nabeepchen

I was interviewing a woman yesterday for one of my articles, and the subject was disability.

“Here in Buffalo [New York] we have the second highest rate of Multiple Sclerosis in the U.S.,” she said knowingly.

And of course I asked, “Who’s first?”

“Seattle,” she said.

Now, I’ve heard a lot of things about Seattle in terms of diseases, such as its high rate of syphillis, HIV infection and tuberculosis. But never MS.

The woman wasn’t an expert on MS, but she assured me that Seattle was the hotbed of activity in this country. Highest prevalence, she repeated, like she’d said it many times before.

Multiple sclerosis isn’t anything contagious, so it wasn’t like I was afraid to go out and catch it from someone’s spit (as I’ve noted many times, spitting on the sidewalk is a favorite pasttime here). Rather, MS is an interesting mixture of both genetic and environmental components. People of European descent, who live in cold and temperate climates, are at the highest risk. And the climate seems to come into play only as you are growing up. Once past the age 15, moving from the North Pole to Bora Bora will have no effect.

I didn’t grow up in Seattle, so unless it was being caused by some indigenous microbe yet undiscovered, I really didn’t feel “at risk” for MS. But just to satisfy my curiosity, I did a quick Internet search. And wouldn’t you know, the woman is wrong wrong wrong.

Eastern Washington state and what they call the “Inland Northwest”are blessed with the highest prevalence of multiple sclerosis in the United States and the second highest in the world. I guess she assumed that Washington state means Seattle, never realizing that the Eastern part of the state, which lies on the other side of the Cascades, is a totally separate world. Climate, lifestyle, cost of living, political views…the two halves may not even as well belong to the same state.

Western New York/Northwestern Pennsylvania has the second highest prevalence rate in the country, so she was right about that one.

And now, the $50 million question–who is number one worldwide? That honor goes to Scotland, and more specifically, the Orkney Islands. Why is the rate there so high? Good question, and something I’m sure that they’re trying to figure out.

Once again, the wisdom of George W. Bush and the addle brained antics of his supporters comes into question. Public health, and health care in general, is definitely not the strong point of this administration.

Point in question: Bush believes that marriage and abstinence (and probably abstinence within marriage, judging from the laxity of support for family planning programs in general) are the answers to the woes of the earth. Now in theory, I have to agree. Abstinence, except to have desired children, would certainly eliminate overpopulation and improve the environment, dramatically cut the rates of sexually transmitted disease, help build stronger and more prosperous families by not having more children than they can afford to feed and educate…and so on. It is a wonderful idea, but unfortunately, so is the idea of having the tooth fairy come and leave a nickel under your pillow.

This is the real world. It doesn’t work.

On March 30, NY Times columnist Nicholas D. Kristof noted that encouraging married people to use condoms might decrease the risk faced by African women of contracting HIV from an unfaithful spouse. And yes, unfaithful spouses seems to be quite prevalent in many African cultures. Marriage, alone, does not stop HIV infection where infidelity is well woven into the culture. Marriage, in fact, can be a killer. The soaring rates of HIV infection among faithful wives in Africa proves this beyond a shadow of a doubt.

Money Spent on Suppressing Information

As one reader noted, in a letter to the editor, that the U.S. plans to spend $8 million this year in Uganda, on abstinence-until-marriage programs.

In a report released on March 30, Human Rights Watch reveals that these programs censor information about condoms and fail to inform young women of the H.I.V. risks within marriage.

Infidelity, polygamy, marital rape and domestic violence - this is the reality of marriage for too many African women. Instead of telling women to abstain until marriage, the administration must realize that this is precisely what many African women do, only to contract HIV from their husbands.

The author of this letter then goes on to offer a more viable solution, and that is to stop teaching African women that marriage will prevent them from contracting HIV.

Now that makes sense, doesn’t it. Why doesn’t the Bush program bother to utilize the skill, knowledge and expertise of doctors, scientists, and other health workers who actually LIVE in Africa and who understand the culture? Why does the administration continue to think that you can simply throw rhetoric at foreign cultures, and expect them to march in line?

This too, comes at the same time a study found that it was condom use and death from AIDS that was actually bringing down infection rates in Uganda–and not abstinence and “be faithful” programs.

A Nigerian physician also commented on Kristof’s article, and as a person well versed in African culture, stated that not only is condom use indispensable to fighting AIDS in Africa, but Bush’s program needs to make female condoms available to empower the women.

As a Nigerian psychiatrist and public-health physician who has worked with Nigerian women, I know that African men will not use condoms, not with prostitutes or girlfriends and definitely not with their wives - who, they believe, are their property.

He goes on to write that the average African woman is unable to say no to her husband’s sexual demands, even if she knows that he has been unfaithful. The result of “just say no” to sex can be a beating or divorce, and divorce can leave an African woman destitute. They would most probably not get child support, there are limited to no social welfare services to help them, and their culture would put the blame on them for the divorce.

Yes, apparently, marriage in Africa can be deadly, and it is a shame that our administration chooses to blindly set forth to “cure” AIDS in Africa–without any real clue as to what is at stake.

Image courtesy of Stock-xchng.com

And here’s a sad one for health history. On April 8, 1992, Arthur Ashe revealed to the world that he had AIDS. While the hysteria of the 1980s was starting to wind down by the time that Ashe made his announcement, AIDS was still a disease that best friends didn’t talk about. It was still considered dirty, sinful, punishment from God, and a disease which people brought upon themselves by engaging in illicit behavior–and so they got what they deserved.

I will be the first to admit that people are careless, even the ones who are well aware of the potential rewards of risky behavior. But Ashe had acquired AIDS “the clean way.” He was not a sinner, but simply a man who needed heart surgery. He underwent two procedures and received a blood transfusion during the second one, in 1983. It is believed that contaminated blood was the source of his infection. His HIV infection was accidentally discovered 5 years later, when once again, he required surgery.

But even though Ashe’s acquisition of the disease was “clean,” and the holier-than-thou crowd couldn’t accuse him of receiving his just rewards for sinful behavior, it was still a courageous act to come forward and speak out. Unfortunately, treatment for AIDS in 1992 was still extremely limited, and once the virus progressed to full blown disease, most patients succumbed rather quickly. Ashe died ten months after publically acknowledging his disease. At the age of 49, Ashe died of AIDS-related pneumonia.

In case anyone is wondering who Arthur Ashe is, he was a tennis player. A star player. In 1975, Ashe won the Wimbledon men’s singles crown and was also ranked the best male tennis player in the world. He also became the first black American to play on the U.S. Davis Cup team.