Helen Epstein, scientist-turned-journalist and author of The Invisible Cure: Africa, the West and the Fight against AIDS, has a sharp new article in the Guardian titled "There is no room for sexual morality in an honest conversation about Aids." It's an important message from someone who has focused many of her writings on HIV on the issue of fidelity, and it does an excellent job of unpacking the risks associated with a morality-based approach to fidelity promotion-particularly for women.
It also does a nice job of stepping outside the ideological platitudes that so often structure the HIV/AIDS conversation, and opting instead for an informed exploration of how complex change actually looks in practice. Epstein writes:
I've been thinking about this for nearly 15 years, and it's become increasingly clear to me that the key to fighting Aids lies in something for which public health has no name or programme. It is best described as a sense of solidarity, compassion and mutual aid that is impossible to quantify or measure. It has to be this way. Because our sexuality is shaped by society and because sex itself involves more than one person, behaviour change is a collective act, not one of individuals acting alone.
Nicely put. Epstein bases her analysis on her experiences as a scientist-researcher in Uganda in the 1990s, drawing a comparison (despite cultural and epidemiological differences) between Uganda's response to HIV/AIDS in the late 1980s and early 1990s (resulting in a 70 percent decrease in the infection rate) and the gay community's response to HIV/AIDS in the 1980s in the U.S. (resulting in an 80 percent decrease in the infection rate).
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Along the way, she makes some important points: first, she stresses that HIV rates in Africa are not high because Africans have more sexual partners than people in other regions of the world (research demonstrates that the contrary is true, in fact), but rather because Africans are more likely to have concurrent sexual relationships. It was the acceptance of this epidemiological reality-as well as a focus on the related reality that everyone is vulnerable to HIV/AIDS, not just truck drivers, sex workers, and other so-called promiscuous people-that made Uganda's first HIV prevention campaigns so effective.
Of course, things are different in Uganda now, and the country that was once hailed as Africa's greatest HIV prevention success story has now become a destination for HIV/AIDS carpetbaggers and ideologues worldwide. Most distressingly, now that Ugandan President Yoweri Museveni and his wife Janet have disavowed the practical, science-and-solidarity-based messages, opting instead to stump for abstinence and crusade against condoms. They are supported by the Bush administration and a slew of U.S.-funded right-wing Christian organizations with no experience in HIV prevention but plenty of experience in morality promotion. As a result Uganda's infection rate is on the rise.
It's an unconscionable situation. Putting aside the cooked-up conclusions from the right-wing cheerleaders at the Heritage Foundation, research has shown time and time again that abstinence-only programs are a complete and utter waste of time for everyone but the people getting paid to promote them. HIV-positive Ugandan activists like Beatrice Were have done an excellent job of articulating the dangers of a fidelity-based approach to HIV prevention, which often leads women into a false sense of security, failing to emphasize that fidelity only protects you if your partner is faithful too. As Epstein points out, it's one thing to talk about partner reduction in places where people commonly have concurrent partners, but talking about fidelity in moral terms (and thereby associating HIV with moral failure), is a strategy destined to make the problem worse.
Epstein highlights the perils of a morality-based approach through an analysis of a poster in Botswana that was part of a U.S. government funded HIV prevention campaign. The poster showed a condom and a boxing glove alongside the slogan, "It can take the fiercest punches." She reflects:
The ad reflected the prevailing view among epidemiologists at the time, that HIV was spread by "high risk groups" – meaning, typically, promiscuous people. This was true in most of the rest of the world, but not in Botswana. The boxing glove ad and others like it may have promoted a false sense of security, and by associating HIV with womanizing and violence, the ads may also have unintentionally reinforced the shame and denial that has made Aids prevention in southern Africa so difficult.
Good point. As Epstein's article emphasizes, there are two kinds of approaches to HIV prevention: those that divide people, and those that unite them against HIV. By dividing, we don't simply cause suffering, stigma, and alienation in a world that already offers enough of all three things during the average lifetime. We also silence and exclude, in the name of morality, those who could be our most powerful allies.