assumptions about black peoples’sex lives andhealth.Surely,AIDS is sexually transmitted inAfrica,but as in the United States there ismuch more to the story than sex alone.InTuskegee the denial of treatment was deliberate.In Africa the devil is negligence by internation-ally funded AIDS programs.African women and young children are mostvulnerable to medically transmitted HIVinfections.Women of reproductive age get moreinjections and invasive examinations than otherdemographic groups.They start having childrenearlier and have more children than Americans.They need more life-saving transfusions forchildbirth complications and for pregnancy-related anemia.They are also placed at riskbecause of medically questionable injectionsand transfusions.A vexing problem is to ensurethat they get blood when they need it withoutexposing them to HIV,Hepatitis B or C,andother diseases.This will require investments intraining,salaries and equipment.The problem of pregnancy-related anemia ismost serious in areas with endemic malaria.During pregnancy women lose much of theirimmunity to the disease.The problem iscompounded by poor diet and the numerousstresses caused by poverty.Likewise youngchildren who have not yet developed immunityto malaria fall ill and often need blood.The following comments by Charles Obonyo,aKenyan physician,highlight a reality ignored byexperts and the media covering AIDS:
“It has become clear in recent years that the prevalence of severe pediatric anemia requiring blood transfusion, particularly in malaria- endemic regions, has markedly increased. At the same time, the prevalence of HIV among blood donors is also on the increase, to the extent that safe blood has be- come a scarce and rare commodity.”
In the U.S.the greatest risk of HIV infection for heterosexuals is amongpeople using unsterile needles or women whose sex partners use unsterileneedles.In this country people infected by needles are called “junkies”orIV drug users.In Africa they are called patients.The October 1999 WorldHealth Organization Bulletin reported that over 50 percent of injectionswere unsafe in African countries for which data were available.UNAIDS estimates that 5-10 percent of global HIV infections are directlyrelated to blood.Even if we accept these minimal figures,their significancefor AIDS prevention in Africa is much greater.Investing in AIDS withoutplugging this hole is like pouring water in a bottomless bucket.Withoutsafe health care,much of the future spending on AIDS in Africa will beboth ethically dubious and ineffective.The proportions of HIV infection resulting from sex or other causes arenot known.A recent large perspective study in Rakai,Uganda published inthe journal
indicates that that a great deal of previous work onAIDS in Africa was at best incomplete or drew sloppy conclusions.Thestudy found that people became HIV-positive regardless of their history ofexposure to sexually transmitted diseases (STDs).The Uganda researchfollows earlier studies showing that many or most HIV-positive women atoutpatient or maternity clinics had no previous history of sexually transmit-ted diseases.Such findings run contrary to the viewpoint that STDs andpromiscuity alone account for the fact that Africans are so vulnerable toHIV/AIDS.Some donor countries are doing much more than the United States toprotect people from HIV infection in hospitals and clinics.The Germanagency GTZ has taken a leadership role by supporting blood screening inthe Congo.However,the U.S.,the leading global source for AIDS preven-tion funds,has so far paid scant attention to the problem.As the majordonor,the U.S.virtually calls the shots at both the World Bank andUNAIDS.This gives Mr.Clinton and his successor the opportunity andresponsibility to ensure that future investments are both ethically viableand effective.