Feature HIV and AIDS

AIDS and the irrational

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2638 (Published 26 November 2008) Cite this as: BMJ 2008;337:a2638
  1. Helen Epstein, independent consultant on public health in developing countries
  1. 1New York NY 10031, USA
  1. helenepstein{at}yahoo.com

    The director of UNAIDS, Peter Piot, is stepping down in the next few weeks. In an open letter to his replacement, Helen Epstein argues that the agency should give the issue of concurrent partners high priority in combating HIV in Africa

    In a recent survey of HIV positive South Africans, almost half believed that traditional African medicine is more effective than antiretroviral drugs.1 This is upsetting news. The country has invested heavily in antiretroviral drugs, rapid HIV tests, CD4 cell counters, and condoms and is the site of many clinical trials into novel treatments and HIV prevention devices. In the midst of all this technology, why do irrational beliefs about AIDS persist?

    The reasons are complex. AIDS advocacy groups attribute misconceptions about AIDS to sexual shame and the misguided leadership of former president Thabo Mbeki, who questioned the relation between HIV and AIDS. However, rumours about AIDS—that it is caused by witchcraft, US backed germ warfare against black people, or some foodborne poison—are common everywhere.2 In Nigeria, for example, a barber recently told a reporter that three quarters of his clients bring their own clippers because of fear of AIDS—even though there has never been a documented case of HIV transmission through hair dressing.3

    Unfortunately, the international public health community, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in particular, may be contributing to the mystification of AIDS in Africa by promoting a needlessly overcomplicated view of the epidemic that has sown confusion among researchers and ordinary Africans alike. Although UNAIDS can be proud of its success in getting most governments around the world to face up to AIDS, it must also face up to its failure to help the most severely affected communities understand the causes of the epidemic.

    The root of the problem may …

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