Response to Mwanza and Rakai Studies

Kesaobaka Modukanele

HIV/AIDS - Biology, behavior and Global responses.

Blog post for Tuesday October 13th

In many countries with propelling HIV/AIDS prevalence rates, governments have continuously battled with the challenge of reducing infection. Some interventions that have previously been used involve encouraging communities to know their status’ or , teaching health education like with the ABC campaign. In countries with nationalized health systems, HIV positive people have been enrolled in anti-retroviral therapy. However, despite the fact that the Rakai and Mwanza study has shown that controlling STI infection in communities could go a long way into helping reduce the spread of HIV/AIDS, it doesn’t seem like this prevention intervention is commonly adopted by governments. It may be that the Rakai study proved successful because the target population was very controlled and it was much easier to do routine check-ups and be able to treat new infections. In these controlled groups, home based mass treatment as in the case of Rakai, and STD case management in Mwanza were used to treat infected individuals. However, in reality it might be difficult to do either mass treatment or case management due to all the cultural complexities that arise with STI treatment, especially since contraction of many STI’s are rooted in sexual concurrency. In implementing such an approach, issues like gender inequality, population mobility, family structure, etc have to be taken into consideration. Lets take population mobility as an example. In many African countries, it is common for men living in rural settlements to migrate to urban settlements in pursuit of employment. If they contracted an STI, it might be hard to a) get routine checkups away from home since these interventions are very geographical or b) agree to be enrolled in a mass treatment program on their return to the home, as that would be admitting to being unfaithful to their wives, and create tension within the home. The Mwanza and Rakai studies, although proven effective, did not take such cultural issues into serious consideration. For this reason, these studies seem very theoretical and rather hard to implement. A community based STI prevention intervention like this should definitely make cultural considerations.