A Curious Case: The new HIV/Aids denial

2014-04-29 10:00

Years ago, before the US Agency for International Development (USAID) poured more than R45?billion into this country’s HIV-prevention programmes, my friend Lucian poked me in the ribs during school assembly and whispered under his breath: “You know what Aids stands for?” I replied no.

“American Idea for Discouraging Sex!”

It was typical Lucian, the quick-witted dissident among my high school friends.

On stage stood an Aids activist explaining to us the modes of HIV transmission. A little further into his spiel, almost as if he’d heard Lucian, he declared: “Aids does not stand for American Idea for Discouraging Sex.”

This alternative acronym was apparently a potentially dangerous joke that activists were doing their damnedest to shut down. Older and more educated, I find myself now wondering if there might be some truth to it.

For in the intervening years, thanks to the graduation of HIV/Aids from an epidemic to a pandemic, social conservatism has asserted itself over sexual behaviour in this country under the guise of preventative healthcare. It has done so with funding from USAID and others, aided by behavioural change theory championed by Johns Hopkins University.

And now, with the recently reported increase in the number of new HIV infections, conservatism looks set to assert itself once more, even though it has thus far made hypocrites of us all. And it has done far worse.

We stand today a nation where at least 70% of those aged 15 and up are sexually active and 40% are married, yet nearly half of us believe sex before marriage is morally unacceptable.

The first two statistics are from a survey by the Human Sciences Research Council (HSRC) on HIV prevalence, incidence and behaviour. The third is from a global morality survey conducted by the Pew Research Centre, a US

“fact tank”.

The surveys are not interoperable numerically, but both followed methodologies aimed at obtaining nationally representative views. Together they present a picture of a nation whose sexual beliefs are at odds with its sexual behaviour.

This duplicity is why news reports about prominent figures having unprotected sex become the subject of national intrigue for weeks on end – even for the two-thirds of the sexually active population who reported in the HSRC survey that they, too, did not use condoms in their last sexual encounter.

Alarmed by the survey’s findings, the council has recommended the health sector step up HIV-prevention programmes that use social and behavioural change communication (SBCC) strategies to reduce the social acceptance of the “disturbing trends of increased HIV-risk behaviour”.

It said the undesirable behaviours include having multiple sex partners, engaging in age-disparate sexual relationships and not using condoms.

I highlight these three because they demonstrate most clearly how conservativeness has dovetailed into HIV-prevention strategies. They are, clinically speaking, behavioural determinants of HIV transmission. But responding as though they are indistinguishably and equally “disturbing” does not allow space for the healthy, open, national conversations we need to have.

It is entirely possible that shaming the social behavioural determinants of HIV transmission without nuance, forces many to aspire to unrealistic standards of moral purity. And it’s likely this disassociates personal beliefs from real-world sexual behaviour.

For example, encouraging monogamy over having multiple sexual partners operates within a history of religious conservatism, romantic Eurocentric fantasy and racist tropes about Africans’ “rampant libidos”.

And the health sector encouraging us to be monogamous by using SBCCs to change social mores such that multiple sexual relationships appear abnormal, mobilises these problematic histories, fantasies and tropes.

Focusing on monogamy also clashes with interventions whose primary focus is to encourage consistent and correct condom use in all sexual relationships, regardless of type.

This when we know that increasing proper condom use will achieve the same outcomes without stigmatising those who, for whatever reason, prefer to have multiple sexual relationships.

The HSRC’s recommendations also underplay gender inequality, which is built on patriarchy and economic inequality. There exists a power disparity that denies, especially poor, women the right to a say whether their relationships will involve multiple partners and whether they or their partners will use condoms consistently. Age-disparate relationships are also driven by similar manifestations of gender inequality.

Though the HSRC recognises this, it stops there, offering only vague recommendations. In so doing, it demonstrates, too, that conservatism seldom works only on the social substratum of a society. It seeps into the imagination and averts people’s eyes such that the behaviours of the affected become the scapegoat for what are structural economic failures.

By refusing to recognise this, we are complicit in this country’s second shameful act of HIV/Aids denial.

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