African Exceptionalism Explains High HIV Rates and Failure of HIV Drugs?

8 Mar

It seems like only a short time ago that pre-exposure prophylaxis (PrEP) was the next big thing in HIV prevention, being referred to as a ‘game changer’ at various HIV industry conferences, where accurate data often give way to gushwork. PrEP is the use of antiretroviral drugs to prevent HIV by people who are uninfected with HIV, but who are seen as being at risk of being infected.

However, a brief article on Reuters AlertNet reports that PrEP, along with vaginal gels, are “unsuitable for Africa”. The implication seems to be that there is nothing wrong with the drugs, but that Africans don’t ‘adhere’, they “did not use the medicines properly” and “more than 70 percent did not use the medication as instructed”. If only they would do what they were told, the drugs would work, apparently.

That people who are not sick tend not to be good at ‘adhering’ to a drug regime, that even people who are sick do not always adhere as drug manufacturers would like, is nothing new. The article goes on “HIV/AIDS experts said the results showed how important a factor human behaviour is when devising ways to prevent HIV”. Indeed, but any chance some of the incident infections in the trial were not due to sexual behavior? We are not told, and it seems unlikely such a possibility was even considered. It generally isn’t.

Despite heading up a pharmaceutical front group AVAC, that sees the use of technologies such as antiretrovirals as the best way of spending the HIV billions, Mitchell Warren says “HIV prevention is never just biomedical – behaviour is key”. But he is talking about the drug taking behavior of those Africans, whose risk, we are assured, is a result of their sexual behavior. How can people like Warren still be so sure that almost all HIV transmission in African countries is a result of sexual behavior?

As one of the people involved in the trial says: “We need to rethink the design of these intervention trials…in healthy people because it is difficult for anybody to take a pill or anything every day, particularly when you are healthy and do not feel that you need a drug”. But we also need to rethink the idea that HIV is almost always transmitted sexually among Africans. Trials like this should also look at non-sexual risks, such as those from unsafe healthcare, cosmetic and traditional practices.

Perhaps I’m imagining it, but the title ‘Anti-AIDS pill, vaginal gel unsuitable for Africa’ sounds presumptuous to me. It sounds as if there is something about Africans that makes these expensive technologies less useful in Africa than they may be elsewhere. It seems to go hand in hand with the assumption that HIV is almost always a result of unsafe sex, but only in Africa.


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