The Moral Element of AIDS

Kevin Vance

What’s a good, culturally sensitive westerner to do when culture seems to prevent some Africans from heeding his advice to practice “safe sex”? This is the conundrum that was recently illustrated in a New York Times feature titled “Cultural Attitudes and Rumors Are Lasting Obstacles to Safe Sex.”

I expected a long litany of complaints from the public-health community about the ignorance of Africans and the wickedness of Christians (especially the pope) who suggest that condom use is not the panacea that will finally solve the AIDS crisis.  Instead, reporter Donald McNeil gives an interesting take on the spread of AIDS in Africa that is much more complex than a supply (of condoms) and education (about condoms) problem.

For instance, he writes that “Casual sex is on the rise.” This seems to point to a moral problem at least as much as an educational and mechanical problem. And there’s this:

Many Africans, researchers say, are in one or more relationships that may include sex only infrequently but last for years. Some are open, as in polygamy; many are clandestine, as with old lovers, bosses or even, perhaps, an abusive uncle who cannot be shaken off.

In such networks, infections spread rapidly. Also, men here, like many men everywhere, complain about condoms.

Now we have casual sex, committed polygamy, long-term adultery, and abuse. He goes on to throw misogyny into the mix, as well as prostitution in nearly all its forms.

Also, much sex is what social scientists call “transactional.” Young women from all but the wealthiest families are under constant pressure to trade sex for high school tuition, for grades, for food for their siblings, even for bus fare.

“If a woman says to me, ‘Please give me 2,000 shillings to get to the pharmacy,’  ” said Topher Kamara, 46, the counselor who is a former officer, naming an amount equal to one dollar, “I will say to her: ‘You want 2,000? Lie down and surrender your goods.’ ”

Ms. Atwongyeire described a poor girl who “found a sugar daddy” because she needed sanitary pads so her classmates would not tease her.

The once-widespread rumor that sex with a virgin cures AIDS has faded (as has a local rumor that sex with a pygmy is a cure). But men still pay teenage girls because they fear “reinfection,” and, Mr. Kamara said, “because older women will make us push them to orgasm, but a young girl will let him satisfy himself and leave.”

It’s a chilling reminder for libertarian-minded Americans that this is what much of the world’s prostitution looks like. While women still have some agency over their bodies, and may even have some negotiating power, worldly deprivation leaves many women vulnerable to the predatory desires of men with extra cash.

Even though prostitution is illegal in much of Africa, the Ugandan government seems to turn a blind eye. And, since something like a market will apparently come to exist for everything people desire, and because men prefer to have sex without a condom, a market for condom-free sex with HIV-positive men has developed. It’s hard to imagine a sort of consensual freedom that violates the dignity of the human person any more than this.

One other cultural barrier that prevents Africans from practicing “safe sex” is that “condoms thwart pregnancy.” It turns out that women and men prove their respective womanhoods and manhoods by fulfilling the teleological purpose of sex. I’m skeptical that this plays much of a part in the spread of HIV, since one would also want to account for the stigma of illegitimacy. Presumably, this procreative impulse wouldn’t extend into morally illicit physical relationships, but I’m no expert. Perhaps it does contribute to the spread of the disease between philandering husbands and faithful wives, and perhaps that is itself a part of the problem.

Sadly, McNeil’s piece ends more conventionally. Alas, it seems like the imagination of a New York Times reporter can only extend so far when it comes to solutions to the AIDS pandemic. More sex education and more condoms are the only answers that leap directly from the page. I hope that one doesn’t need to be particularly conservative to see the moral element of this crisis that cries out for a moral solution.

About a year ago, Travis Kavulla had a very interesting piece in The New Atlantis that looked at the problem of AIDS in Africa. He saw much of the same thing: massive social/moral problems, a causal understanding of the world that differs markedly from modern science, and the seeming inability of condoms to thwart the crisis in Africa as they did in the United States. Kavulla explores possible solutions, and finds one big area where cultural factors coincide very favorably with public health: moralizing religion.

The only lasting solution to AIDS in Africa will come through behavioral change. In a society that associates ailments with individual and collective moral wrongdoing, an approach that re-moralizes sexual behavior and encourages Africans to take control of their bodies is the most promising path to tread. That is not to say that it is easy or can be accomplished quickly. Any successful AIDS policy will probably involve a degree of social coercion—ostracism of those who do not abide by the moral consensus, a public shaming of hypocrites who preach one thing and practice another. Such a policy allows an essentially religious movement to co-opt the government and the generous foreign aid it receives. To some extent, this is what ABC policies already do, though they are still hampered by the squeamishness of American grant-makers who wish to decouple abstinence and monogamy from the religious and moralizing message they are often embedded in, and instead treat them as sterile and scientific methods by which to avoid infection. Rather than promoting condoms and sending a mixed signal, it would be better to continue to make them freely available in places known to those people, mainly city-dwellers and sex workers in market or industrial towns, who are already using them or inclined to do so because of the anonymity and casualness of their sexual relations.

The Western public-health lobby, bred in a culture that preaches unconstrained freedom of the individual in the realm of sexual relations, is put off by talk of moralizing policies, or of any policy that de-emphasizes condoms. But it needs a dose of its own advice. It must stop imposing its own agenda on Africa. It must realize that HIV has a social dimension that must be addressed, that Africans are naturally wont to view this disease, which perversely inverts the life-giving act of sex, as a moral calamity. The sooner the donor community realizes this, and reorients its policies to fit African realities, the better.

When one considers that the Christian communities of Africa – and their partners around the world – have a message that carries substantial promise of alleviating suffering and despair, it is disappointing that western governments and NGOs act in some ways that are actually counterproductive to the physical and spiritual aims of old time religion.

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