This won’t make me any friends, I realize. As long as I’m not making friends, let me ask another un-p.c. question about AIDS in Africa and here. If the superinfection problem is real, it means that unsafe sex (here or abroad, gay or straight — but see my previous post for qualifications) could rapidly spread drug-resistant virus through a population on antiretrovirals. The result is that broader access to antiretrovirals in Africa could produce a breeding ground for drug-resistant HIV. How will this affect the international AIDS advocacy dynamic, if First Worlders start to see Third World antiretroviral drug access as a threat to their own public health?
I’ve been verbally attacked in public places by close friends for even mooting this line of thinking. The objection seemed to be that “we’ll cross that bridge when we get to it,” right now “we need to save lives.” But the fact remains that sometimes we do have to think in the long-term, that’s why we have these complicated neo-cortical systems that have the ability to override our emotional impulses (in theory).
Not only are there negative long-term consequences epidemiologically, I also believe there are negative social consequences of swamping the market with cheap drugs that treat the symptoms, but do nothing to the underlying illness and mitigate the consequences of risky behavior. The results from trials in Zimbabwe and Botswana do indicate that Africans do stick to their regimens rather well, so the nay-sayers, I included, were wrong when we asserted that the drugs would be wasted by improper application. Nevertheless, I do believe that this catastrophe that is causing such problems in Africa and to a lesser extent the rest of the world highlights the risks for certain types of behavior that were culturally or biologically favored in a different context.
As I have stated repeatedly, Thailand was supposed to be the center of the “post-African AIDS epidemic,” but seroposivity remains ~2%. In contrast, Uganda is touted as a “success” at 5% seroposivity. In fact, previously unaffected southern Africa became the center of the AIDS epidemic in the 1990s. Does anyone doubt that the fact that this region of the world exhibits polygamous mating patterns is part of the cause? The fact is that human beings, in relatively literate and stable societies (Botswana), still engage in risky sexual behavior when the HIV infection rates in the surrounding population hovers around 25%! We have seen the same behavior among homosexual men. It is clear that in much of the world women serve as a restraint on male sexual recklessness (as best as they can), but in southern Africa (and other regions as well), the traditional expectation of multiple simultaneous sexual partners for men undermines this. In addition, Christianization and the concomitant “official” abolition of polygamy, has spread the sexual network far and wide as women no longer live under same roof and must have several “boyfriends” to support them. You can also look at this chart and see that the AIDS epidemic in the United States is concentrated among blacks and to a lesser extent Latinos.
Liberal whites can make grandiloquent gestures of altruism, because the epidemic is not tearing through white or Asian societies in the same manner as it is in black or brown cultures. Whether the difference is cultural or biological, we must explore it. Some of us have met the enemy and it is us.