Friday, December 29, 2006
First, there was the editorial about the high rate of malaria among people with HIV/AIDS in sub-Saharan Africa. The editorial ultimately was pushing for more research into treatment for malaria (that's a no-brainer), but the repetitive "HIV/AIDS/Malaria" mantra does a disservice to both HIV/AIDS and Malaria challenges. Of course there is a higher rate of malaria among people impacted by HIV/AIDS: people in the latter category have compromised immune systems. Plus, we know well that the poor are disproportionately impacted by HIV/AIDS because of a lack of education, lack of testing and prevention resources, and a daily desparation that places them at greater risk to exposure, as well as cultural practices (such as group circumcisions without adequate sterilization practices; this too seemed to be "news", as an article appeared about traditional cultural practices like shared breast-feeding responsibilities in some tribes was spreading HIV/AIDS, and this was a surprise to "experts"). Many of these same folks cannot afford mosquito netting or anti-malarial medication; combined with the compromised immune systems, the higher rates of malaria (as well as jsut about any other condition) should be expected and a surprise to no one. The damage, from a media perspective, is the melding of HIV and malaria, rather than using these connection to better understand both and how they are different. We already know from my work that the majority of people here in the US (including nurses and healthcare providers) don't know the four body fluids that transmit HIV, so when the media adds malaria to HIV, without truly clarifying and appreciating how they are spread, this is only going to get worse. The behavioral, cultural and transmission issues are vastly different.
The other news was that circumcised males have far lower rates of HIV than uncircumcised males. Fantastic! But, in the NYTimes article about this, the word "prevention" was connected with this news. To this I shout "DANGER!" If people think that because they are circumcised, they have to take less precautions, we are on a slippery slope to a no good place.
Every day, it seems clearer to me that we need a serious session of re-defining what we are talking about. The paradox is that we seem to need a simplification of definitions (such as HIV as a disease of body fluids so that no one is surprised when they read that shared breast-feeding is spreading HIV) in order to better understand it in all its complexities and ultimately end the spread of HIV/AIDS.
Social Service Lament
We here at The Mosaic Initiative are committed to HIV prevention, and have a concrete goal of blanketing the local community with an effective prevention message between now and December 1, 2006. Someone recently asked how often we will be promoting this; I'd say for the next two years, if absolutely everyone in this country (and around the world) were to be tested, AND were then adequately educated about "not spreading/getting HIV", we could make dramatic shifts in the current course we are on. What is interesting, and perhaps telling, is that the arenas where people are at the greatest risk in our local community receive their services seem to be the most reluctant to engage in the work. I have recently started to shift focus from churches to social service providers in developing the fall campaign. Of the nearly dozen providers I have contacted in the past months, two have replied. This despite having met some of the others face to face and agreeing to follow-up with a call. I don't think that the reluctance is deliberate or, possibly even conscious. I think it is more a function of a systemic demon - people are so overworked that they don't have the opportunity to take a step back, be introspective, and reflect on how our missions (really, no matter what our individual causes) really overlap. I also believe that when we work together we can accomplish so much more, but the institutional divides create barriers to effective and efficient partnerships. Of course, people may feel that HIV is not "their issue" (as I've been told), but when we are talking about prevention, isn't that something that can benefit everyone. Further, if the promise to to work with people, and we will do much of the leg/grunt work, we can actually help ease some of the burden. The need to collaborate is here, but the challenge to do so requires deep change, and this is where I believe the "status quo" of service continues to trump effective prevention.
posted by mosaicinitiative at 12:10 PM