AIDS: No easy answers

President Jacob Zuma this month acknowledged that South Africa is “not yet winning” the fight against HIV/Aids, pointing out that the country’s mortality rates may soon overtake birth rates, calling for the introduction of “extraordinary measures”. The president’s reality check is welcome — especially in light of his own previous puzzling comments on the subject — and must now prompt the government to catch up on the neglectful prevarication of the Mbeki era.

But exactly what should we expect the government to do? The truth is that all of the solutions offered for prevention and treatment are, in practice, imperfect.

On prevention, the contest between those who advocate abstinence and those who promote the distribution of condoms is missing an important point. Neither argument, nor that which promotes a combination of both, has succeeded in convincing those most at risk of HIV infection. There is a profound cultural resistance to both strategies.

Abstinence and fidelity are the safest method of avoiding HIV transmission, yet that message is not being heard. It is further undermined by the indiscriminate promotion of condoms, which communicates that sexual activity need not be modified, placing in danger of infection those who will take chances when condoms are unavailable and those who use defective prophylactics.

The discourse on Aids often fails to account for the realities of sexual behaviour. For many people, sexual activity is not a matter of choice. In many cases, women and girls especially have no autonomy over their sexuality, and are coerced into sexual activity by social pressures, poverty or violence. Many young men also are subjected to social demands which lead them to engage in sexual activity against their better judgment.

Complicating matters further, there is a widespread belief among the youth, in all sections of South African society, that HIV is transmitted only through vaginal intercourse. So many abstain from that, but adopt even more dangerous sexual practices in the fatally mistaken belief that these are safe.

Short of the discovery of a miracle vaccine, the only way to address our high infection rates is to agitate for a radical social and cultural modification of sexual attitudes and behaviour, accompanied by the social and economic empowerment of women.

The stigma of HIV/Aids also contributes to the spread of the disease. When HIV-infected people, especially women, are ostracised by their communities on account of the virus, they will naturally be reluctant to be tested. But without knowing their HIV status, they risk passing the virus on to others, and in the case of mothers even to their infant children.

HIV testing, followed by counselling when necessary, must be vigorously promoted and facilities be made available, accompanied by a consolidated campaign to conscientise the public to regard HIV/Aids not as a source of shame — regardless of how it was contracted.

Catholic agencies are already doing excellent work in the area of providing testing, counselling and social upliftment.

More than just a health issue, as Mr Zuma rightly pointed out, HIV/Aids is primarily a socio-economical disease. But even in the domain of health, there are no simple solutions. In his article this week, for example, Fr Stefan Hippler explains how anti-retroviral medicines (the side-effects of which are still subject to debate) can be detrimental if the patient’s social circumstances militate against the medication’s vitally strict regimen.

With HIV/Aids, there are no easy answers. Alas, often the answers that are offered respond to the wrong question. It must be our national priority, therefore, to identify and address the correct questions.