• Email
  • Single Page
  • Print

God and the Fight Against AIDS

3.

It is a great shame that no American or Ugandan has tried to revive the Zero Grazing campaign, because that program probably contributed greatly to the decline in Uganda’s HIV rates. Africans are at higher risk of AIDS than people elsewhere not because they have so many partners, but because they often have more than one long-term partner at a time.13 Ugandan tribes, like many in Africa, are traditionally polygamous. Men are entitled to marry as many wives as they can afford to support, and they sleep with them at closely spaced intervals. But polygamous cultures, in which many people conduct several ongoing sexual affairs at once, create fertile ground for the spread of HIV. If all the men slept only with the women they were married to and the women did the same, HIV would not spread. However, extramarital affairs inevitably occur, as they do everywhere. In addition, economic hardship has meant that these days many men have difficulty providing for even one family, but they nevertheless continue to conduct informal relationships with mistresses, who may have additional partners themselves, sometimes out of economic necessity.

Thus the practice of formal and informal polygamy creates a network of simultaneous or “concurrent” sexual relationships that links sexually active people not only to one another but also to the partners of their partners—and to the partners of those partners, and so on—creating a giant web that can extend across huge regions. If one member contracts HIV, then everyone else in the web may, too.14 Polygamous men generally seek out young women, even as they themselves age. In this way, formal and informal polygamy pumps the virus from one generation to the next.

Long-term “concurrency” is far more common in Africa than in Asia and in the West, where heterosexual people tend to practice “serial monogamy.” Martina Morris, a sociologist at the University of Washington, has shown that long-term concurrency is more of a public health danger than serial monogamy because it permits HIV and other sexually transmitted diseases to spread to others quickly, rather than confining them in a single relationship for months or years. Moreover, a recently infected person is much more likely to transmit HIV than a person who has been infected for a while. Thus, when a serially monogamous HIV-positive person eventually finds a new partner, his ability to infect that partner has been reduced. If someone at the hub of a network of concurrent relationships becomes infected, however, he or she is likely to infect his or her other partners very rapidly.

In 1986, Ugandan health officials had not heard of “long-term concurrency” and Professor Morris had not constructed the computer models that traced the transmission of HIV. Nevertheless, the Ugandans knew that HIV was spreading rapidly through networks of sexual relationships, and it was killing people. They also knew it would be unrealistic to insist that all men abandon their extra wives and mistresses, many of whom depend on the men for the opportunity to work on the land and for money and consumer goods for themselves and their children. Zero Grazing was a compromise. It recognized that sexual arrangements in Africa are often different from the Western nuclear ideal and serial monogamy. Zero Grazing was mainly addressed to men, and its real message was:

Try to stick to one partner, but if you have to keep your long-term mistresses and concubines and extra wives, at least avoid short-term casual encounters with bar girls and prostitutes. Also, you mustn’t casually seduce and exploit young women, who may be susceptible to your charms and wealth.

During the Zero Grazing campaign, the proportion of Ugandan men and women with casual partners fell by 60 percent. On surveys and in focus groups conducted throughout the country, most people said that they were protecting themselves from HIV by reducing their partners or “sticking to one.”15 By the time the Zero Grazing campaign was replaced by condom promotion and other programs in the early 1990s, the decline in the HIV infection rate was well underway. After 1995, when condom social marketing programs took off, the proportion of men with “non-regular” partners rose again. But HIV rates continued to fall, albeit far more slowly. Then, after 2000, HIV rates rose slightly. The reason HIV rates have not soared, even though more men have multiple partners, is almost certainly that the men are using condoms. The reason HIV rates are no longer falling is probably that these men are not using condoms consistently, especially in the longer-term, concurrent relationships where HIV transmission is most like to occur.

I asked David Apuuli, the affable head of the Uganda AIDS Commission, why the government did not revive the Zero Grazing campaign, which seemed to have been so effective. He giggled, poked me with his elbow, and winked theatrically. “You know what that was all about, don’t you?” What Dr. Apuuli meant was this:

What kind of an idiot are you? What do you think the Christians are going to say if we start talking about Zero Grazing? Zero Grazing recognized that polygamy, both formal and informal, was normative and legitimate. That would not fly in the current political and religious climate. Mrs. Museveni would have a fit, and the Bush administration, which pours billions of dollars a year into Uganda, would be very dismayed if the country they hold up as a triumph of abstinence education started promoting Zero Grazing.

But there may be other reasons why Zero Grazing is unlikely to be revived. For one thing, there is no multimillion-dollar bureaucracy to support it. For condoms, there are the large contractors like PSI with headquarters in Washington and thousands of employees in plush offices all over the world. Abstinence-only education is supported by a similarly well-endowed network of faith-based and abstinence-only education organizations, mainly in the US. Zero Grazing was devised by Ugandans in the 1980s, when they were facing a terrible problem, and had to deal with it largely on their own. Now that AIDS is a multibillion-dollar enterprise, donors with vast budgets and highly articulate consultants offer health departments in impoverished developing countries a set menu of HIV prevention programs, which consists mainly of abstinence and condoms. Beleaguered health officials have no time, money, or will to devise programs that might better suit their cultures.

Another reason why abstinence programs are favored over Zero Grazing may have to do with the sexual hypocrisy common to all known societies. The revival of interest in virginity in Africa is not always driven by American money. In southern Africa, many communities have revived the custom of virginity testing—in which older women examine unmarried younger women to ensure their hymens are unbroken. Virginity testing has become so popular among the Zulus that it is sometimes carried out en masse, at football stadiums. Meanwhile, Swaziland’s King Mswati III decreed in 2001 that all young, unmarried Swazi women should abstain from sex for five years and wear special tassels in their hair, as a signal to men to leave them alone. Fines were imposed on subjects who broke the rule.

Like other abstinence programs, Swaziland’s was not a success. Today, four years after the decree, 40 percent of all Swazi adults are HIV-positive—the highest HIV infection rate in the world. While the King frowns on premarital sex, he tolerates polygamy, and indeed has thirteen wives of his own, at last count. He chooses a new bride each August at the annual Reed Dance Festival, where thousands of topless girls in traditional grass skirts dance and sing his praises. In 2003, when the King chose a seventeen-year-old, he fined himself one cow.

The South African anthropologist Suzanne Leclerc-Madlala attributes the revival of interest in virginity to an increasing sense among elders, especially men, that they are losing control of young people and women. All around they see worsening economic and social conditions and the horror of AIDS, and because they are only human, they blame this state of affairs on the loosening morals of increasingly educated, urbanized women and young people, rather than examining how their own behavior also contributes to these problems.16

4.

After two weeks spent visiting pastors, watching Joyce Meyer sermons on TV, and shopping at stores with names like Trust in God Hardware, I felt I needed a change of scene. One of the women’s dorms on Makerere campus has a reputation. “Go there some Saturday night,” said a professor I knew. “That’s when the men in their big cars come and pick up the girls and take them out. Sometimes you just see men sitting in front of the entrance, waiting. They call it ‘benching.’” The dorm in question wasn’t far from where I was staying, so one Saturday night I walked over. As I approached, I saw some people sitting along the edge of the parking lot, facing the entrance of the building. At first I thought they were “benchers,” but about half of them were women, their eyes glistening with tears. They were watching a Christian movie about a girl who has just told her boyfriend she is suffering from cancer. I watched as they prayed together, and then I spotted a couple walking away from the dorm. As I drew closer to find out what was going on, I realized they were discussing Saint John’s Gospel.

Afterward, I wandered over to Pastor Ssempa’s abstinence rally at the Makerere campus swimming pool. There must have been three thousand people there and I couldn’t get past the huge overflow crowd on the street outside. The show consisted of skits, comedy routines, testimonies from former sinners, prayers, and thundering Christian rock music, sung in local languages by Ugandan stars. The entire audience all swayed together, dancing and singing and waving at the night sky. The music was so powerful the ground itself seemed to tremble.

As the music became increasingly ecstatic, a few members of the audience began to twitch and shake in a peculiar way. Then a woman some distance away from me began to writhe quite violently, and in a fit that might be described as orgasmic, she suddenly flew backward into the crowd and had to be pulled up by her friends.

She was battling the spirits,” one of the students explained to me.

Afterward, as I was walking back to my hotel, the rumble of the music still in my ears, I departed from the crowds of students and followed a dark road lit only by the moon and the occasional approach of slow-moving, yellow-eyed cars. Many of the sidewalks on campus are broken, and here and there the smashed concrete opens into dark, stinking sewage channels below, as if they had been torn open by some spasm of the earth. Flocks of bats hung from the jungley black branches of bottlebrushes and eucalyptus, and giant scavenger birds loomed on the crests of the trees, their long stiff beaks chattering like tom-toms. Disco music surged from numerous nearby bars, and images of nude dancers and homosexuals and pornographers and beer-addled prostitutes merged with the memory of the hysterical woman at the rally.

Sexuality truly does belong to the world of magic and unreason. It is impossible to plan and control it totally. We were made that way. If sex were an entirely rational process, the species would probably have died out long ago.17 But the delirious, illogical nature of sex makes setting a realistic HIV prevention policy very difficult. Cheerful, sexy condom ads that fail to address the real dangers of AIDS may promote a fatal carelessness; but an exclusive emphasis on abstinence until marriage may well lead to an even more dangerous hysterical recidivism. The genius of the Zero Grazing campaign was that it recognized both the universal power of sexuality and the specific sexual culture of this part of Africa, and it gave people advice they could realistically follow.

—March 31, 2005

Letters

God and Aids May 26, 2005

God, Aids & Circumcision May 26, 2005

  1. 13

    See Christopher Hudson, “AIDS in Rural Africa: A Paradigm for HIV-1 Prevention,” International Journal of STD & AIDS, Vol. 7, No. 4 (1996), pp. 236–243; Martina Morris and Mirjam Kretzschmar, “Concurrent Partnerships and the Spread of HIV,” AIDS, Vol. 11, No. 5 (1997), pp. 681–683; and Daniel T. Halperin and Helen Epstein, “Concurrent Sexual Partnerships Help to Explain Africa’s High HIV Prevalence: Implications for Prevention,” The Lancet, July 3, 2004, pp. 4–6.

    Table: Frequency of concurrent and suspected concurrent relationships

  2. 14

    Polygamy is also common in the Middle East, where HIV infection rates are extremely low. However, these cultures are very likely protected by the widespread practice of male circumcision, which probably cuts the risk of HIV transmission by some 70 percent, and by intense surveillance of women’s behavior, so that while many men have multiple concurrent partners, few women do. See my “Why Is AIDS Worse in Africa?” Discover, February 2004, and John Donnelly, “Circumcised Men Less Likely to Get AIDS,” The Boston Globe, November 16, 2004.

  3. 15

    Tom Barton, “Epidemics and Behaviours: A Review of Changes in Ugandan Sexual Behavior in the Early 1990s,” unpublished report for UNAIDS, Geneva, 1997. Zero Grazing may be a natural reaction to the threat of AIDS. Just as in Uganda, partner reduction, combined with strategic, consistent condom use in casual relationships, has been responsible for HIV declines in Thailand and in the gay community throughout the developed world. See Susan Kippax and K. Race, “Sustaining Safe Practice: Twenty Years On,” Social Science and Medicine, Vol. 57, No. 1 (July 2003), pp. 1–12; Daniel Low-Beer and Rand L. Stoneburner, “Behaviour and Communication Change in Reducing HIV: Is Uganda Unique?” African Journal of AIDS Research, Vol. 2, No. 1 (2003), pp. 9–21; Martina Morris and Laura Dean, “The Effect of Sexual Behavior Change on Long Term HIV Prevalence Among Homosexual Men,” American Journal of Epidemiology, Vol. 140 (1994), pp. 217–232.

    Rates of casual sex have recently been declining in many African countries, including Kenya and Rwanda, and HIV rates are also beginning to fall in these countries. Professor Susan Watkins of the University of Pennsylvania has observed similar behavioral changes in Malawi, although statistics there are unreliable, so it is hard to say whether this has reduced the spread of HIV. (See Susan Cotts Watkins, “Navigating the AIDS Epidemic in Rural Malawi,” Population and Development Review, Vol. 30, No. 4, December 2004, pp. 673–705.) It has taken much longer for these changes to get underway outside of Uganda, possibly because there have been no campaigns to encourage partner reduction, and because social and economic factors in other countries may make this kind of behavior change more difficult. (See my “Fidelity Fix,” The New York Times Magazine, June 13, 2004.)

  4. 16

    Suzanne Leclerc-Madlala, “Protecting Girlhood? Virginity Revivals in the Era of AIDS,” Agenda, Vol. 56 (2003), pp. 16–25.

  5. 17

    Thanks to Alex Coutinho of the AIDS Support Organization in Uganda for discussions on this point.

  • Email
  • Single Page
  • Print