factors that result
from poverty" have failed and led to the "perpetuation of racial
stereotypes," Gettysburg College economics professor Ellen Stillwaggon
writes in The
Nation. Instead, what is needed is an "interdisciplinary approach that
incorporates biological and social data into an analysis of the social
context of HIV disease in Africa," according to Stillwaggon, author of
Stunted
Lives, Stagnant Economies: Poverty, Disease, and Underdevelopment. She
asserts that "sexual behavior alone cannot explain HIV prevalence as high
as 25% of the adult population in some African countries and less than
1% in the United States." Further, there are "significant levels of unprotected,
multipartnered sex in the United States and Europe," but no corresponding
"heterosexual epidemic of AIDS" like that in African nations, Stillwaggon
says. "Treating African AIDS as a special case caused by a hypersexualized
culture obviously reinforces racist stereotypes and pessimism
over Africa's future," she adds. Such a focus also "pushes AIDS policy
to an almost exclusive reliance on behavior modification and condom use
and away from general health and nutrition, and it gives us little preparation
for similar epidemics that are now incubating in South Asia and Latin America."
Focus Prevention
on Poverty
Instead, Stillwaggon proposes that prevention programs
examine the culture of impoverished nations and praises South African President
Thabo Mbeki for questioning how poverty in Africa affects the development
of HIV/AIDS there. She says that "pre-existing health conditions play a
key role in susceptibility to disease," adding, "We should expect HIV/AIDS
to develop differently in rich and poor countries, just as do tuberculosis,
pneumonia, measles and nearly all other infectious diseases." Populations
in poverty are "characterized by malnutrition, parasite infection and lack
of access to medical care and antibiotics for bacterial STDS" -- the "biological
conditions for greater susceptibility to infectious diseases," Stillwaggon
says. HIV prevalence is "strongly correlated with falling
protein consumption, falling calorie consumption, unequal distribution
of national income and ... labor migration," she adds. Stillwaggon notes
that prevention programs that focus on the "synergistic relationship among
malnutrition, parasite infestation and infectious disease" do not deny
that HIV is an STD or that it causes AIDS. She concludes, "Strengthening
immune systems will help to protect people from some of the consequences
of unsafe sex and from other infectious diseases as well" (Stillwaggon,
The Nation, 5/21).
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