Its all about sex baby ....

Excuse my geekishness .... but it was fascinating week for AIDS in the news this week ... with two stories in the two of the biggest media players in the world ... telling almost opposite stories ....

The New York Times published a piece dramatically entitled Plague of Nations reviewing a recently published book (The Invisible Cure by Helen Epstein) ... which highlights the work of an American researcher - Maxine Ankrah - who had investigated in the sexual behaviour of Ugandans in the late 80s and 90s ... and found the cause for the precipitous drop in HIV rates in Uganda ... namely that Ugandans had stopped having affairs and remained faithful to their partners .... President Museveni had called for a "zero-grazing" approach to sex ... and hey presto .... Uganda became the HIV prevention world's poster-child country .... and PEPFAR's main stick to beat countries into abstinence submission ..... and of course the donor funds pored in ....

Epstein then makes the point that some (dopey) UN AIDS researcher ... apparently misunderstood Ankrah's work ... and wrongfully attributed the Ugandan miracle to increased condom use (just imagine!!) .... and then used this misguided conclusion to set global policy of promoting condoms (and thereby more sex!) around the world ....(inevitably as with all US media sources - the bungling UN gets relatively short shrift ....)

Now - the NYT/author of the Invisible cure don't want to sound racist here .... and acknowledge that it is not that Africans are shagging voraciously around the continent (there has to be something to do after the sun goes down right? ... when there's no telly) .... and the article quotes recent studies that have shown that Africans do not have more sex or even more sex partners than people in other parts of the world .... yessiree ... those blacks are apparently NOT out there shagging everything that moves (whatever those hip hop videos or white supremacist pamphlets tell us) .... in fact (according to my mate Tim who studies this ... a phd in sex ... ) the average number of sexual partners over a lifetime is pretty much equivalent across the world .... at 6 .... (high? low?!!)

But instead - the crux of all this is that - Africans are more likely to have concurrent relationships (ie have sex with more than one person at the same time .... naughty naughty ) .... which tend to be associated with less condom use and more risky sex ..... whereas in America apparently - these lifetime 6 partners are more likely to occur one after another sequentially ... and serial monogamy is associated with lower risks of HIV transmission .... even if they don't use condoms ....

The Take Home Message - Abstinence and Being Faithful are the key to preventing HIV (and hence the invisible cure ... geddit?) ... which sounds scarily anthemic of PEPFAR ....

In sharp contrast .... the BBC ran a piece essentially declaring abstinence programmes ineffective in stopping "risky sexual behaviours", following the publication of a study from Oxford in the British Medical Journal. Hmmmm .......

This study's message was that if promotion of abstinence in developed countries did not stop sexually transmitted infections or pregnancies - then it follows that such programmes have even less chance of working in developing countries where people have even less choice or control over sexual decision making ... and hence are pretty rubbish at preventing the spread of HIV.

The Brit media did not hold back in making a few pointed jibes at the US and the PEPFAR ideology of abstinence (condoms, needle exchanges, safe practices for prostitutes etc are all subjects non grata in the wonderful world of PEPFAR) ....

The accompanying editorial in BMJ went further .... and highlighted that whereas abstinence only programmes had largely failed - interventions promoting condoms had been hugely successful when targeted appropriately .... suggesting sarcastically that the US prioritises such interventions for its own specific populations where HIV transmission is amongst the highest in the world (blacks, hispanics, prisons, druggies, Men-who-have-sex-with-men etc) ....

Ouch ... is this the end of the US-UK special relationship? Has the Beeb become anti-american? Since when has the NYT been a government ideology mouth piece?

What it does highlight however is quite how politicised this pandemic was, is and will continue to be. Interestingly - Human Rights Watch - an organisation with a pretty good reputation (and - predictably - not the Bush regime's favourite NGO) published a report in 2005 urging Uganda to resist the US-driven anti-condom agenda condemning the false morality of its basis and requesting that future interventions be based on real science. The articles published this week show yet again how hard it is to find science or reporting that is unadulterated or unbiased .... and how little we have progressed ....