The critique
The HIVprevention.co approach is based on a simple fact about epidemics - if each infected person infects on average less than one person the epidemic dies down.
The reality is that heterosexual HIV transmission (not including mother to child transmission or blood transfusion or IV drug use transmission here) in the "epicenter" countries (Subsaharan Africa, India, Thailand and China) happens mostly under one or more of the following conditions:
1. Male predatory sex on women/girls unable to resist (poverty, gender status,
social norms etc.)
2. Intergenerational sex - Older men, young girls
3. Influence of alcohol
4. With a sex worker (prostitute)
5. Rape
6. HIV positive men infecting their monogamous wives who of course have no power
to negotiate "protection".
Leaving aside the technical infrastructural issues of cards/databases/access to databases etc. none of the above are situations where "carding" will likely occur.
So unless I am completely misreading the idea, I am unsure about the applicability of this method outside of a very niche situation.
The response
Thank you for all the valid points which you have raised.
What I am proposing is not a "health card" in any shape or form. It is a piece of plastic with a person's photo and a 16-digit number, period. This number may, or may not, be related to health data in a remote computer. The health data, if any, can be "healthy" or otherwise. There is no way of using this data to locate in any way the individual. Indeed, should the individual destroy his, or her, anonymous card, the link in the opposite direction would also disappear.
I don't know where you are writing from or what your origins are. Personally, I was born in Africa and have lived in a lot of countries in Europe, the Far East and even the States. My grandparents come from 3 different countries and my 2 children from mothers in countries 4 and 5. I am polygot speaking 6 languages. I have been a bachelor for much of my life and have a reasonably good idea of what goes on where.
The one thing which I have observed is that sex is universal and that sexually-transmitted diseases have no respect for borders. At the same time, I will stress that some cultures (i.e. networks) are far more vulnerable to transmission than others. HIV probably existed in Africa for thousands of years but the taboos of these "primitive" tribes prevented the disease from spreading. Now we have "progress" and these taboos have been discarded and the network has totally changed - we are living with the consequences of the work of European missionaries. Another scenario is being played out in Russia and its previous dominions, the end of communism has led to a rearrangement of the network and HIV is spreading, initially through injecting drug users, as a wildfire.
Strangely enough, some of the societies which are most heavily criticized in the West have networks which limit the spread of STD's very effectively - I am referring to many moslem societies. I don't care much for their social systems, however. I like freedom and I believe that my proposal is a reasonable compromise.
What I am proposing is not intended to be a blanket solution to the whole of the HIV fiasco. Indeed, if my proposal were to work well for only a "niche" , I would be delighted since that would represent a large number of individual lives saved or improved.
You mentioned lots of countries but not the United States. In the USA, around 40,000 individuals get infected with HIV each year. For genital herpes the total number of infected americans is 45 million. I quote from the CDC - "HSV-2 infection is now five times more common in 12- to 19-year-old whites, and it is twice as common in young adults ages 20 to 29 than it was 20 years ago". This concept is equally applicable to this incurable disease.
For the Unites States, these 6 categories that you mention either do not really apply or the anonymous card would be of use. For example, many prostitutes in the United States work in legal brothels or carry out their activities by telephone or over the internet. Many of them do "walk the streets" but these are only the most visible ones, not the most numerous. Clearly, for the less desperate prostitutes, this proposal has merit - it is good for business.
For Russia and its neighbouring countries, the sharing of needles by drug users (many of them prostitutes) is the main vector of transmission at present. This concept is useful to them. The second stage will be when these prostitutes pass it on to married men - here this concept is equally useful just like for the States. If this concept is used soon, the third stage where these married men pass it on to their spouses will not be reached.
Africa is a very difficult one. However, it is worth bearing in mind that there are more cell phones in Africa than fixed-line phones (the first continent to achieve this). Furthermore, phones are shared and rented out so that the real number of phone users is much greater than the number of phones/capita would imply. Here is a link to a recent article in the Wall Street Journal about Botswana. This is a country with a population of 1.5 million only where HIV has reached 35% of the population and where Merck and the Gates Foundation has undertaken to spend $100 million over 5 years (starting in 2000) on HIV/AIDS treatments. We are now 2 years into this program and so far according to a recent article in the Financial Times "about 2,000 people have so far enrolled for anti-retroviral treatment receiving treatment". Truly amazing.
All I can say, with absolute certainty, is that with a fraction of these sort of sums, using my proposed concept, several hundred thousand people would be protected, albeit imperfectly, against infection in that most unfortunate country.
Let me now go through your 6-point list for Botswana:
Male predatory sex on women/girls unable to resist (poverty, gender status, social norms etc.).
If the males are infected and the females not, there is nothing my system can do in this situation. If the other way around, the men would be well-advised to check the women first - they are strongly motivated to use this concept.
Intergenerational sex - Older men, young girls
Contrary to popular perception, this arrangement is frequently arrived at with the agreement of the family of the girl. They want her to build up a little capital (and give them some money) so that she can marry later on. Her family will help protect her interests and use this concept.
Influence of alcohol
Nothing can help there.
With a sex worker (prostitute)
Just like in the West, there are different classes of prostitutes. Some will want to use it and will be in a position to do so and and some not.
Rape
Appropriate medication can prevent the vast majority of women from getting infected - that has been the experience in South Africa. Let's not forget that the chance of infection is pretty low per sexual episode if the woman is healthy.
HIV positive men infecting their monogamous wives
The trick here is to prevent the men from getting infected in the first place. Let's not forget that the women are not just sitting at home doing the knitting - they frequently also have liasons. In any event, I really don't see why married couples who are separated over long periods because one of them works far from home can't subscribe to this concept. In the UK, 10% of children are not the biological children of the man who everyone thinks is their father. I doubt if it is very different in places like Botswana.
Finally, I really hope that it comes across that what I am proposing can only be a small part of the solution.
Alfred
London, UK