2010 1 Dec
Today is World AIDS Day. I don’t think about HIV as much as I did a few months ago, when I was still in Africa and my job was to help with the epidemic. But today, I’m thinking about it, and I have something very simple to say:
HIV is about sex.
One of the big lessons I learned about HIV in Africa is that many, many people will do amazing mental and rhetorical backflips to avoid talking about how HIV is actually spread. It’s astonishing. You’d think that when talking about HIV, you’d have to talk about sex; you’d be wrong.
In the areas where I worked, a massive percentage of people were infected with HIV. In a number of places it was about 25%. In some populations, it was more like 40%. Think about those numbers for a second — and remember that many people who had contracted HIV had already died. In other words, uncountable numbers of people had already died of AIDS-related causes, and among the people who remained alive, the percentages still got as high as 25% and 40%.
And yet I got the message over and over and over that we mustn’t talk about sex! For example, I was told by some school authorities that I could not give safer sex information to their students because that might “encourage the students to have sex”. In other words: God forbid we tell students where to get condoms and how to use them, because that might encourage them to think sex isn’t wrong and dirty. What the authorities were really telling me is that it’s more important that we continue to stigmatize sexuality, than it is to protect people from HIV.
Another example of this phenomenon is highlighted when we look at how the USA’s HIV charity money is spent. The President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) places rather elaborate restrictions on how the money is spent, and while there’s nothing wrong with restricting aid money in principle, these restrictions include a provision that states that no PEPFAR money may fund an organization that doesn’t actively oppose sex work. In other words: God forbid we support sex workers and help them stay safe while they do their jobs, because that might make sex workers feel like they’re accepted members of society. What PEPFAR is really saying is that it’s more important that we continue to stigmatize sex work, than it is to protect people from HIV.
PEPFAR also demands that none of its money go towards condoms or initiatives that promote condoms; there are rumors that Obama will fix that, but I haven’t heard any confirmation of that yet. Maybe things are getting better on that score? And in one of my articles about Africa, I wrote that:
I can’t help noticing — with an occasional ironic smile — the phoenixes arising from these ashes. Firstly, it turns out that the best way to shut down sex-negative arguments against explicit sex education is to invoke the specter of HIV. One 2008 report from a well-respected local organization argued that AIDS prevention efforts should include straightforward lessons on pleasurable acts, such as oral sex or sex toy usage!
A 2004 “New York Times Magazine” article on HIV in southern Africa made the case that while “many experts contend that sexual-behavior change in Africa is complicated because women’s fear of abusive partners inhibits private discussions of sex, condom use and HIV,” the crisis also contributes to a better environment for those discussions. One researcher is quoted pointing out that, “young South Africans are much more likely to talk about sex and are developing ‘a vocabulary for discussing feelings and desires’.” Furthermore, southern African movements for women’s empowerment invariably cite HIV as a reason change is necessary now. Because gender oppression is acknowledged as a driver of the epidemic, gender equality is an explicit goal of both governments and major HIV organizations. Even admirably sane laws about sex work are being discussed — considerably saner than most Western ones, in fact. The laws probably won’t pass, unfortunately, but at least they’re on the radar.
In other words, in a weird way, the existence of HIV can be a positive thing because it’s a major factor forcing society towards honest, open, respectful conversations about sexuality. I believe those conversations to be good for a variety of reasons, but here’s why they are crucial to stem the tide of HIV — they make it much, much easier for people to both learn about the disease and take steps to avoid it. (After all: if you can’t talk to your partner about sex, then how are you going to communicate well about condom usage? If you don’t understand your own sexual desires or those of your partners, then how are you going to keep yourself out of sexually vulnerable situations?)
But we are not out of the woods yet. We’re not even close. And there’s ample room to slide backwards. I have read that HIV rates in America were falling for a while but are now rising again. And there are so many issues with which America is not doing much better than Africa — for example, our awful societal ideas about sex work. It seems to me that we Americans marginalize sex workers almost as much the African nations where I worked; and when sex workers are marginalized, they become more vulnerable to HIV. Indeed, just about any population whose sexuality is ignored, stigmatized, and swept under the rug is likely to be more vulnerable to HIV; history has shown this over and over, as for example with the gay community.
As long as we can’t have reasonable conversations about sexuality, we will never understand HIV. As long as we can’t have open, honest, non-judgmental conversations about sexuality, we will be hamstrung when we try to cope with it on both the individual and the community level. HIV is about sex. To deal with HIV, we have to be able to deal with sex.
The image at the beginning of this post shows a model wearing an amazing dress made entirely of condoms; thanks to the gallery at the website for The Wisdom of Whores, Elizabeth Pisani’s incredible book about the HIV epidemic and the international response. Pisani’s book is one of my favorites, ever — there are some valid critiques to be made, but even with those in mind, I just love it. Note that in honor of World AIDS Day, Pisani’s publisher is offering the book as a free download for the next month. Seriously, please read it. I have read very few books that I thought were simultaneously so entertaining, so well-written, and so important.
And, if you’re looking for someone to donate to in honor of World AIDS Day, then may I suggest Doctors Without Borders? Of all the organizations I dealt with in Africa, I was shocked by how little I felt like they wasted time and effort. They’re awesome.