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
"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
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
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
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.