AIDS: A new strategy

by Editor · November 25, 2008

When a decade ago the experts drew up their worst-case scenario for HIV/Aids in Africa, they failed to anticipate the furious extent of the disease. Whatever worst-case scenario we might write now for a decade hence may likewise underestimate the devastation of the pandemic, unless a consensus can be achieved on how to understand the disease and how to fight it.

HIV/Aids is a cyclone of often overlapping vicious cycles. Clinging to old certainties, many leaders in positions of real influence have sought refuge from the storm in fragile tents of denial and mendacity. Former President Thabo Mbeki, for example, disputed that a modification of African culture was necessary because admitting so might acquiesce to a perceived Western view of African men as sexual savages.

At the same time the Catholic Church has expended much energy on debating the question of whether condoms can play a role in preventing HIV, delaying the obvious conclusion. It is inconceivable that the Vatican, when it finally releases its position on HIV-prevention strategies, will rule out entirely the use of prophylactics. The use of condoms is crucial when people will not or cannot follow the first and best line of defence: abstinence outside marriage and fidelity within. But these virtues are not always a matter of choice in societies marked by poverty and the social subjugation of women.

Both abstinence and condoms are widely seen as compromising African notions of gender identity. Therefore, the Church is fighting a losing battle by insisting wholly on abstinence and marital fidelity (especially since the majority of those who are infected � women � have little sexual autonomy), while the advocates of condoms as a primary strategy have recorded few accomplishments. This does not mean that both strategies must be discarded. On the contrary, both have an important role to play, in varying degrees of emphasis, especially in addressing school children, who are at great risk even at the onset of puberty.

These strategies cannot be ends in themselves, however. There are many fronts in the war against HIV/Aids. Two of these are crucial: the social and economic empowerment of women, and the extinction of stigmatisation.

The notion that HIV/Aids is invariably a consequence of immoral conduct must be rigorously challenged. Sexual activity is not always a matter of choice. The most virtuous female can be infected by a philandering husband or coerced into sex by social or economic pressures, never mind rape. And even when licentious conduct leads to infection, the Christian instinct must be not to condemn and ostracise, but to offer care (or at least toleration).

Much of the time, sexually active people do not know they are HIV-positive. The destigmatisation of Aids will diminish the prevalent resistance to HIV-testing and the often attendant denial of a devastating result. As a result of greater openness to testing and acceptance of HIV-positive results, sexual behaviour should be more widely amended to prevent the spread of the virus.

Any Aids-prevention strategy which excludes the social and economic empowerment of Africa�s women and girls will fail. The pandemic will continue to devour Africa for as long as patriarchal culture deprives women of sovereignty over their own sexuality; for as long as women�s poverty and disempowerment renders sex as a currency; for as long as sexual violence against women and girls is regarded as culturally or socially tolerable; for as long as women and girls are lacking access to educational opportunities to inform themselves of their human rights and sexual health; and for as long as men continue to deny the murderous properties of their sexual culture.