|A Proposal for Slowing HIV Contagion Among Africans|
he major vector of HIV contagion among black Africans is heterosexual intercourse. In contrast to heterosexual transmission among Europeans and North Americans, female-to-male contagion seems to occur roughly as frequently as male-to-female. The most likely explanation for this is that African men have a much higher incidence of STD-related penile lesions, which permit easier access of the virus to the male's bloodstream.
To prevent this African heterosexual contagion, it has been proposed that public information campaigns be waged to encourage monogamy. Another proposal calls for the widespread distribution of condoms. However, neither of these approaches is likely to be adequate, given the existing resistance of urban African males to such constraints. What is needed is a "sex positive" method of impeding HIV transmission.
I propose that African urban areas be saturated with small (2-ounce) tubes of lubricant gel, containing a viricidal agent such as nonoxynol-9. These tubes should be labelled, in appropriate languages, as follows:
GEL OF JOY
The tubes should be distributed by volunteers, who would be instructed to ply the streets of urban areas, giving them free to all males between the ages of 15 and 45. By its very nature, "Gel of Joy" should commend itself and enter into immediate and habitual use by most sexually active males.
There are about 25 million black, male African urban dwellers in the 15-45 age range. Reckoning that an average of 6 tubes will be accepted by each such male each year, a total of 150 million will need to be supplied to the continent. It is possible that the tubes can be mass-produced for as little as $120 per thousand. This would mean an annual production cost of $18,000,000, which would be raised by seeking contributions from Western countries. African nations, in their turn, would be asked to bear the cost of distribution.
It is probable that the use of this "Gel of Joy" will offer effective protection to males, in that any penile lesions would be coated with the viricidal lubricant. Use of lubricant would probably also protect the lesions from further abrasion and potential bleeding. However, research is needed to confirm these assumptions. Also, females would obtain only minimal protection from an infected male partner, as his semen is not adequately mixed with the viricidal gel. And care must be taken to select viricidal agents which kill HIV but do not destroy protective vaginal flora nor cause allergic reactions. The female population would benefit in the long run, if for no other reason than by the prevention of further rapid increases in the proportion of HIV-infected males.
It is possible that heterosexual intercourse is not the principal cause of HIV infection of African men. Perhaps they are infected, instead, by the use of unsterilized needles when they are in treatment for sexually transmitted diseases or other ailments. But if this were the case, we would expect a higher incidence of HIV disease among 5 to 14 year old children. And the problem of HIV-infected needles could be largely resolved by a similar strategy of generous donations to African nations of sterile hypodermic equipment, which can be manufactured cheaply in the developed world.(printer friendly version)