Thanks to gleefully rediscovered jeff Ballinger for the pointer.

Robert Ochai, director of the trailblazing AIDS support organisation TASO, has noticed that some of group’s the 23,000 treatment clients are giving up their HIV drugs because they have been “cured” by faith healers, according to a report in The Monitor. Apparently, faith healing has become big business in Uganda.

“Several Pentecostal churches in the country, more so in Kampala, invite the sick, including those with Aids, for spiritual healing. Some churches promise miracles, sometimes in exchange for their patients’ valuables. The most publicised case is of Ms Frances Adroa who claimed last year that she was tricked by pastors of the Universal Church of the Kingdom of God into offering her car to the church. She later sued the pastors after her condition deteriorated and they refused to return her car,” reports Kakaire Kirunda.

Eating in to family finances is bad enough. Deliberately encouraging people to give up life-prolonging therapy is far worse. But the effect on the epidemic as a whole could be catastrophic, too. If a person is on antiretrovirals, it is critical that they stay on them (or, to use the AIDS Inc. jargon, that their “compliance” is high). If they stop taking them for a bit, because they run out, forget, can’t be bothered, feel rotten or whatever, the amount of virus in their blood shoots up. That damages the immune system and makes it more likely that they’ll get sick, it increases the likelihood that the virus will mutate into drug-resistant forms, and it makes it much, much more likely that they’ll pass their infection on if they have unprotected sex.

Partly because of the extraordinary level of support provided by organisations like TASO, compliance among Ugandans on ARVs is very high. Undermining it in the name of God and Mamon is beyond cynical, it is downright wicked. In this regard, the “faith healers” are no better than witch doctors or traditional healers who sell expensive herbal cures for AIDS.

For an insight into the complicated relationship between traditional beliefs, modern medicine and faith, I urge you to read Johnny Steinberg’s book Sizwe’s Test, to be published soon in the UK under the less interesting title Three Letter Plague. He’s writing about South Africa rather than Uganda but he does so with depth of feeling and great humanity. It’s thought-provoking, and a lovely read.

Four in ten sex workers in Cambodia were infected with HIV when the government started its admirable programme to promote condoms in brothels, karaoke bars and on the streets. Sex worker groups also organised to demand health services, and for the most part, they got them. HIV infection rates came crashing down, halving in just 5 years. It is estimated that condom promotion had saved 970,000 Cambodians from HIV infection by 2007.

The programme worked because brothel owners and sex workers were organised, easy to reach and involved. Now, under pressure from the White House, Cambodia has launched a massive crackdown on the sex trade. The result, according to the Phnom Penh Post, is that sex workers are losing their livelihoods, their jewelry, their cash, and getting beaten up in the process.

Cambodian authourities have been persuaded by rescue missionaries such as the International Justice Mission (aka Cops for Christ) that women who sell sex for 5 dollars a day would rather sew T-shirts for three cents a piece. “It is no problem for [prostitutes] when brothels are closed. They can learn different professions from the ministry and local NGOs,” a policeman was quoted as saying.

Sex workers beg to differ.

Chanting “save us from saviors” and waving placards saying “condoms protect, police threaten,” hundreds of red-shirted sex workers demanded their human rights be respected and asserted they did not need to be “saved” from their jobs in brothels, least of all by lecherous, avaricious police officers.

The crackdown is the result of a new “Law on the Suppression of Human Trafficking and Sexual Exploitation”, which is based on US-style model anti-trafficking legislation. It assumes that the best way to get rid of the very nasty crimes of trafficking and sex slavery is to criminalise the sex industry as a whole. Never mind that there is not a shred of evidence to support this view, and a fair bit of evidence that the reverse might be the case. (A new study from New Zealand, for example, shows that decriminalisation of sex work has led to less exploitation with no increase in prostitution.) What the US Administration demands, Cambodia seeks to deliver. Even the US Ambassador to Cambodia, Joseph Mussomeli, has said he thinks it is likely that Phnom Penh has initiated the crackdown “just to keep the Americans off their back”.

To that extent, it has worked. The latest State Department report on trafficking, published a few days after the crackdown began, has upgraded Cambodia from the wicked to the less wicked category on its trafficking watchlist.

Does the crackdown mean men will stop buying sex? Unlikely. Does it mean that it will be harder to deliver the sorts of HIV prevention and health services that have won Cambodia accolades as an example of “international Best Practice”? Almost certainly, as sex worker activists, reproductive health specialists and even United Nations Secretary-General Ban Ki-moon have pointed out. (Disclosure statement: I drafted the introduction and epidemiology chapters of the Asia Commission report at the launch of which Ban argued against the criminalisation of prostitution.)

I’ve commented on what’s happening in Uganda before. But readers may be interested in this comment from Sam Ruteikara in the Washington Post. I provide the link not because I agree with his comment, or even particularly because I disagree, but because it is a phenomenal example of spinning the facts by accusing others of spin. Spin doesn’t save lives. Honesty might.

Some would say that means Uganda’s First Lady is a threat to national security; her enthusiastic embrace of abstinence as the main weapon against HIV is thought by some to have contributed to Ugandans getting sloppier about using condoms. (A paper on trends in sexual behaviour in rural Uganda will be published soon in AIDS.)

The army blames bad behaviour when the boys go to other countries on UN peacekeeping missions. By God, there must be a lot of bad behaviour if the figures cited in the New Vision story are right. The UN (and indeed the Ugandan army) screens peacekeeprs for HIV before they go on active duty, so most of the 2,500 Ugandans would have been uninfected when they put on their blue berets. When they came back, the paper says, 90 percent were infected. This is simply not plausible; under two percent of the population is infected with HIV in Benin, (compared with seven percent in Uganda). Yes, rates in sex workers will be higher than that but still…

But for me, the best non-sequitur in the story is this: “Dr. Godfrey Bwire of the UPDF said the HIV prevalence rate in the army was high, but he concealed the figures citing security reasons.”

“Gays are one of the drivers of HIV in Uganda, but because of meagre resources we cannot direct our programmes at them at this time,” Kihumuro Apuuli, chairman of the Uganda AIDS Commission, told the paper yesterday. I’m interested in this statement for two reasons. 1) As far as I can determine, Uganda has never permitted a systematic review of risk behaviours or infection levels among gay men in the country, so it’s hard to know whether they really are a “driver” of the epidemic. 2) What’s getting in the way of doing any decent prevention in this group is “meager resources”.

Odd, that. US taxpayers alone stumped up US$ 236 million for HIV programmes in Uganda in fiscal 2007, and they forked out a similar amount the year before. Uganda sucked in over 100 million in grants from the Global Fund in rounds 1 and 3, and the World Bank put up another US$ 97.5 million. Virtually every other major donor has funded HIV programmes in Uganda in the last decade. Ugandan President Yoweri Museveni is obviously aware of the gay community — Lord knows he and his supporting God Squad spend enough time harassing them.

But OK, let’s accept that the government would like to do something nice for gay men but can’t because there’s nothing left of the millions of dollars that have sloshed around in its national response to AIDS. Here’s my question: How come there is nothing, not a murmur, about prevention efforts for gay men in its latest Global Fund application? Kampala is asking for ANOTHER quarter of a billion dollars, and it’s still not planning to spend any of it on “one of the drivers of HIV in Uganda”.

So, though we’ve got little clear evidence so far that she’s right, I don’t take issue with her diagnosis. I do, however, take issue with her prescription: cross your legs. That’s right, she’s on her abstinence kick again. It’s hard to know to what extent she’s trying to suck up to George Bush, that global crusader for abstinence who’s government coughed up close to 500 million dollars for HIV in Uganda in 2006 and 2007. But even her formerly pro-condom husband has come over all wobbly about rubbers.

Uganda’s initial prevention efforts were much praised. They have also been much squabbled about. But I think most now agree that HIV transmission fell in the late 1990s because people had fewer partners, and less unprotected sex with the partners most likely to be infected. Some young women started having sex later, but the most solid data we have suggest that by age 23, the early abstainers had caught up with their peers in terms of infection rates. Unlike HIV, abstinence doesn’t last for ever.

Thanks to Adrian for pointing me to the NV article.

Condoms, when they get used in the real world (with bursts, slips and whatnot) reduce the risk of acquiring heterosexual HIV by upwards of 90%. But of course lots of people don’t use them, and lots more only use them some of the time. For an individual, using condoms 73% of the time still offers more protection than circumcision (and obviously the benefit is greater still if people use them with those partners most likely to be infected with HIV). But most people are realistic about their own behaviour. Yes, I’ll try and use condoms, but it’s quite nice to know that when I drift into second bottle territory and perhaps slip up, my chances of getting HIV will only be a third of what they were before I got snipped.

Public health types worry about the “when I perhaps slip up” part of it. They fear that if people start to regard circumcision as a “natural condom”, the latex will go out the window. Where rates of condom use are currently high, the widespread promotion of circumcision could undermine condom use and potentially lead to more risk of infection rather than less. There’s also some concern about how well circumcision protects in anal sex. It’s hard to disentangle, because so many gay men like to be tops and bottoms in anal sex. But a new study among gay men in the US, by Greg Millet of CDC (reported by Reuters) suggests that circumcision does not protect even those men who always take the insertive role.

My own suspicion is that the trauma (by which I mean tears and microlesions) associated with anal sex is greater than the protection associated with lopping off the foreskin, and with it the Langerhans’ cells that are particularly susceptible to HIV infection. Conclusion: If you’ve got a penis and you like to sleep around, by all means get the snip. But use your latex too, (even in second bottle territory).