PHA-Exchange> The Fidelity Fix/ Uganda Silent Revolution

[S.Minkin]

Dear PHA Friends,

Some of you may have seen the New York Times Magazine article attributing  declining rates of HIV infection in Uganda to the  promotion of sexual fidelity. That is only part of the story. The article missed the impact of  Safe Health Care in preventing HIV transmission.

Here is my as yet unpublished response. We need also to highlight Safe Health Care success stories. 

Best wishes,

Steve Minkin

Subject: RE: The Fidelity Fix


 

Helen Epstein's fine article attributes Uganda's success in HIV prevention to "The Fidelity Fix". (June 13 2004). That's only part of the story.

 

Safe Health Care is the silent revolution in HIV prevention. Ugandans today are very conscious of the risk of medical transmission. To prevent AIDS, Uganda women carry 'Mama Kits" to hospitals containing all the sterile materials necessary for safe child birth. Safe blood and safe injection practices are much more common today than they were at the height of the epidemic. 

 

The findings of a large, prospective study in Rakai Uganda  run contrary to the viewpoint that promiscuity alone accounts for the grip of AIDS on Southern Africa.  The results published in 1999 in the journal AIDS were not as expected. In Rakai Uganda the overwhelming majority of "HIV seroconversion occurred without recognized Sexually Transmitted Disease symptoms or curable STD detected by screening." The Uganda research follows studies elsewhere in Africa where many or even most HIV-positive women at outpatient maternity clinics had no previous history of sexually transmitted diseases. The only logical conclusion drawn from such research is that many Africans are infected outside of sex. 

 

Imagine AIDS in the United States or Europe if we had ignored the potential for hospitals and clinics to become centers of HIV infection. Suppose we highlighted condoms and sex education but were haphazard in the application of universal precautions and blood screening. Suppose our hospitals and clinics played viral roulette by sometimes using sterile equipment but often reusing syringes needles, catheters, specula and other invasive equipment over and over again. Under these circumstances AIDS epidemics in the US and Africa would have much more in common. We, too, would have an overwhelming health problem, with large numbers of women and children dying from AIDS. 

 

The World Health Organization Bulletin reported that over 50 percent of injections were unsafe in African countries. In the US and Europe the greatest risk to heterosexuals is not from sex but rather from HIV infected needles and to women having sex with needle infected men. In the US people exposed HIV infected injections are disparagingly called "junkies". In Africa, they are patients. 

 

Such issues have not been popular within the international AIDS community. I personally do not understand the global double standard. Surely,  the germ theory of disease operates the same for Africans as it does for people living in other parts of the world. 

 

 

Stephen F Minkin

The Network for Infection Prevention

PO Box 6073 

Brattleboro, VT 05302

 

Tel: 802-254-4472; email: smink at sover.net

 

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