It’€™s not that people don’€™t know what to do to prevent HIV/AIDS, but rather that prejudice and stigma, disguised as morality, tradition and religion, prevent societies responding effectively to the epidemic.

This was the no-punches-pulled message of Australian political scientist Dennis Altman giving the Jonathan Mann Memorial Lecture* to the International AIDS conference.  

The need to focus on vulnerable groups in HIV prevention makes two problematic assumptions ‘€“ that people can be neatly divided by behaviour into identifiable groups and that all people have equal access to knowledge and resources to make free choices, said Altman

Increasingly both liberals and conservatives were placing greater emphasis on choice, he said, but this ignored the harsh reality that in order to have a choice, people needed both knowledge and the means to act on it.

‘€œThe more socially and economically marginalized a population, the greater its vulnerability to infection,’€ said Altman citing refugees, migrant workers, prisoners and indigenous and tribal populations.

He said someone who sold their body for sex in order to survive was more likely to be vulnerable to HIV. It was not enough to focus only on their behaviour, but on the poverty and despair that underpinned it.

Altman said a concern among some gay men in the early years of the epidemic that it would stigmatize homosexuals to be too closely linked to HIV had been replaced by a ‘€œfrightening silence’€.

‘€œTo always speak of HIV transmission through heterosexual intercourse without recognizing that many men will engage in sex with each other is to send the very dangerous message that homosexual intercourse is without risk.

Altman sharply criticized the growing tension between public health and religious and ideological pressures which he said often saw the United States and some of its most bitter opponents uniting in their support of repressive legislation.

He said countries such as Switzerland, the Netherlands and Australia contained the spread of HIV in intravenous drug users through the introduction of needle exchange and harm reduction programmes. However the US and ‘€œmost Asian governments’€ still disputed this evidence with the result that injection drug use was fuelling the HIV pandemic in ‘€œalarming proportions’€.

Altman also criticized Commonwealth countries pointing out that in most of Britain’€™s former colonies in Asia, Africa and the Caribbean, homosexuality was criminalized because of British laws which have been kept on the books by governments that boast of their opposition to colonialism.

Defending the need for theoretical discussion, Altman said ‘€œhow we think about and frame the questions will help determine the answers’€.

He added that far too little attention was paid to ‘€œanalyzing the barriers that religion, politics and human hypocrisy erect against effective programmes of HIV prevention’€ particularly at conferences such as the International AIDS conference.

Building his case against hypocritical governments and religious leaders, Altman said there were many reasons for anger in the face of the spreading HIV pandemic.

‘€œBut anger that is not supported by analysis, and that does not lead to action, is wasted and self-indulgent,’€ he said.

 He said that the catch-all term ‘€œcommunities of faith’€ ignored the ways in which fundamentalists of all faiths perpetuated gender and sexual inequalities which helped drive the epidemic.

‘€œAs the world becomes more dangerous and uncertain, and political attention is increasingly focused on war and terror, how we respond to the challenge of halting the spread of HIV is a central test of human decency and human solidarity,’€ he said.

* Jonathan Mann was a leading doctor and public health official from the United States who did much to promote a human rights agenda in the global response to HIV/AIDS and to draw attention to the link between poverty and ill health. He and his wife were killed in the crash of Swissair flight 111 in 1998.