OF AIDS AND SEX
Charles L. Geshekter
New African October 1994
is seen in Kenya. Below a lurid picture of a worm wriggling through
a human heart, the caption reads: "Careless sex is a fruit
with a worm in it. AIDS."
At the 10th
International AIDS Conference in Yokohama in August, Dr. Yuichi
Shiokawa put the sentiment in a different way. The African AIDS
epidemic, he said, could be brought under control only if Africans
restrained their sexual cravings.
Nathan Clumeck of the Universite Libre in Brussels is skeptical
that Africans will ever do so. In a recent interview with Le Monde,
Clumeck claimed that "sex, love and disease do not mean the
same thing to Africans as they do to West Europeans because the
notion of guilt doesn't exist in the same way as it does in the
Judeo-Christian culture of the West."
about the sexual excesses of Africans are old ones.
travelers returned from Africa bringing tales of black men allegedly
performing carnal athletic feats with black women who were themselves
sexually insatiable. The affront to Victorian sensibilities was
cited alongside tribal conflicts and other "uncivilized"
behavior to justify the need for colonial social control.
researchers have added new, undocumented twists to an old repertoire:
stories of Zairians who rub monkey's blood into cuts as an aphrodisiac;
claims that ulcerated genitals are becoming widespread; and urban
folklore about philandering East African truck drivers who get HIV
from prostitutes and then infect their wives.
The World Health
Organization claims that 10 million HIV-positive Africans are responsible
for 300,000 cases of AIDS reported since 1981. On the face of it
this seems to be a catastrophe. Unlike in developed countries, where
over 90 percent of AIDS cases are homosexual males, intravenous
drug users and blood transfusion recipients, African AIDS is supposedly
suffered by men and women in equal numbers who contract it, presumably
from heterosexual intercourse. The African figures are often cited
by the AIDS establishment and safe sex activists in Europe and the
United States to prove that "everyone" is at risk.
discrepancies about the dynamics of HIV transmission, skepticism
about what really causes AIDS and mounting evidence of imprecise
medical diagnoses are stirring up a backlash among African scientists.
They argue that in Africa AIDS is not a contagious epidemic linked
to sexual habits but is the new name for old diseases that result
from inadequate health care, widespread malnutrition, endemic infections
and unsanitary water supplies. Dr. Richard Chirimuuta of Zimbabwe
notes sarcastically that in order to have one-third of the sexually
active adults in some central and east African countries infected
with AIDS, "life in these countries must be one endless orgy."
A growing number
of African physicians including Dr. Mark Mattah (Midland Center
for Neurology in England), Dr. Sam Okware (former director of AIDS
research in Uganda) and Dr. P.A.K. Addy (director of clinical microbiology
in Kumasi, Ghana) say they think the panic over the heterosexual
transmission of AIDS may be a hoax. Dr. Felix Konotey-Ahulu, a Ghanaian
physician at London's Cromwell Hospital, toured Africa countries
a few years ago to assess the "epidemic." In a scathing
report for Lancet, Dr. Konotey-Ahulu asked, "If tens of thousands
are dying from AIDS (and Africans do not cremate their dead), where
are the graves?"
scientists, including Dr. Luc Montagnier, the French virologist
who discovered HIV, claim that the practice of female circumcision
facilitates the spread of AIDS. How do they explain the fact that
Somalia, Ethiopia, Djibouti and Sudan, where female circumcision
is the most widespread, are among the countries with the lowest
incidence of AIDS?
In fact, there
is little evidence to support Western perceptions of African sexual
promiscuity. Widespread modesty codes for women, whose sexuality
is considered a gift to be used for procreation, make many African
societies seem chaste compared to the West. The Somalis, Afars,
Oromos and Amharas of northeast Africa think that public displays
of sexual feelings demean a woman's "gift," so that sexual
contacts are restricted to ceremonial touching or dancing. Initial
sexual relationships are geared to the beginnings of making a family.
The notion of "boyfriends" and "girlfriends,"
virtually universal in the West, has no parallel in most traditional
No one has
ever shown that people in Rwanda, Uganda, Zaire and Kenya-the so-called
"AIDS belt"-are more active sexually than people in Nigeria,
which has reported only 722 AIDS cases out of a population of 100
million, or Cameroon, which reported 2,870 cases in 20 million.
Scientists dismiss the notion that males from any continent or region
are more addicted to sex than those from another because testosterone
levels, the measure of sexual vigor in men, never vary more than
a tiny fraction of a percent anywhere in the world.
IN 1991, researchers
from the French group Medicins Sans Frontieres and the Harvard School
of Public Health conducted a survey of sexual behavior in the Moyo
district of northwest Uganda. Their findings revealed behavior that
was not very different from that of the West. On average, women
had their first sex at age 17, men at 19. Eighteen percent of women
and 50 percent of men reported premarital sex; 1.6 percent of the
women and 4.1 percent of the men had casual sex in the month preceding
the study, while 2 percent of women and 15 percent of men did so
in the preceding year.
sex surveys have ever been carried out in Africa, yet AIDS researchers
blithely assume that heterosexual HIV transmission in Africa parallels
the dynamics for HIV among homosexual men in the West. There is
no scientific basis for this. Because female-to-male transmission
of HIV is extremely difficult, AIDS has never "exploded"
into the heterosexual populations of the U.S. and Europe, even though
condom-less sex remains the norm.
From 1985 to
1991, Dr. Nancy Padian and her associates studied 72 HIV-negative
male partners of HIV-infected women. As reported in the Journal
of the American Medical Association (1991), they found only "one
probable instance" of female-to-male transmission. As for sexual
transmission in general, a definitive study in the British Medical
Journal (1989) by the European Study Group on AIDS concluded that
the only sexual practice leading to an increased risk of HIV infection
for men or women was receptive anal intercourse.
Even the definition
of AIDS differs from one continent to another. In Europe and America,
AIDS-defining diseases include 29 unrelated maladies ranging from
pneumocystis carinii pneumonia and pulmonary tuberculosis to cervical
cancer. In addition, an HIV-positive test and a T-cell count below
200 are necessary for a confirmed diagnosis.
But in Africa,
the term "AIDS" is used to describe symptoms associated
with a number of previously known diseases. In the mid-1980s, those
common diseases were suddenly reclassified as "special opportunistic
AIDS-related infections" and Africans were warned to change
their sexual practices through abstinence, monogamy and condoms-or
they would die.
a British medical anthropologist and AIDS researcher, concedes that
African "risk populations are assumed rather than revealed."
So why are AIDS cases in Africa nearly evenly divided between men
and women? The answer lies in the World Health Organization's definition
of "AIDS" in Africa which differs decisively from AIDS
in the West. The WHO's clinical-case definition for AIDS in Africa
(adopted in 1985) is not based on an HIV test or T-cell counts but
on the combined symptoms of chronic diarrhea, prolonged fever, 10
percent body weight loss in two months and a persistent cough, none
of which are new or uncommon on the African continent.
HIV TESTS are
notoriously unreliable in Africa. A 1994 study in the Journal of
Infectious Diseases concluded that HIV tests were useless in central
Africa, where the microbes responsible for tuberculosis, malaria
and leprosy were so prevalent that they registered over 70 percent
false positive results.
everything we know about viruses tells us that they are equal opportunity
microbes. They will attack men and women weakened by malnutrition,
the most effective cause of immune suppression. Venereal diseases
left untreated can also impair one's immunity, rendering any victim
susceptible to other infections. Africans are often assumed to die
from "AIDS-like" symptoms after their immune systems have
been weakened by malaria, tuberculosis, cholera or parasitic diseases.
these deaths "AIDS" and claiming there is a new epidemic
in Africa, are health officials from the West, perhaps unwittingly,
helping to provide opportunities for development agencies, biomedical
researchers and pharmaceutical companies who clamor for more money
and markets? Certainly, promulgating the idea that AIDS is an epidemic
caused by sexual promiscuity will deepen Africa's dependency on
Western aid for diagnostic tests, high-tech sterilization equipment
and medical personnel.
of having millions of Africans threatened by AIDS may be to make
it politically acceptable to use the continent as a laboratory for
vaccine trials and the distribution of toxic, anti-HIV drugs like
AZT. Vaccine experiments in the United States have been curtailed
due to government regulations and fear of lawsuits from research-related
injuries. However, according to a 1994 Rockefeller Foundation report,
"Accelerating Preventive HIV Vaccines for the World,"
risky HIV vaccine trials would be tolerated-even welcomed-in African
the extraordinary time lag between HIV infection and onset of "AIDS"-now
set at six to 12 years-AIDS activists warn that their awareness
campaign will require many years of active government intervention
and funding to overcome resistance to behavioral changes.
These new missionaries
with their messages of safe sex seem especially preoccupied with
changing men's behavior. They want to turn African women into "gatekeepers"
who negotiate sexual relations and risk-reduction strategies. At
the Yokohama AIDS conference and the recent U.N. Conference on Population
and Development in Cairo, feminists insisted that AIDS would be
halted only when women were empowered to reduce inequalities by
creating "networks" that enhanced gender sensitivity and
prevented sexual victimization.
IT IS the political
economy of underdevelopment, not sexual intercourse, that is killing
Africans. Poor harvests, rural poverty, migratory labor systems,
urban crowding, ecological degradation and the sadistic violence
of civil wars imperil and destroy far more African lives. When essential
services for water, power and transport break down, public sanitation
deteriorates and the risks of cholera and dysentery increase. African
poverty, not some extraordinary sexual behavior, is the best predictor
of AIDS-defining diseases.
should scrutinize ethnocentric stereotypes about African sexuality
and thoroughly reappraise the entire HIV=AIDS orthodoxy. The purported
link between HIV and AIDS was only hypothesized 10 years ago but
it has subsequently acquired a life of its own, especially among
fund raisers and sex educators who, like the theory, remain immune
people everywhere should be encouraged to behave more thoughtfully
in their sexual lives. They should be provided with reliable counseling
about condom use, contraception, family planning and venereal diseases.
But whether in Cameroon or California, sex education must no longer
be distorted by terrifying, dubious misinformation that equates
sex with death. *
L. Geshekter is a professor of African history at the California
State University, Chico.