As championed by the United Nations and other NGOs, the international commitment to providing ‘health for all’, universal basic schooling and adequate shelter has long been contradicted by a development approach based upon a market fundamentalism that subordinates human welfare to corporate profits – necessitating an enormous shift in global priorities.
Bongaarts and his colleagues found a positive statistical correlation between lack of male circumcision and HIV sero-prevalence in the capitals of 37 Africa countries (Bongaarts et al 1989:373-5). Although most geographically localized studies of risk factors have not considered circumcision, a few have and have also discovered positive associations between HIV infection and lack of male circumcision (e.g., Greenblatt et al 1988). It is not known what the causal connection is between these factors but Barton (1989:13) notes that "post-coital abrasions in the foreskin is common in uncircumcised males."
In 1977 the World Health Assembly of the World Health Organization passed a resolution promoting the development of training and research related to traditional medicine. The following year in Alma Ata, WHO and UNICEF issued additional resolutions supporting the use of indigenous health practitioners in government-sponsored health programs. Such programs were initially directed at traditional birth attendants (TBAs) as distinct from traditional healers. The first well-documented collaborative program involving traditional healers in Africa predated the resolutions (having started in 1954) and focused on psychiatric care (1). More recent programs have focused on primary health care, especially on the "appropriate health technologies" of child survival such as oral rehydration therapy (2). Others have been restricted to screening and referral of patients to government clinics (MacCormack 1986:157). However, official, national-level collaborative programs of any sort are still rare in Africa.
As part of an initial phase of a pilot program to develop collaboration between indigenous healers and government health workers, qualitative research was conducted with traditional healers in Manica Province, Mozambique. The purpose of the research was to establish a knowledge base to develop a culturally-appropriate strategy for inter-sectoral communication related to the prevention of infant and child diarrheas. Dehydration as such was not understood, however the outstanding symptom of depressed fontanelle was recognized as a serious condition not necessarily related to diarrhea. Diarrhea and dehydration were nevertheless found to be linked through the concept of nyoka. Nyoka is believed to be a Guardian of Bodily Purity that dwells within all people. When impurities or contaminants enter a body, the nyoka reacts with cramps, diarrhea and a downward "pull" of a child's fontanelle, among other symptoms interpreted as the nyoka's attempts to purify the body through the expulsion of impurities. Nyoka appears to be a symbolic expression of the need to respect the human body. It is a complex concept that bears resemblance to biomedical concept of the immune system. It is linked with fundamental ideas about health and illness that find expression in notions of pollution or contamination that are found elsewhere in Africa
There have been suggestions that President Bush was able to promise $10 billion in new money to fight the AIDS pandemic in part because there is now a way to spend the prevention part of this sum (about half) in a way that is acceptable to conservatives. It's true that conservatives favor this approach, but that doesn't mean it doesn't work.
Readers of Global AIDSLink have long known about the ABC approach to AIDS prevention: Abstain, Be faithful, or use a Condom. Readers also know that Uganda did not invent this; they only implemented the ABC approach in an especially effective way. In the past few months, Uganda's ABC approach has become the model for AIDS prevention for the Bush administration, at least for the countries where the President's HIV/AIDS Initiative will be targeted. The House and Senate AIDS bills make specific reference to Uganda's ABC model, and I am one of the experts who testified about this model in both houses of Congress. In my opinion, the main thing Uganda did right was to implement a balanced program of the ABCs, and to actually include all three elements.
