Every major campaign against AIDS in Africa has been based on the premise that heterosexual sex accounts for 90 percent of transmission in adults. Yet safe-sex efforts have not stopped the spread of the epidemic, which now affects 30 million people. Economic anthropologist David Gisselquist therefore suspected that HIV might be spreading primarily by another route. After analyzing 20 years of epidemiological studies, he and his colleagues concluded that unsafe injections, blood transfusions, and other medical procedures may account for most AIDS transmission in African adults. Their analysis indicates that no more than 35 percent of HIV in that population is spread through sex.
Gisselquist's interest in AIDS was stimulated by the guidance he received while traveling through Africa as a World Bank consultant. "They give you a syringe and say, 'Carry this with you, and avoid all the health care that you can.' We've been paying for third-world health care while advising ourselves to avoid it," he says. When he examined hundreds of papers on AIDS in Africa, he found evidence to back up those concerns. A study in the Democratic Republic of the Congo, for instance, found that 39 percent of HIV-positive, vaccinated infants had uninfected mothers. In contrast, Gisselquist could not uncover any clear data proving that sexual intercourse dominates the spread of African AIDS. In Zimbabwe, HIV incidence rose by 12 percent per year during the 1990s, even as sexually transmitted diseases sank by 25 percent overall and condom use rose among high-risk groups. Gisselquist recently reported his findings in four papers published in the International Journal of STD & AIDS.
Medical researchers may have overemphasized sexual transmission of African AIDS in part because condom-use campaigns dovetail with their concerns about overpopulation, Gisselquist says. They also fear that people in Africa will lose faith in modern health care. Gisselquist urges new efforts to halt the spread of AIDS: "Aid programs need to push infection control in health care. And we need to give the public the advice and the tools for protecting themselves in medical situations," such as new syringes and single-dose vials.