PHA-Exchange> 24 in preparation of PHA 2

[Claudio]

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 community 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 weakened 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 promotion 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 countries 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 activity 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 vulnerability, for the very high rates of HIV transmission among poor populations - unrelated to individual sexual behaviour. Despite their common sense validity and the weight of historical evidence in their favour, they have received very little attention.

 

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 interfere 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 devastating effects of malnutrition, undernutrition and specific nutrient deficiencies on the immune function, susceptibility to infection 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, unsurprisingly, is associated with increased risk of transmission. 

 

Let us recall that many African households are caught in a poverty cycle of low food production/consumption, low income, poor health, malnutrition, poor environmental sanitation and infectious 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 infection --which is what the rich countries all did-- is primary prevention, far more 'primary' than condoms or safer sex. 

AK 


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