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is DC really West Africa?

15 March 2009

The sense of urgency conveyed by the comparison of our capital to other parts of the world with high HIV prevalence is eye-opening. With all of the work the US does abroad (and with the great number of undergrads who ask me how to get jobs working on HIV/AIDS in Africa), I think it’s important to include in the conversation our own experience with HIV and AIDS, and there’s no place better to start than our nation’s capital.

Nonetheless, Washington DC is not West Africa.* Beyond the glaring difference that DC is a city in the industrial north and West Africa is a geographical area comprised of multiple countries spanning urban and rural areas in the developing south, there are some important differences specific to both the transmission of HIV and the treatment of AIDS.

  1. The primary modes of transmission are different in DC (multiple: MSM, heterosexual sex, IDU) than in West Africa (heterosexual sex). That means any response to the HIV epidemic in DC will require more hard thinking about the different ways in which HIV is transmitted.
  2. HIV testing and AIDS treatment are free in the US for anyone who cannot afford it. While technically the same holds true in a number of African countries, the availability of testing and treatment in West Africa is much more difficult to reach because of lack of supplies, geographic concentration of resources to typically urban areas, and transport constraints (either availability or cost).
  3. The virus type is different in DC (HIV-1) than in West Africa (HIV-2). HIV-2 is biologically similar to HIV-1, but has a reduced virulence compared to HIV-1 and is geographically limited to mainly West Africa (Marlink 1994 [gated]).

One interesting point where the Washington Post article missed an opportunity to compare DC to West Africa is in the discussion about the limited resources with which the district’s AIDS office works, and the judgment about how those resources were spent:

Until recently, the District’s AIDS office lacked a fully staffed surveillance unit to collect, analyze and distribute data. Inevitably, the office lost credibility, and although it has received millions in federal and local funds — $95 million this year — some care providers questioned whether resources were being properly allocated.

Though I appreciate that HIV and AIDS are a global problem with similarities across divergent contexts, I also think the people who are navigating the AIDS epidemic in Africa are doing so with many fewer resources. Emanating from that, the implications of HIV and AIDS will be very different. And, what exactly are we saying in our encouragement to get people to do something when we compare ourselves to Africa? Are we trying to elicit an OMG response? Something in me says we should frown upon that.

*My geographical area of expertise is Malawi, a southern African country with an HIV prevalence estimated at 12%. I do not purport to be a technical expert on the HIV/AIDS experience in Washington DC or West Africa, but am relying on publicly available policy documents and peer-reviewed articles in my contrast of the two places.

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