The road to HIV/AIDS prevention and treatment is an arduous one. Vaccine research and trials have been plagued with failures.[i] Culture and poverty in highly affected areas have left education programs fruitless. The marginal position of women, especially in Sub-Saharan Africa, has left them practically defenseless against infection by their often more promiscuous male partners, who often refuse to use condoms. In early July, however, a study of a prophylactic anti-retroviral gel in South Africa yielded favorable results against HIV infection. The success of this clinical trial, along with the success of a compensation program in Malawi aimed at keeping girls in school in hopes of reducing their HIV risk, was highly touted at this year’s International AIDS Conference in Vienna. Female education and agency, or ability to assert power or act alone, are often cited as some of the biggest factors in HIV risk in countries with the highest rates of infection, so how will these successful trials translate into a cultural context?
In the case of the antiretroviral tenofovir gel, female, agency is complete. It is a vaginal gel that was tested for daily application as well as application before each sex act. The average rate of HIV infection over the 30 weeks of the trial dropped 39% on average, with the high being 54% among high adherers.[ii] Obviously, this is not perfect. However, for women who have never had the opportunity to reduce their risk of infection this is a big deal. Many women say that their boyfriends or husbands won’t use condoms or that they want to get pregnant.[iii] With this gel, they reduce their risk despite their men’s refusal, and it does not stop pregnancy. However, it has not been tested on pregnant women. A similar trial in the US in 2008 yielded 100% success, or no infections, among the 200 women administered tenofovir gel.[iv] This is promising as a daily prophylactic approach to HIV prevention.
The Malawian study was somewhat less sustainable but also successful. Malawian girls and their families were paid small sums of money so that the girl would stay in school. The small amounts of money kept girls from turning to prostitution to feed their families, and, on average, the girls at the end of the study who had been paid had fewer sexual partners and lower incidence of HIV infection.[v] Obviously, this is not sustainable in the long run, but it does show the value of female education and the power of poverty in the spread of HIV. However, this means that HIV infection rates will probably remain high as long as these countries remain impoverished, as this often drives women to prostitution.[vi]
Apart from the apparent risk of prostitution itself, another practice that has come to light recently in Sub-Saharan Africa is the use of “flashblood.” This is the practice of injecting the blood from another intravenous drug user into one’s body for the residual high.[vii] This was first discovered among heroin users in Tanzania, and is most common among prostitutes.[viii] The practice is said to give some of the drug’s effects to the second user, though probably due to residue in the syringe rather than the blood.[ix] This seems to happen most often when one person gets paid and can afford drug while others can’t, so they share.[x] Despite the basic risk of needle sharing in general, injecting another’s blood, especially the blood of a prostitute and intravenous drug user, is probably the easiest way contract HIV. Although this practice is not widespread, it could increase the incidence of HIV in Tanzania, one of the Sub-Saharan African nations with the lowest rates of HIV infection.[xi] This is particularly worrisome because studies show that clean needles are both cheap and readily available in Tanzania, so flashblood use is only to stave off the symptoms of withdrawal.[xii] It will be more difficult to eliminate the risks associated with this practice than it was to lower the HIV rate among other drug user populations who were simply supplied with clean needles.[xiii] The challenge will be to instill an understanding of the risks and a fear of the outcome.
The fight against AIDS is full of steps forward as well as setbacks. It is clear that female education and agency, as could be supplemented with the availability of an antimicrobial gel, would be helpful in stemming the spread of the disease. However, it is also apparent that the spread of HIV is dependent on poverty and women’s worth. AIDS cannot be beaten by education or drugs alone, but rather a combination of both.