209263 Breaking the silence: Safer sexuality and conception for HIV-positive Africans

Monday, November 9, 2009: 5:30 PM

Paula Tavrow, PhD , School of Public Health, Dept of Community Health Sciences, Bixby Program in Population and Reproductive Health, University of California, Los Angeles, Los Angeles, CA
Julia Dudek, MPH , Childrens Hospital Los Angeles, Los Angeles, CA
A striking failure of AIDS programming is that HIV-positive Africans' desires for sexual intercourse and procreation have been expected to be sublimated, even though young adults account for nearly half of new infections. The dominant prevention paradigm has been to change individual sexual behavior through promoting adherence to the “ABCs” (abstain, be faithful, use condoms). However, the ABCs actually represent a throwback to 19th century Christian moralizing about “good” sexual practices, since being faithful to an HIV-positive partner is not protective. Moreover, faith-based programs in Africa often depict the condom as “not 100% effective” and appropriate only for those unable to control their sexual urges, rather than as the optimal strategy when sero-status is unknown or discordant. In this presentation, we will discuss how donors and African governments—through their funding priorities, programs, and dictums—in essence have abrogated the sexual and reproductive rights of HIV-positive Africans, which may be fueling the epidemic. Our analysis of voluntary testing and counseling guidelines from various African countries reveal that sexual counseling of HIV-positive people is deficient and no mention is made of safer conception. Artificial insemination and sperm washing for sero-discordant couples is not being discussed or offered. Even AIDS support organizations do not legitimate PLWHAs' sexual and reproductive desires. If a new paradigm gains credence, in which HIV-positive Africans' sexual and fertility desires are considered natural and legitimate, then prevention programs to promote safer conception and pleasurable sex for HIV-positive people would be normative—and transmission might be significantly reduced.

Learning Objectives:
1. Identify the main deficiencies of the dominant AIDS prevention paradigm in Africa 2. Describe how HIV-positive individuals’ sexual and reproductive rights have been neglected 3. Discuss possible new strategies to promote these rights and reduce sexual transmission of HIV

Keywords: HIV/AIDS, Sexuality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Helped set up Tanzania National AIDS Control Program in the late 1980s while a USAID Health Officer; have conducted AIDS-related research in Kenya and Malawi from 1995 to present
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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