IDS AND THE AFRICAN

AIDS AND THE AFRICAN

 

THE DYING

'We grew up telling ourselves, "If you have

one girlfriend, you're not man enough."'

 

By Wil Haygood, Globe Staff, 10/10/99

 

                      JOHANNESBURG - Hector was a nobody with few girls. And so he

                      got them. For the price of a warm beer he had a bedtime partner

                  every night. He'd boast of his conquests like so many boys in this country

                  boast of their moves on green soccer fields.

 

                  Hector's dying now.

 

                  Colin found his women in the bars of Hillbrow, the section of Johannesburg

                  where white liberals used to congregate during the mean days of apartheid.

                  These days a lot of flesh gets peddled in Hillbrow. Colin found girl after girl

                  after girl.

 

                  Colin's dying now.

 

                  Pete and Sonny Boy couldn't stop themselves from bedding women. Their

                  fathers bedded many women. Sex and more sex was due them, they felt. A

                  rite of passage.

 

                  Pete's dying now, and his girlfriend, Queen, is already dead. She lies in a

                  township graveyard, right alongside their son, Manietjies, who was 6. They

                  called him little Pete. Little Pete died four months ago of AIDS. Just like his

                  mother.

 

                  The deaths made Sonny Boy blue. But he swears he'll save big Pete. Big

                  Pete is skinny as wheat. One hundred and five pounds, and dropping. Sonny

                  Boy needs some fresh fruit and vegetables for Pete, but doesn't have a dime

                  in his pocket. Still, he believes in miracles. ''I will care for Pete,'' Sonny Boy

                  swears. ''You will see.''

 

                  Sonny Boy could use a miracle himself. He's dying too.

 

                  Hiding behind a historical reluctance to speak openly about sex, African

                  political and religious leaders have failed to acknowledge this deeper cultural

                  crisis at the root of the AIDS epidemic. And international experts, averse to

                  sounding judgmental or racist, tread lightly on the epidemic's behavioral

                  undercurrents. Behavior, consequently, has been narrowly defined as simply

                  having safe sex. But as effective as condoms are in stopping the transmission

                  of HIV, they do not stop epidemics.

 

                  "Without addressing behavior, the response to prevention strategies will

                  always be limited,'' said Elhadj As Sy, head of the United Nations AIDS

                  program for Eastern and Southern Africa, based in Pretoria. "We'll create

                  some results here and there, but unless there is a fundamental change in

                  behavior, there will be no drastic change in the evolution of the epidemic.''

 

                  HIV is transmitted primarily through heterosexual contact in sub-Saharan

                  Africa. The alarming spread of the disease has been fueled by larger factors:

                  rapid political and economic change, Westernization, migrant labor, poverty,

                  and gender inequality. Promiscuity, however, is quickly dismissed in Africa

                  as a racist term: code, in fact, for the myth of the black man's unbridled

                  libido.

 

                  But AIDS experts throughout the region agree that far too little is understood

                  about sexual dynamics in modern African societies. Important questions thus

                  arise: Why, for example, are teachers the third highest HIV-infected job

                  group in Namibia, after truckers and the military? Is a man who lives at home

                  but takes many partners abiding by traditional sexual norms? Why does HIV

                  spread fastest among youths, the age group most informed about AIDS and

                  condoms?

 

                  "People don't want to do this research, so there are patterns of black

                  behavior no one wants to acknowledge,'' said Mary Crewe, director of the

                  Center for the Study of AIDS at the University of Pretoria. "They'd rather lay

                  blame on the apartheid past, which I'm not sure is right.''

 

                  Contrary to what infection rates in sub-Saharan Africa suggest, HIV is not

                  easy to contract. In a stable and healthy environment, the probability that an

                  infected man will transmit the virus to an unprotected woman is less than 2 in

                  1,000, according to World Bank figures. But it is easy for that risk to rise. A

                  person afflicted by other sexually transmitted diseases, which are rampant

                  across the region, is two to nine times more likely to contract HIV if exposed

                  to it. And if a man has 10 partners, and the partners have each had 10

                  partners, he's potentially been exposed to 100 people.

 

                  In addition, several socio-economic factors lead to high levels of casual sex

                  in sub-Saharan Africa, experts say. The region has seen serious upheaval for

                  decades, the past 10 years being among the most turbulent. Genocide in

                  Rwanda and the end of apartheid in South Africa caused the movement of

                  masses of people; porous borders, regional development corridors, and

                  political change have reshaped and extended sexual networks. Poor health

                  care facilities, meanwhile, leave many without access to quality treatment and

                  prevention, while high unemployment leaves youths idle.

 

                  "When you see such an epidemic as we have, it points to a very stressed

                  society,'' said Clive Evian, a South African doctor who helps industries cope

                  with AIDS-related labor costs. "HIV epidemics go with a package: an

                  emerging economy, transitions from traditional cultures into industrial

                  economies, high levels of other sexually transmitted diseases, and economic

                  stress on families.'' Among the factors fanning the AIDS epidemic, migrant

                  labor and gender inequities have perhaps been the most damaging.

                  Throughout the century, men from around the region were drawn or

                  conscripted to work in distant gold, mineral, and diamond mines. They left

                  their families behind in rural villages, lived in squalid all-male labor camps,

                  and returned home maybe once a year. Lacking education and recreation,

                  the men relied on little else but home-brewed alcohol and sex for leisure.

 

                  A man who makes his living deep inside a South African gold mine has a 1 in

                  40 chance of being crushed by falling rock, so the delayed risks of HIV

                  seem comparatively remote. Mining companies pay out $18 million a year in

                  wages to 88,000 workers in the pits of Carletonville, the center of South

                  Africa's gold industry. The wages buy, among other things, sex. Some 22

                  percent of adults in Carletonville were HIV-positive in 1998, according to

                  UNAIDS, a rate two-thirds higher than the national average.

 

                  "High alcohol and sexuality are symptoms of things going wrong on a big

                  scale,'' Evian said. "They reflect a kind of aggression, the sad social state of

                  the man. They have been thrown into horrible lives and become frustrated. It

                  would happen to any man anywhere.''

 

                  Most African women, meanwhile, live in poverty. They have little or no

                  economic control, and therefore virtually no say in sexual relationships.

                  "Women know they are in danger, but there is nothing they can do about it,''

                  said Lahja Shiimi, HIV/AIDS health program officer in northern Namibia.

                  "Men decide when to have sex, with whom to have it, and how.''

 

                  Physiologically four times more susceptible to HIV infection, women in the

                  region are contracting the virus at a faster rate than men, and at a younger

                  age. Most of the women who tested positive for HIV in Namibia in 1998,

                  government figures show, were in their early 20s, while most men were in

                  their mid-30s. According to the latest UNAIDS statistics, 46.7 percent of

                  Namibian women at rural prenatal clinics tested positive in 1996.

 

                  If mobility, migrant labor, and gender imbalance are conducive to the swift

                  spread of HIV, they also underscore the breakdown of social cohesion.

                  When truckers and miners go home, they take the virus with them.

                  Sometimes they infect their wives, sometimes women become infected

                  through sexual contact with other men while their husbands are away. Rural

                  infection rates are catching up to urban figures. The role men traditionally

                  played as head of the family has broken down. Boys grow up without

                  fathers. Wives are left impoverished and unprotected. A South African

                  woman is raped every 26 seconds, the highest rate in the world.

 

                  But socio-economic arguments about AIDS do not fully explain how sexual

                  relationships are changing as African societies evolve. Notions about

                  masculinity and fertility vary widely among Africa's diverse ethnic groups.

                  Health workers across southern Africa agree, however, that traditional

                  cultures had strict rules governing sexual relationships. Those codes have

                  broken down and nothing has replaced them.

 

                  "In our culture, having a lot of women is a kind of status,'' said Milka

                  Mukoroli, the HIV/AIDS coordinator at Rundu Hospital in Rundu, Namibia.

                  Under the old rules, "a man might marry two or three women, but he would

                  never stray from home, and the first wife had to be consulted about each

                  new wife.''

 

                  Now, Mukoroli said, wives never know about their husbands' other women.

                  Men take lovers furtively. Many traditional cultures frowned on premarital

                  sex. Today, older men look for young girls to take care of, seeking sex in

                  exchange for providing school fees and nice clothes, often in the mistaken

                  belief that sex with virgins can cure AIDS. Health workers say many male

                  secondary-school teachers sleep with their female students. A new study of

                  Carletonville conducted by the Pretoria-based Council for Scientific and

                  Industrial Research found that 60 percent of women are HIV-positive by the

                  time they are 25. Throughout sub-Saharan Africa, infection rates among

                  teenage girls are significantly higher than for teenage boys. Infected by older

                  men, the girls then infect boys their own age.

 

                  "Social pressure should be put on older men to avoid forcing or coercing

                  young girls into sex, or enticing them with sugar daddy gifts,'' a UNAIDS

                  study on behavior released last month concluded.

 

                  Changing behavioral patterns are not restricted to men, AIDS workers say.

                  Traditionally, women were not supposed to enjoy sex. Increasingly,

                  however, they are asserting their own sexual needs and priorities.

 

                  "Promiscuity is prevalent predominantly because heterosexual relationships

                  are changing,'' said Peter Schmidt, a German doctor serving as chief medical

                  officer in the AIDS-afflicted Ohanguena region of Namibia. "This is a very

                  sensitive subject and very difficult to tackle. So many dependencies in

                  African societies relate to sexual relations.''

 

                  The heterosexual nature of the epidemic does not rule out the probability that

                  HIV is also transmitted between men, but homosexuality is deeply closeted

                  in African societies and there are comparatively far fewer same-sex

                  infections, according to AIDS experts. Youths provide a compelling reason

                  to think differently about behavior. Across the region, young people have

                  been exposed to more education about HIV and condoms than their elders,

                  yet they have the highest infection rates. Knowledge about risk and condoms

                  hasn't slowed the epidemic.

 

                  A new study of sexual behavior among youths between the ages of 11 and

                  24 in KwaZulu-Natal, South Africa's hardest hit province, indicates why:

                  Young people are on their own in an aggressive and evolving sexual

                  environment without the communication skills necessary to negotiate the

                  function or frequency of sex in relationships.

 

                  Consequently, the social ills governing gender relations among adults

                  reappear among youths. Both men and women in the study said that

                  condoms threatened trust within the relationship. Most women said they

                  were powerless against male sexual coercion. Many from both sexes said

                  they would prefer abstinence or monogamy, but said peer pressure is a

                  strong influence.

 

                  "For young people, sex is a must to be taken seriously by their peers,'' said

                  Christine Varga, research fellow at the Australian National University in

                  Canberra, currently based at the Reproductive Health Research Unit in

                  Durban.

 

                  Significantly, said Varga, who conducted the KwaZulu-Natal study, young

                  people feel increasingly isolated from the adults in their lives. Traditionally,

                  cultures included some mechanism for passing on the rules of sexuality and

                  intimate relationships to adolescents. Parents, however, never spoke to their

                  children about sex. Unmarried aunts or older sisters informed younger nieces

                  or sisters coming of age. Uncles and older brothers did the same for boys.

 

                  Now confusion prevails. Rural youths in particular "are much more likely to

                  evince attitudes that are a combination of old conservatism and new

                  sexuality,'' Varga said. They combine new attitudes like "sex is a must'' with

                  traditional mores such as "condoms are for prostitutes.'' The result is

                  high-risk sex.

 

                  From 1997 to 1998, infections rose 65 percent among South Africans

                  between the ages of 15 and 19. All too quickly, HIV is claiming another

                  generation.

 

                  "The way to fight the epidemic is not just with condoms. We have to change

                  mores,'' said Patricio Rojas, the World Health Organization representative in

                  Namibia. "Openness happened fast in Africa, and it happened wrongly.

                  There is no grooming of boys and girls as partners in a relationship, so sex

                  has no aspects beyond the instinctively physical. We have to create an

                  environment of normality again.''