What causes Aids?

President Thabo Mbeki has made many harmful statements on the question of HIV/Aids. History will rightly record these as having tarnished his good reputation.

However, one of his propositions does contain a grain of truth: Poverty causes Aids.

Aids is, of course, caused by a virus transmitted through infected blood; but there are also combinations of social factors that feed the pandemic and poverty is at the root of these.

Another significant social cause, particularly in Africa, is a male-dominated culture in which women (who represent the vast majority of HIV-infected people on this continent) are economically, socially and sexually disempowered.

Many impoverished women are compelled to make themselves sexually available to men so as to feed themselves and their families. Transactional sex often is not a matter of choice (never mind morality), but one of desperate necessity.

South Africa has one of the highest rates of inter-generational sex, mainly linked to situations of poverty, which accounts for the HIV-infection of many young girls.

This country also has one of the worlds highest incidence of coercive sex ranging from conventional rape to a womans involuntary submission to a man.

Women are anatomically and physiologically more susceptible than men to contracting HIV and sexually transmitted diseases. When women lack sovereignty over their bodies, the risk of infection is compounded.

Thus biology, poverty and a patriarchal social order conspire to leave women and often their unborn or new-born child most vulnerable to HIV/Aids.

In the words of the late Jonathan Mann, former head of the World Health Organisations Aids Programme: Male-dominated societies are the greatest threat to public health in the world today.

Dr Mann, who died in a plane crash in 1998, provided a useful model for Aids prevention by combining the science of HIV/Aids with social issues of human rights and public health.

Any HIV prevention policy, whether it emphasises condoms, abstinence or both, is incomplete and indeed ineffective if it fails to address the core reasons why people are at risk of infection in first place.

To women most at risk of being infected with HIV, the ideals of sexual morality often are an extravagance they have no power to exercise. Aids prevention means empowering these women by addressing both the effects of poverty and of male domination.

The Church, which has rightly called for behaviour change in individuals, has an important role to play in advocating a social transformation.

Alleviating poverty, working to dismantle a patriarchal system and capacitating poor women are absolutely crucial in fighting the Aids pandemic.

These, of course, are long-term objectives. Many women will continue to be sexually exploited and placed at risk of HIV-infection.

There is a glimmer of hope. Microbicide gels or creams, used by women, are regarded by many experts as a potent alternative in HIV prevention. In societies where women are often compelled to enter into sexual contact, microbicides place the power to protect themselves into their hands.

It is imperative that the Church should study without delay the moral implications of the use of microbicides, and make the findings widely known.

If microbicides are doctrinally and medically sound, their use and distribution must be vigorously encouraged by the Church.