Silence, AIDS and Sexual Culture in Africa

© 2000 Ketan K. Joshi, Courtesy of Photoshare. A mural in Durban, South Africa promotes awareness about HIV/AIDS in Africa at the 13th International AIDS Conference.

"There is a mystery at the heart of the AIDS epidemic in Africa that scholars have explored but have been unable to explain...The mystery... has to do with that stubborn and multi-layered AIDS silence, or what the professionals call 'the denial' that has consistently characterised the AIDS pandemic in Africa... The silence has to do with... that much used and abused, dearly beloved sacred cow... called 'culture'. In the two weeks following the AIDS 2000 Conference, incidences have impressed upon me, once again, the hopeless situation of women in the face of AIDS...

Thandi, shortly after her wedding, inherited two orphaned children from her sister-in-law who had died of AIDS. Now, a second sister-in-law is dying of AIDS, and her sickly baby has constant diarrhoea. What bothers Thandi is the fact that she is a trained nurse, equipped with knowledge that might be helpful: but as a sister-in-law, in her husband's home, and one without a child of her own, she dare not open her mouth. How could she suggest that there might be something seriously wrong with the baby? They would say that she is jealous... She keeps quiet. Perhaps she herself will be the next sister-in-law in that home to go down in silence...

People in KwaZulu-Natal are dying like flies. Going to funerals has now become the premier weekend activity, as it was in the late 80s to early 90s, during the 'total onslaught' years. Admittedly, this epidemic is not only affecting women, but their stories have a special poignancy that is embedded in a kind of silence and helplessness that does not affect men. Millions of women are being squashed under the weight of the compounded multiple silences of AIDS. Has the AIDS 2000 'Break the Silence' Conference really helped them?...

More than anywhere else in the world, the advent of AIDS in Africa was met with apathy, or what some researchers have called 'an under-reaction'. This was noted at all levels of society, whether individual, communal or national. This under-reaction stood in stark contrast to responses in other parts of the World. In Europe, the USA and Australia, for example, marked sexual behavioural change indicated drastic developments in the first year of HIV/AIDS being seriously discussed. In Thailand, the first evidence of the arrival of AIDS saw a rapid dwindling of clients at brothels, to the extent that many were forced to close due to lack of business. The scenario for both North America and parts of South America was similar. It was recognised that prevention education campaigns would have to constitute a sustained effort. These reactions occurred as a response to HIV levels that were a fraction of those found in Africa. Yet, no such reaction was recorded for Africa...

The general lack of behavioural change was once attributed to scant information. Over time, this explanation has become less tenable, as ongoing studies demonstrate a combination of adequate knowledge with continued high-risk behaviour. Today, there is hardly any doubt that more intensive or better constructed information campaigns will do little to change behaviour...

By turning our collective attention to academic debates on the origins or existence of AIDS, we are conveniently avoiding facing up to sensitive issues around sexual culture. By pinning our hopes on vaccines and cures, we risk 'over-medicalising' our engagement with AIDS. We simply cannot afford to get lost among the trees and lose sight of the forest, the latter being the socio-cultural-sexual context that provides such a fertile breeding ground for HIV/AIDS.

More provocative still is the evidence that has been gathered since the AIDS epidemic began in Africa on the sexual culture that characterises much of sub-Saharan Africa, specifically with regard to levels of premarital sexual relations and extramarital relations. There is a significant body of well-researched and well-documented social science studies that points to high level of premarital sexual activity, extramarital relations and sexual violence, making African societies, taken as a whole, more at risk for both STDs and HIV/AIDS than those in other parts of the world. In many communities, women can expect a beating, not only if they suggest condom usage, but also if they refuse sex, if they curtail a relationship, are found to have another partner or are suspected of having another partner.

'Gifts for sex' is a practice that expresses itself most strongly in premarital and extramarital relationships... Only recently, with Christianity, has sexuality become bound up with religious belief systems that imply sinfulness, and it has never been related, as in Europe, with romanticism. Sex, then, could be viewed rather more objectively and instrumentally in an African context. Selling sex for money or other material benefits in the face of Africa's entrenched poverty and women's continued financial dependence on men is one form of transactional sex."

"From my own research with young people in townships around Durban, there is quite clearly another prevalent form of transactional sex....It involves girls eagerly and easily exchanging sex to pay for chain-store accounts, cell-phone bills, designer-label clothing, etc... As one young woman commented: 'If I want jewelry and other nice things, I must get them now. After we're married, forget it! Our men are awful'...

Along with the general under-reaction to the growing epidemic... there is, a great reluctance- that some have called 'a refusal' - by Africans to come to terms with the real sexual cultures of their societies... There are widespread beliefs that males are biologically programmed to need sexual relations regularly with more than one woman, and often concurrently. Such beliefs are logically consistent with societies that were traditionally polygamous...

Studies consistently suggest that sex is regarded by the young as necessary, natural and an expression of love, as well as an activity that their peers expect of them if they are to be considered 'normal'. The use of a condom is taken as a sign of mistrust, as well as the hallmark of one who indulges in casual sex. Condom use in marriage is almost unheard of. Partner dynamics are characterised by an avoidance of direct communication, with the assumption that men should control the sexual encounter.

Common to both young men and women is the belief that a man has a right, or even duty, to force himself onto a woman who displays reluctance or shyness. Gender-based violence itself is often seen as a sign of affection, showing how deeply the man cares. Sex in marriage is simply expected as part of the marriage 'deal' whenever the husband demands it. Indeed, even in cases where the woman discloses her HIV-positive status to a husband, studies show that the husband is likely to continue conjugal relations with her while refusing to be tested himself...

What emerges most clearly from all these studies is the fact that there is an urgent need to recognise and accept the nature and shape of contemporary sexual practices by men that have dire consequences in the wake of AIDS. By turning our collective attention to academic debates on the origins or existence of AIDS, we are conveniently avoiding facing up to sensitive issues around sexual culture. By pinning our hopes on vaccines and cures, we risk 'over-medicalising' our engagement with AIDS. We simply cannot afford to get lost among the trees and lose sight of the forest, the latter being the socio-cultural-sexual context that provides such a fertile breeding ground for HIV/AIDS.

This points to the crux of the heavy silences that nourish AIDS in Africa, including the silences and denials of governments. What needs to be addressed is the role of men, particularly their attitudes and behaviours that reflect their sexual irresponsibility and a certain death sentence, not only for themselves, but also for millions of women and children...

Firm measures on the part of government to foster the transformation of the sexual attitudes and practices of young and middle-aged men will run the risk of inciting the hostility of, politically, the most dangerous section of the population. Perhaps this explains why the issue is so carefully avoided. But until such measures are taken, and our leaders speak out with vigour and determination we will continue to re-enact the high-risk sexual culture and the silence that enshrouds it..."

By Suzanne Leclerc-Madlala. Dr. Leclerc-Madlala is a medical anthropologist and lecturer in the School of Anthropology and Psychology, University of Natal. AIDS Bulletin. September 2000. Reprinted with permission.