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QUEENSTOWN, SOUTH AFRICA -
Most people thought the Kenyan Professor, Wangari Maathai, would recant, or at least suppress, her previous statement that AIDS was "... formulated in a lab by a mad White scientist in the West as a tool of genocide to wipe out Black peopleí" when she became the first Black woman to be awarded the Nobel Peace Prize.
She did not. Instead she re-emphasised her suspicions.
When Presidents of respectable countries like South Africa (Thabo Mbeki) and biological professors who studied in respectable institutions in the US become recusants and cast controversies over generally accepted views about the HIV virus, it is time for each and every African to clarify our own stance.
It is sad for a person on the street, who is directly exposed and affected by the devastating consequences of AIDS when all-too-often the debate about it involves a petty contest of egos or less relevant preoccupations about its origins.
Even sadder when practical solutions are often hijacked by racial, political, religious or cultural agendas.
The AIDS debate among its active workers has degenerated into "condom only" or "abstinence/fidelity only" approaches that fuel mistrust and prejudices among those who should be working together to combat the pandemic. A person who is looking for real solutions about AIDS must look at what is happening at ground level and make up her/his own mind. It is daily becoming clear that an effective and meaningful approach will come from experiences gained on ground level.
It is the measure of our petty shallowness that we would allow as grievous an issue as the AIDS pandemic to be hijacked by racial egos and speculative imagination. We've reached a stage where, due to assumptions about simplistic solutions or idealized or nostalgic worlds, we're talking at, not to, each other. AIDS workers from largely Western organisations come with the naive assumption that all individuals are free to make empowered choices about their worlds. And their African counterparts, for the sake of salvaging superficial pride, like to deny the obvious and fiddle while the continent is burning. Meantime, the graveyards are filling very quickly. We shall not even come close to denting the epidemic until we find an approach that seeks to take into account the complex social, cultural and economic factors that influence behaviours and the real conditions of choice in our respective societies.
Too often, as I've already indicated, behavioural change is viewed by those who work in African communities for AIDS education through a Western "developed"-world perspective. They assume that autonomous individuals make informed choices based on in-depth understanding of the facts. They assume AIDS education is all that's needed to turn the pandemic around. It bewilders them when the desired results are not forthcoming. Facts on the ground show that most people who're HIV positive in our country (South Africa) already had the rudimentaries of AIDS education.
In my hometown, for instance, there're about eighteen black medical doctors; six of them are HIV positive and two have a full-blown AIDS. Why, if AIDS education is so effective? The crux of the matter is that the rate of transmission of the HIV virus is highly determined by behavioural habits. There's a preponderant habit in the black community of resisting condom use because people feel sex with a condom is unnatural. "Flesh to flesh." "Who wears a raincoat when taking a shower?" are terms one often hears among people who disregard condom use, usually with tragic consequences.
Another erroneous assumption is that everyone in African communities wants to be, or is already, sexually active from early ages. This stereotypal attitude on the part of the AIDS workers who happen to come to Africa, mostly from Western-sponsored NGOs (Non Governmental Organisations), prompt negative responses from black Africans who feel affronted by the generalisation. In fact, there's a growing number of South African youth, especially girls, who -- through the influence of mostly "born-again" congregations -- prefer waiting for their wedding day for their first sexual experience. This helps in the fight against AIDS as these girls are no longer easy victims of the promiscuous tendencies that increase a person's exposure to the HIV virus. Admittedly these girls are still in a minority but it is growing and mostly educated.
The immense social and cultural pressures to conform to accepted stereotypes remains one of the major general factors for the spread of HIV in the country. There's the rate of promiscuity among the well off, like the example of the doctors above, which spreads the virus at an alarming rate. Economic pressures are a factor working against receiving diagnosis and treatment, mostly among broken, poor families. The interchange of sexual partners among migrant workers, who spend months on end far from their spouses and family support system and who're plunged into unbearably harsh working and living conditions by exploitative local or multi-national employers, is another factor.
[Each of these trends leave a situation where] it's no wonder that one is still highly likely to be infected by the person one considers to be their monogamous partner.
All-too-often AIDS education has failed to take in this wider picture, [opting instead] for simplistic prevention strategies. Those efforts are doomed to failure, even in the short term. A fuller understanding of HIV prevention that identifies three "layers" (impact, risk reduction and vulnerability) in the pandemic is called for. HIV prevention strategies must address all three layers if they are to be effective.
Discriminating against those who do not follow the church's teachings will gain us nothing. What is important is finding ways of curtailing behavioural choices of those who are vulnerable to infection. All initiatives that aim to reduce vulnerability are, and must be, recognised as essential components of a fuller HIV prevention strategy. The Church, with its rich body of doctrine and the theology of Catholic social teaching, has always demanded that its members denounce the injustices of the world and work to redress imbalances. We cannot sit around folding our hands while the pandemic sows death in our communities because we insist on a moral high ground.
- Impact emphasises the essential link between care and prevention. Keeping those affected by HIV in good physical, emotional and economic health for as long as possible is an essential component of prevention as it helps avert the decline of families into poverty and the stigmatisation that fans the pandemic.
- Risk reduction involves providing individuals and communities with an accurate and full understanding of the risks of infection. It means helping people to acquire the skills and resources to make changes in their personal or professional lives to minimise these risks. This means enabling people to adopt measures, based on the fullest scientific evidence available, that afford them immediate protection, partial or complete. Typical risk reduction strategies include abstinence, mutual fidelity, reducing the number of sexual partners and condom use. Because the sexual route is not the only source of infection, it means also ensuring safer blood transfusions, drug injecting and antenatal and delivery practices.
Reducing the risk of infection is not about choosing one or other option randomly to suit social or religious pressures. It is preferable to think of it in terms of a continuum running from high-risk activities to those carrying low or even no risk. Reducing risk is a process of moral education in which people come to see what risks their behaviour entails and continues until they take steps to reduce that level of risk in their circumstances. Any strategy that enables a person to move from a higher-risk activity towards the lower end of the continuum is a valid risk reduction strategy.
For a Catholic, like myself, this strategy is based on sound theological principles. For the non-religious it might be based on more traditional values, like the consideration of lobola (bride's worth), which is higher for virgins. What is important is that we identify values which individuals subscribe to and use them effectively as weapons against the AIDS pandemic. There's hardly any culture that does not understand the value of abstinence, chastity or faithfulness to one partner.
But sometimes people make choices that fall short of these ideals. That's when moral compassion is called upon. It is useless, even cruel, for a Catholic, for instance, to insist on the evil of condom use for a person whose psychological understanding has not reached or refuses to acknowledge the wisdom of these ideals.
- Vulnerability requires HIV prevention strategies to address the fact that, too often, people's behaviour does not change until their wider circumstances change -- like gaining a higher moral conscience. Any attempt by an individual to carry out their chosen risk reduction strategy constitutes behavioural change for that person. Church-based programmes, with their prophetic role in seeking the social transformation that will enable personal growth, must help people to grow more fully in their God-given identity.
Promoting abstinence might mean upholding the value of not having sex until marriage, while also recognising that for some young adults abstinence might mean only delaying the age of first sexual encounter beyond the more physiologically vulnerable teenage years. In another sense, promoting abstinence might also mean waiting until one is in a more stable relationship.
Faithfulness might mean the exhortation of mutual fidelity on married couples, while also acknowledging that, in another context, the component of faithfulness might mean fidelity to a single long-term partner or fidelity to a strategy of reducing the instances of casual sex. In the end sexual preference must depend on the moral conscience of the individual.
The data is clear that condoms, when used correctly and consistently, reduce but do not remove the risk of HIV infection. This fact cannot be excluded from, or misrepresented in, any information on risk reduction strategies, regardless of the political or moral position of those promoting them. Condom campaigns have been particularly effective with groups at the highest risk -- prostitutes, for example -- who may have few if any other realistic options for reducing this risk without them.
But facts show also that condom campaigns have been considerably less effective in the general population as a public health strategy. Hence I condemn the "condoms only" or even "condoms mainly" campaigns for the general population that have often been promoted with the same dogmatism as some "abstinence only" campaigns. They similarly distort information.
A complementary and collaborative approach for the dismantling of mutual prejudices deplores the obstructive positioning, judgementalism and dogmatism of opposing factions that too often feature simplistic polarised approaches. If we are to conquer the AIDS epidemic we must find a way of reconciling solid science and good community development practices with established and evolving moral teaching.
The Catholic Church is deeply rooted in local communities throughout the developing world and is a major contributor to the struggle against AIDS in the countries worst affected by the pandemic. The Church is therefore well placed to promote a more holistic understanding of prevention and to foster reconciliation between opposing factions, drawing these towards an attitude of mutual acceptance and collaboration. The challenges of the pandemic are urgent and compelling; the challenges of the Gospel are no less so for Christians. The Church, rightly so, does not take her moral standards from the values of the world. But as Christians, we have to find a way of mercy w hile standing firm on our moral understanding or the future generations will hold us to account on both.
© 2004, GENERATOR 21.
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