AIDS: Away With Political Correctness

As the XVII International Aids conference ended in Mexico City, its 25,000 delegates had more money – including $39 billion approved in July by the US Congress – but no better ideas about spending it.

As usual, this gathering heard earnest discussions of human rights and social justice.

However, from my perspective as a public health epidemiologist, time would have been better spent pondering the science of HIV transmission to ensure the huge sums will be spent on what is needed, rather than on the politically-correct programmes to date.

New US estimates got a lot of attention but did not change any of these issues because the number is a small percentage of the population and does not represent any change in the overall HIV situation in the USA.

We now know that apart from a few HIV epidemics due to infected blood, epidemic HIV transmission has occurred only in populations with the highest HIV risk behaviour, principally having multiple and concurrent sex partners or sharing needles with other drug-users.

Sub-Saharan Africa has been particularly hard hit because up to 20 to 40 per cent of adolescents and adults of both sexes in some countries routinely have several long-term and concurrent overlapping sex partners.

While people outside Africa may have as many sex partners in a lifetime, these tend to be in a serial monogamous pattern that limits epidemic HIV spread.

Similarly, homosexual men who have multiple and concurrent partners are at high risk of epidemic HIV transmission.

From the beginning, HIV prevention programmes have not focused sufficiently on these high-risk groups, in part because they have been diluting their prevention efforts by trying to prevent “generalised” HIV epidemics that have not and cannot occur in any “general” heterosexual population.

For decades, UNAIDS and AIDS programmes throughout the world have been operating on the politically-correct but epidemiologically-flawed position that virtually everyone is at risk of an HIV infection, especially the poorest.

This is wrong. Numerous studies in Africa have consistently shown that the richest men and women have HIV prevalence rates two to three times higher than the poorest, probably because the rich can afford more sex partners.

Globally, Aids programmes have wasted billions of dollars on HIV prevention directed at the general public, particularly youth, who, outside of sub-Saharan Africa, are at minimal or no risk.

The “politically incorrect” idea that Aids prevention should focus more on those at the highest risk now appears to be increasingly accepted by mainstream Aids experts.

The head of HIV/Aids at the World Health Organisation admitted in June that “it is very unlikely there will be a heterosexual epidemic” outside sub-Saharan Africa.

However, changing high HIV-risk behaviour remains difficult since these are socially unacceptable and illegal in many countries.

Many governments hinder efforts to prevent HIV transmission by opposing needle exchange for drug users and keeping prostitution illegal.

Meanwhile, HIV prevention programmes in sub-Saharan Africa have been undermined by the politically-correct myth that poverty and discrimination are the driving forces of HIV epidemics, instead of risky sex.

If we are serious about limiting HIV transmission, then the politically correct paradigm needs to be abandoned.

Apart from Africa, prevention programmes should target the highest HIV-risk behaviour groups – gay men, injecting drug users, sex workers and their clients.

Professor Chin teaches epidemiology at the School of Public Health, University of California at Berkeley.