Biomedical science, behavioural interventions and a dollop of justice and rights: In conversation with Linda-Gail Bekker

Original content from our Mapping Pathways blog team

"I’m a great protagonist of putting effective biomedical technology next to proven structural and behavioral interventions, including a good dollop of justice and rights and then asking: how does one actually make the prevention package focus on this particular population at hand?"

In the second of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about vulnerable populations in Africa and the burden of HIV there. Read part one here

MP: We recently spoke to Charles Stephens of AIDS United who spoke about disturbing trends in vulnerable communities such as young black gay men in the U.S. What is your take on Africa, which carries the bulk of burden of HIV?

LGB: Southern Africa is the region where the HIV burden is greatest. . We have seen reductions in East Africa and West Africa is, to a certain extent, less troubled. The southern tip of Africa has really struggled with the HIV epidemic and my own country South Africa, with the greatest per capita of HIV, is particularly hard hit. While we obviously have contributions of perinatal infections, with universal PMTCT, we are hoping that eradicating pediatric HIV is an achievable goal.

But while the perinatal burden is happily on the downswing, there is an ongoing  incidence in young women, starting at sexual debut and peaking at the age of 25.  The incidence in young men starts later, in the 20s and peaks at the age of 35. So we see this alarming increase in incidence, particularly among young women from Africa who engage in penetrative, vaginal, heterosexual sex. So for our African context this is THE vulnerable population and we have to find prevention packages for that population in particular. People sometimes make the mistake of thinking of adolescents as small adults.  This is wrong. Adolescents need and deserve their own tailor-made prevention packages.

MP: What are some of the other vulnerable populations that are at risk in Africa?

LGB: We do also have concentrated epidemics in key populations that are vulnerable and in this age of biomedical technology, they too need tailor-made packages for prevention. My group has been focused on men who have sex with men (MSM), particularly MSM of colour, since the prevalence in this community is much higher than men in general, regardless of colour. Migrant populations, incarcerated populations and people who sell sex all have higher rates of HIV.

MP:  What needs to be done to address the problems facing these vulnerable populations?

LGB: I’m a great protagonist of putting effective biomedical technology next to proven structural and behavioral interventions, including a good dollop of justice and rights and then asking: how does one actually make the prevention package focus on this particular population at hand?

We have a lot of work ahead of us to specifically design, implement and test for effectiveness in each of these packages in each one of these populations.

Imperfect as it may be, we need to start trying to work out how to put these things together in very specific way. But it does require that we know our populations and understand their vulnerabilities.

But what stalls this progress is prejudice, judgmental thinking and mythical perceptions. This is where a project like Mapping Pathways is important since it tries to understand what people are thinking at the moment about these things. Too often, people’s opinions are actually what decide what happens and decisions made in the medical field are sometimes driven by emotion and not by hard fact or evidence. The Mapping Pathways project seeks to find out how people feel so that feelings can be contested by facts.  Hopefully by employng this very pragmatic approach, we can move best approaches forward as soon and as urgently as we can.

Stay tuned to the blog as we bring you part three of our conversation with Linda-Gail, where she speaks about the AIDS 2012 conference and the FDA approval of Truvada for PrEP. 

Stay tuned for the Mapping Pathways monograph, coming in early 2013

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