Changing habits

2010-02-12 00:00

HIV prevention is based on getting people to change their sexual habits — but this is a very difficult process, as President Jacob Zuma has shown.

Although South Africa has almost a million HIV-positive people on treatment, actuaries tell us that over 300 000 citizens are still being infected with the virus every year.

This prompted health economist Professor Alan Whiteside to remark recently that “HIV treatment without prevention is like mopping the floor while the tap is running”.

The bottom line is: unless we are able to improve on our HIV-prevention efforts, the health system will soon be overwhelmed by those who need treatment. Already­ our hospitals and clinics are battling to deal with HIV/Aids, and the Treasury estimates that we’ll need an extra R2 billion a year until 2021 to pay for HIV treatment.

But HIV prevention is a slow and difficult process. Most of the weapons assembled by social scientists over the past decade to protect humanity against HIV infection­ are based on getting people­ to change their sexual behaviour­ and this does not happen overnight, especially among older people with entrenched patterns­.

For years, South Africans have been battling to learn the sexual alphabet that our prevention campaign has been based on: Abstain, Be faithful and Condomise.

Despite the millions of rands spent on scientific exploration, HIV weapon number one for the sexually active remains a little latex­ bag called a condom. Semen and vaginal fluid carry very high levels of the HI virus and the genitals are a prime site for infection. Condoms (both male and female) provide the only physical barrier that is known to keep HIV out during sex.

Condom use has increased among young men particularly, according to the 2009 National Communication Survey on HIV/Aids, released two weeks ago. Almost eight out of 10 young men aged 16 to 19 had used a condom during their last sexual encounter, but only one in 10 men aged 50 to 55 had done so. People older than 55 were not polled, so 67-year-old Zuma fell off the survey radar.

But the president’s aversion to using condoms during his extramarital relationships, despite having numerous children born out of wedlock, is a good example of just how difficult it is for older people to adapt to less risky sexual behaviour.

In 2005, Zuma was accused of raping an HIV-positive woman. During his trial in 2006, he admitted that he had not used a condom and was ridiculed for saying that he had protected himself by taking a shower after sex. But last year, despite marrying two more wives, Zuma also produced a baby with a woman who was not his wife, Sonono Khoza.

After years of puzzling over why HIV/Aids is so high in southern Africa­, social scientists have hit on what they believe is a trend peculiar to southern Africa: widespread “multiple and concurrent partners”.

While Brazilians have more sexual partners in one year than South Africans, these tend to be one-night stands. But southern Africans tend to have more than one partner over a longer period of time, creating a vast interlocking “sexual network”. People in longer relationships are less likely to use condoms, thus enabling HIV to travel easily through their sexual­ network.

Polygamy does not pose a danger when it operates as a closed set of exclusive relationships, but the danger occurs when the partners have sex outside of the closed set.

Again, our president is a clear example of a man involved in “multiple and concurrent partnerships”. He has three wives, one fiancée (Gloria Ngema), half a fiancée­ (Princess Sebentile of Swaziland) and last week told us he is also “in a relationship” with Khoza­, the mother of his four-month-old baby.

Another behavioural danger is “intergenerational sex” — at least for women. Young women under the age of 25 are up to six times more likely to be HIV-positive than young men of the same age. This is because many young women are involved with older men. An age difference of five or more years was found to be extremely risky for young women.

“Older men often have infection rates higher than adolescent boys or young men, and age and economic disparity between partners has been shown to compromise young women’s ability to negotiate safe sex,” said social scientist­ Professor Suzanne Lerclerc­Madlala.

Again, Zuma is a prime example of an older man preferring younger women. His latest two wives, Nompumelelo Ntuli and Thobeka Madiba, are both in their 30s. Khoza is 39, while the woman who accused him of rape, known only as “Khwezi”, was 31 at the time. Both Khoza and Khwezi are the daughters of Zuma’s friends — so these were literally cases of “intergenerational sex”.

While Thabo Mbeki’s presidency was characterised by his denial of HIV/Aids, Jacob Zuma may be remembered for providing South Africans with a textbook example of how difficult it is to change behaviour. Neither are good examples in a country where HIV is the biggest killer and our efforts to prevent it are not a simple case of ABC.

— Health-e News.

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