Epi…dream…iology. How HIV prevention programmes are sometimes based on made up stuff.

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In my view, one of the strengths of many HIV and AIDS programmes is that they emphasise community participation, involving the people affected in analysing the issues they face and developing strategies to overcome them.  It can work really well, when it is well facilitated and based in reality.  But in the absence of good data on HIV vulnerability and risk – which is the case in many low income countries – everyone becomes an expert, and there can be a fair amount of people sitting around trying to conjure up the most worst scenarios to respond to.  And as a result, HIV prevention strategies often reflect prejudices and moral panic.  You often end up with long lists of stuff that could, conceivably happen, but no sense of whether it actually does.

I recently came across some conclusions from a study carried out by a development NGO on risks of HIV in the NGO workplace, in a sub-saharan African country.  It is described as “baseline research” but the methodology is not clear.  I do know that some of the recommendations were developed at a workshop where the participants “decided that xxxxx was a risk factor”, which suggests that the conclusions were based on guesswork.

Here are a few excerpts from the study, relating to risk and vulnerability factors (translated from French, hence the oddness of some language).  As far as I can tell, the ultimate conclusion is that AIDS programmes cause AIDS.  Note the blind spot on same-sex relationships, and the fact that condoms aren’t mentioned anywhere. 

“The factors that negatively affect the fight against aids in institutional settings are as follows:

  • The planning of unnecessary overtime by employers and employees of different sexes
  • Placing managers’ offices in isolated or overly discrete (hidden?) places
  • Sending colleagues of different sexes together on missions lasting more than a day
  • Work with beneficiary communities can be tempting for employees especially girl beneficiaries (orphans) and women beneficiaries (widows)

In terms of employees, factors identified were:

  • long field visits away from partner
  • unnecessary overtime by managers and juniors of different sexes
  • the authority of the boss which can lead to more or less forced sex
  • seeking protection at work which can lead to sexual provocation (temptation?)
  • spending a long time in each other’s company (sharing the same office every day) which can lead to over-familiarity and can end in sex
  • participating in workshops lasting more than one day by colleagues of different sexes
  • work in the field that can lead to intimate relationships between employees and programme beneficiaries
  • Infidelity of the partners of employees because they are away so often.

Practices identifed at the level of beneficiary communities are field missions including participation in trainings and improving the lives of beneficaries for whom the new socioeconomic status opens the way to friends who let them satisfy their sexual needs… eg child headed househoulds and vulnerable women who got enough money to get boyfriends and took on other risk behaviours like polygamy, unmarried relationships and alcooholism.”

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