HIV/AIDS Growth in Africa

October 2012

On the radio the other day, the life expectancy of the average Syrian was mentioned. Surprisingly it was in the 70 to 80 age limit, with all the current fighting going on! What is it in South Africa today? The average is 49.33 years (males 50.33 and females 48.39). The main reason for it being below 50 is the devastating impact that HIV/AIDS has had, and is still having. The book, ‘The Invisible Cure, Why We Are Losing the Fight Against AIDS’ by Helen Epstein and published by Picador in 2007, is very enlightening as to why HIV/AIDS is such a prolific killer in Eastern and Southern Africa, and what can be done to halt its spread.

The author is an American researcher who wanted to understand the facts behind how Uganda has dealt so successfully in reducing the HIV infection rate; why the epidemic in East Africa and Southern Africa is so bad; and why current drugs will not stop the epidemic. There is no vaccine yet, even though millions of dollars have been spent on research to produce one. The closest thing to a vaccine that is currently available today is male circumcision, which has been proven to reduce the HIV infection rate by up to 70%.

HIV/AIDS is both a social and a medical problem. It is a recent phenomenon that has spread rapidly, and it is a result of historically rooted patterns of sexual behaviour and colonial development that left many people displaced and poor. This poverty and social dislocation has resulted in a wide economic gap that has allowed for a massive spread of the virus. During the 1990’s the HIV infection rate fell by 60% in an area of Southern Uganda, as well as in Northern Tanzania. Why was this? HIV transmission in this area results from normal sexual behaviour. It is not that Africans have more sexual partners than their Western counterparts. In fact they generally have fewer. What is different is that in many African communities, both men and women have more than one, perhaps two or three, concurrent long term relationships.
Long term overlapping partnerships are far more dangerous in that they link people into a giant network that creates a superhighway for the spread of HIV. This also explains why the huge focus on using condoms has not had the desired effect (the use of condoms is however still vital in curbing the spread). When you are in a long term relationship you tend not to use a condom. Condoms are used mainly in casual or commercial relationships. The problem is that if you are in a network of concurrent relationships, just one person straying and picking up the virus will result in the whole network becoming quickly infected.

Ugandans understood the dangers of this concurrency. But what was even more powerful was that it was talked about – not behind closed doors but in public, in communities, in churches, in taxis. It was also talked about by politicians. There were no ambiguous messages of “died after a long illness”; rather there was an acknowledgement that the virus can affect anyone, from army generals to hairdressers to doctors to taxi drivers.

In 1993 a Professor of sociology and statistics, Martina Monnis, came to Uganda to test a model that she had developed to predict the spread of HIV. It did not allow for concurrent partners and was therefore quickly rejected by the Ugandan doctors who recognised the problem of concurrent partners (imagine if Mbeki, with all his African renaissance dreams, had acknowledged what these African doctors had identified and had supported them instead of denying their insights?)

Martina then did an in-depth study on the sexual practices of the Ugandans. She found that they had fewer sexual partners than Americans. However the HIV rate in Uganda was 18% and in America it had never exceeded 1%. The reason was that Americans have sequential monogamous relationships. About 20% of Ugandan men are formally polygamous. The characteristic of the virus is such that infection occurs more often when an infected person has unprotected sex soon after they have become infected. With serial monogamous relationships, people will first use condoms until the relationship has deepened and there is mutual trust and understanding (and nowadays reliable HIV tests), before condoms are dispensed with. Hence the rate of infection is very low (the poor role model of a polygamous president in our country is not helping to curb the infection rate here).

Another real contributing factor is poverty. The book talks about the work that Rachel Jewkes, an epidemiologist with the South African Medial Research Council, has done on the sexuality of young people living in and around Umtata. Many of the women there take part in ‘transactional’ sexual relationships. In exchange for sex, they receive cash or gifts like cellphones, hair braids or nail polish. These women will be tolerant of the male partner having other partners, and they themselves also seek out concurrent relationships in order to get more money. The tragedy is that the women see the cash or gifts as a sign of love, and not as an exchange for sex, like prostitutes. The gross display of bling by the tenderpreneurs just feeds on the wishes of poor women wanting to be seen to have a cellphone, nail polish, to be driven in a smart car, etc.

So, what will stop the high rate of HIV infection in South Africa? This is the first time that we have seen the word ‘concurrent’ in all the information about HIV/AIDS in our country. The misinformation that we had previously was that people in Africa were much more promiscuous, which goes some way towards understanding Mbeki’s violent reaction to it. The sad thing is that if only politicians were courageous enough to talk honestly about it, the greater awareness and understanding would result in it not having such a stigma as a chronic disease. What can you do today? – talk about it, to your children, your team members, your colleagues, everyone. The greater the understanding, the greater the compassion.

As Ugandans have demonstrated, it can be done. They have ‘Collective Efficacy’, a term coined by Harvard sociologist Felton Earl, to describe the capacity of people to come together and help others who they are not necessarily related to. Wouldn’t that be more powerful for South Africa than silent shame?