Subscribe to this blog's feedAs we consider ways of broadening our HIV prevention strategy, we need to start thinking outside of the box and that includes expanding the number of health care workers, regardless of their background, but rather based on their place within the local society. I believe that too many of the industrialized nations just assume that you must have doctors/nurses to effectively administer any program that involves health care or prevention strategies and as such, that is how they plan and attempt to administer such programs. It is also why so many of these programs fail.
Unfortunately the majority of the HIV infections are in non-industrialized countries that may lack a strong central government, limited financial resources and health care personnel and a minimal infrastructure to support all the needs of their society. It does us no good to structure prevention programs that cannot succeed in such an environment and so we must stop demanding what we think will work and strive to find out what will work.
I did a little research and found that in many countries there are local people trained in the healing arts, and even though they lack any formal medical education, they are often the first ones that people seek for health issues. In some countries the doctor to population ratio can be rather low, say 10 doctors per 10,000 people. With that kind of ratio it is impossible to meet all the needs of those 10,000 people. However, within those same 10,000 people there also exist some type of healers that may number as high as 400 healers per 10,000 people. Couple the two together and you have the backbone on which you can build some prevention strategies, because the strategies that will work are not ones that readily come to mind, so let me give you one simple example.
In many countries there exist an abundance of cultures, which to us may seem unfathomable, yet their followers number in the tens of millions and represent the realities of those cultures. Some of those cultural practices involve the cutting or “scarring†of members for various reasons, such as a rite of passage and these practices are as natural to them as some of our cultural practices (piercing/tattooing) are to us. Unfortunately there are also some cultures that support the barbaric practice of mutilating the genitals of their women, which while deplorable in practice, it still offers us a way to promote HIV prevention. While we may not stop the mutilation, just maybe we can prevent any HIV infections in the process.
I read that in the Philippines some tribes have a tradition of placing small incisions between the eyebrows and during a ceremony it would not be uncommon for possibly 100 participants to use the SAME KNIFE for all of the incisions. Now imagine if that knife is contaminated with the HIV virus? How many of those 100 people using that knife might contract HIV, all without ever knowing the source of their infections? To Westerners the above may seem foolish because far too many naively believe that HIV prevention messages are provided worldwide. However, to the members of such a tribe there is a much greater chance that they know relatively little about the threats of HIV.
Now imagine if we could somehow connect and educate the healers as to the realities of HIV transmission and by doing so, they could do something as simple as sterilizing the knife between cuttings? Cutting, scarring and mutilating happen in many cultures and rather than evaluate the activity we need to simply view it in terms of infection risks and propose the least invasive method of protecting that population. Since our goal is to limit infection rates and we certainly need all the allies we can get, why not utilize the very people that millions rely on for their healing needs? To think, HIV prevention for hundreds or even thousands may be possible, all for the cost of a case, or two, of bleach each year per tribe.
We know how to prevent infections and often the simplest and cheapest methods will work, if only we change our view of what constitutes successful prevention strategies. I believe it is time for us to remove all judgment when developing HIV prevention strategies because only the truth will lead us to finding those methods that work. The issue is not whether anyone agrees with a given cultures ways. The issue is to understand that culture and formulate a program that utilizes all of the resources of that culture.
It is time for science to return as the basis for HIV prevention policies because science does not judge, rather it lays out the reality of HIV and provides a solid foundation on which to build prevention programs. It will take a quantum leap for many countries, especially America, to stop moralizing behavior when formulating HIV prevention policies. Declaring something to be evil does nothing to reach people, serves no useful purpose and as we have seen, any prevention program that limits the truth is destined to fail.
If we really want to develop effective HIV prevention strategies then the world needs to approach all of her cultures, to share the truth about HIV prevention programs, while respecting their traditions. While our cultures may be divergent the need to protect our citizens from HIV is universal.
It is time to stop thinking locally and start acting on a global scale.
