The Wisdom of Whores

HIV research nerds like myself collect information from people at risk because we want to make things better for those people (by providing better prevention services, e.g.), not because we want to make things worse. But what happens when that information gets used as a weapon against the very people we want to help? It’s your worst nightmare.

And it is happening in the northern Nigerian state of Bauchi, according to the BBC’s Shehu Saulawa. The Red Cross conducted a survey of sex workers in the conservative Islamic state, identifying around 320 of them. The next thing they knew the women were being rounded up by the Sharia commission, the defender of Islamic virtue, at least according to the BBC correspondent. (The Sharia commission denies the women were being arrested, saying that its staff were simply “supervising”, because “In every nook and corner and cranny, illegal acts were being committed contrary to Sharia law”).

According to the Beeb story, between 75 and 100 of the 320 women have so far tested positive for HIV. It’s not clear who’s doing the testing, but that’s a prevalence of between a quarter and a third of sex workers infected, “so far”. Horribly high, but not out of line with what’s happening elsewhere in the country. The long awaited report on the 2007 HIV surveillance round (pdf) is finally out: one in two women working in the brothels of Kano and FCT are infected with HIV. The lowest recorded rates are in Lagos, at just under one in four.

HIV rates are astoundingly high among gay men in Nigeria, too (again, close to a quarter of gay men in Lagos are infected) though somewhat surprisingly they are lower among drug injectors. And gay men don’t fare any better than sex workers at the hands of Bauchi’s morality police. Earlier this month a judge slung 18 cross-dressers in jail for messing with sharia law banning homosexuality. If there’s one thing we’ve learned in 15 years of dealing with HIV, it is that even where patterns of sexual networking allow for it, HIV will only spread through the “general population” if it first reaches a critical mass within sub-populations with the highest turnover of partners: sex workers, gay men and drug injectors. In other words, in any epidemic, but especially one where many adults do have sex with several long-term partners but HIV is currently concentrated among people with highest risk, it makes sense to invest in prevention for these groups.

Oh, we’ve learned something else, too. If you try to squash these groups rather than engage with them, HIV rises. What has Nigeria (and its major HIV funders, the United States and Global Fund) made of these lessons? Well, in 2007 The US invested 53 million dollars in HIV prevention, according to the PEPFAR website.

“Prevention activities in Nigeria include prevention of mother-to-child transmission (PMTCT), abstinence and be faithful (AB) programs, blood and injection safety, and other prevention initiatives, including activities focused on high risk populations.”

High risk populations? Hurrah! But no, it doesn’t mean sex workers. Rather, PEPFAR Nigeria singles out “girls who marry at a young age, causing their sexual debut to occur at an early age. This group, which has a mean age at first marriage of 14.6 years, is a vulnerable and largely underserved population…”

The Global Fund doesn’t fund prevention at all, except for the “innocent babies” thing. Though the clarion call these days is “Know Your Epidemic”, it doesn’t seem to translate into “Do The Right Thing About Your Epidemic”. And when the “knowing” it bit ends up with people getting slung in jail, you’ve got to wonder whether it’s worthwhile collecting all those data.

Thanks to Sean Lyons for the Bauchi tip