What are the Sacred Cows of HIV Prevention?

A Conversation with Elizabeth Pisani

Text from today's Caucus newsletter (Aug 6 insert), distributed at AIDS 2008

By Jennifer Johnson, Population Action International

"We need to be clear that this is the best researched disease in history. We know what to do to prevent HIV infection, but we’re not drawing a straight line between what we know and what we do," stated Elizabeth Pisani, author of The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS.

This session [Monday, August 4] sponsored by the Caucus for Evidence-Based Prevention and the International Rectal Microbicide Advocates, was a frank discussion among advocates, framed around Pisani’s idea of the "sacred cows of HIV" (an analogy taken from drivers in India swerving to avoid cows in the road). What are the "sacred cows" standing in the way of progress in the fight against AIDS?

Religious groups that advocate for policy based in ideology rather than evidence may be one. Or the AIDS industry itself, which has framed AIDS as "everybody’s problem" in order to draw attention and funding, rather than focusing attention on the groups most at risk. The history of HIV/AIDS activism may be to blame, creating anti-testing and pro-treatment biases rather than a focus on prevention. There is also the assumption that people will make rational decisions about their health (e.g., using condoms and clean needles), when the evidence is that people are not rational about sex and drugs.

The group also discussed the need to strengthen health systems in general. Are poverty reduction, food security and women’s empowerment issues also AIDS issues or should they be kept separate? As Pisani stated, "Why do we need HIV to fight against sexual violence?" Some liked the idea of using HIV as a catalyst for ensuring these basic human rights, but others thought the funda-mentals of HIV prevention should be the focus.

This discussion is only one of many that are necessary to topple our "sacred cows" and promote HIV prevention based in scientific evidence.

[more photos from this event, and the rest of AIDS 2008, will be posted in a complete set upon IRMA's triumphant return to HQ]