As a US citizen, my tax dollars promote the lie that almost all HIV infections in adolescents and adults in Africa come from sex. Experts who should know better began this lie in the 1980s and have repeated it for decades. The lie ignores early[1] and recent[2] evidence that only a minority of infections come from sex. Most who repeat the lie intend no damage because they believe it.
Whether a deliberate lie or repeated by those who don’t know better, the lie stigmatizes and hurts HIV-positive people. For example:
Beginning in 2015, USAID’s DREAMS program in 10 African countries proposed to reduce new HIV infections in women aged 15-24 years by 40%. DREAMS focused exclusively on sexual risks.[3] By ignoring bloodborne risks, the DREAMS program stigmatized HIV positive women, implying their infections came from sexual behavior, and implicitly charged infected virgins with lying: you’re a slut and a liar. Many young HIV-positive women in the 10 DREAMS countries are self-reported virgins. Since only a small minority of infections in young women in Africa come from sex[4], DREAMS was ill-designed to protect them: predictably, an assessment of Dreams’ impact in South Africa, looking at almost 2,000 women, found that exposure to DREAMS’ programs “was not associated with measurable reductions in risk of sexually acquiring or transmitting HIV.”[5]
WHO in 2012[6] recommended “Couples and partners should be offered voluntary HIV testing and counselling with support for mutual disclosure.” The document recommended counseling couples about sexual risks but not bloodborne risks. Silence about bloodborne risks encouraged HIV-negative spouses to suspect their infected partners got HIV from sex. Such suspicions threatened relationships and families.
WHO in 2016[7] recommended: “Voluntary assisted partner notification services should be offered as part of a comprehensive package of testing and care offered to people with HIV.” As in 2012, WHO in 2016 recommended counseling couples about sexual risks but said nothing about bloodborne risks. As noted above, silence about bloodborne risks threatened relationships and families.
WOMENKIND Worldwide defines sexual bullying to include (page 3 in reference [8]) “…spreading rumours about someone’s sexuality or sexual experiences they have had or not had…” The lie that almost all HIV comes from sex promotes such bullying, encouraging people to suspect and spread rumours about the sexual behavior of HIV-positive adolescents and adults in their families and communities.
Not preventing HIV
Warning only about sex risks not only stigmatizes HIV-positive adolescents and adults, it also undermines HIV prevention by encouraging HIV-negative people to ignore avoidable skin-piercing risks. The DREAMS program, for example, by focuses young women’s attention on sex encourages them to overlook bloodborne risks, which are their bigger risk (see Table 6.1, Figure 6.3, and associated text in reference [4]) Messages that warn about both risks would give people the information they need to avoid HIV.
References
1. Gisselquist D, Potterat JJ, Brody S, Vachon F. Let it be sexual: how health care transmission of AIDS in Africa was ignored. Int J STD AIDS 2003; 14: 148-161.
2. Gisselquist D. Recognizing and stopping blood-borne HIV. SSRN [internet] 2022. Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4174723 (accessed 23 January 2023).
3. Saul J, Bachman G, Allen S, et al. The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PLOS ONE, 7 December 2018. Available at https://doi.org/10.1371/journal.pone.0208167 (accessed 22 January 2023).
4. Gisselquist D. Stopping bloodborne HIV: investigating unexplained infections. London: Adonis & Abbey, 2021. Available at: https://sites.google.com/site/davidgisselquist/chpt6sbh (accessed 24 January 2023).
5. Nondumisoa M. Kathya B, Natsayia C, et al. The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa. AIDS 2022; 36: S39-S49. Available at: https://journals.lww.com/aidsonline/Fulltext/2022/06151/The_association_of_exposure_to_DREAMS_on_sexually.5.aspx (accessed 22 January 2023.
6. WHO. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach. Geneva: WHO, 2012. Available at: #14 COUPLES HIV TESTING AND COUNSELLING (who.int) (accessed 13 January 2023).
7. WHO. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. Geneva: WHO, 2016. Available at: https://apps.who.int/iris/bitstream/handle/10665/251655/9789241549868-eng.pdf (accessed 22 January 2023).
8. WOMANKIND Worldwide. Stop sexual bullying: preventing violence, promoting equality, act now. London: WOMANKIND Worldwide, 2010.
Bloodborne HIV: Don't Get Stuck! 