Tinderbox

NPR published an article and an interview with Craig Timberg; the author of ‘Tinderbox: How the West sparked the AIDS epidemic and how the world can finally overcome it’.

The piece is based in the author’s analysis of the HIV/AIDS epidemic (and the subject of his book), and it’s current state. Timberg shares some of the research and data around the beginnings of the virus, the spread to the ‘West’, and opines on prevention programmes. The article sums up the main points that he brings up over the course of the interview.

The opening quote for the article, “In vaginal sex, you can have sex with hundreds of people and not transmit [HIV], it turns out,” made me raise an eyebrow.

Understandably, I think.

All current research (as far as I’m aware) counts women’s physiology as one of the main reasons for why women are more susceptible to the virus, [TL;DR? Just CTRL+F ‘Biology’] which directly contradicts what Timberg claims in the interview.

I haven’t read the book, but going by the tone of the article and his interview; he seems to overlook several key points in his analysis of the epidemic. He doesn’t even mention something central to the current HIV/AIDS situation: women.

The feminisation of HIV/AIDS is one of the most concerning issues in the fight against HIV/AIDS. ‘According to WHOAIDS, the HIV/AIDS infection rate is constantly on the rise in women. In Africa, women represent 59% of adults living with the AIDS virus and three quarters of HIV positive women live in Sub-Saharan Africa. On a worldwide scale, 17.3 million women aged 15 years or more live with HIV, making up 48% of the world’s total. In Asia, Eastern Europe and Latin America, there is a growing number of women and girls living with HIV/AIDS’ [source]. Obviously all of this is further exacerbated by the existing gender disparity, the prevalence of violence against women, the lack of negotiating spaces, early marriage, and female genital mutilation; amongst others. The burden of dealing with the AIDS epidemic also falls on women- supporting families that’ve lost the main bread-winner to the virus, dealing with vertical transmission (mother to child),  as well as the stigma and discrimination that specifically targets women.

So I do not understand an entire interview that does not even mention how 50% of those living with HIV are women. That makes no sense to me.

In addition, I have grave objections to consistently pushing male circumcision as a magic solution to the epidemic.

He says, “The essential fact is that a man’s foreskin is a different kind of tissue than the other parts of his penis. It’s a little softer, it’s a little thinner and it’s more easily penetrated by the virus. And so a man who doesn’t have a foreskin is much less likely -70% or so less likely- to get HIV, and crucially; the man who can’t get HIV can’t give it to anyone else, can’t give it to anyone else, can’t give it to anyone else. There’s a chain of consequence when you block one infection. ”

Anyone who has read enough around male circumcision and HIV transmission, knows much; much better than to say things like ‘the man who can’t get HIV’ when talking about circumcision. That’s an idea that must not be propagated. It sounds as though I’m nitpicking, but if you listen to his repetition of the ‘can’t give it’- that’s underscoring an incredibly flawed idea. Circumcision does not stop the spread of the infection, it just lowers the possibility of infection.

While initial studies have shown a decrease in transmission, it is something that has (on the ground) shown questionable behavioural issues. After circumcision, there were reports of men refusing to use condoms because they believed that circumcision  would protect them from infection. Most importantly, the focus remains on men alone-it is about preventing the spread of infection in men. Male circumcision programmes look at reducing female to male transmissions more so than others (see the previous link)- and transmission of female to male infection is already considered less likely than male to male or male to female transmission.

These programmes do not, in any way, specifically address the needs of women and girls.- it does not give them the control over their own health/safety or the answers to an epidemic that they are physiological, culturally, and socially more vulnerable to.

In fact, all the examples he uses or references are specific to men. Even an evocative image of a radio advert that utilises a young girl to beseech/guilt her father into coming home- is about her father. It is not about that little girl, her sister, or her mother.

I’m also uncomfortable with how Timberg consistently uses incredibly disempowering imagery and language to describe socio-cultural interactions. I chafe at his use of the word prostitutes- he means sex workers, specifically in the context that he’s addressing.

This is especially true when speaking of the African context- he attempts to explain the polygamous practices, but does not delve into the socio-economic implications. He alludes to young women who have older partners who pay for their education, for example. This form of transactional sex is beyond just sex or about gifts- it is about the very particular issues of a power struggle, of access, and of a patriarchal society. This complete lack of contextual understanding of how it drives the epidemic, and specifically so for women, is shocking. I shudder to imagine how he conveys these sensitive ideas in his book, if he cannot adequately capture this in his spoken interview.

Throwing around phrases such as ‘Stay home, stay safe’ echoes a morality framework that has been proved ineffective and inefficient. While he briefly mentions the ‘abstinence based’ policies of the US government (still continuing, by the way. It did not shift under the Obama administration) and supports an open approach to sex and sexuality; again his comments are very, very specific to men.

There are a number of other issues in his interview and in that particular accompanying article; but I was also surprised that he mentioned funding and HIV/AIDS programming that is driven by the West; but did not even breathe a word about the current funding crisis, the cancellation of Round 11 (that had a particular impact on Africa), or even mention treatment and access to treatment.

I’m  a little curious to see whether he mentions the forced sterilisation and coerced contraceptive use programmes targeted at positive women as he analyses some of the disastrous HIV prevention campaigns. A little curious, but not enough to make myself read his book. Especially when he completely ignores 50% of the very people he is speaking about. The very people that Kofi Annan said, ‘The face of HIV/AIDS is a woman’s face’ about.