I just read The Invisible Cure by Helen Epstein. The sub-title is “Africa, The West, and the Fight Against AIDS. She exhibits a comfort level with Africa that I could relate to. I think she has discovered the answer to the question that has evaded everyone. Why is AIDS so high in certain parts of Africa? Her reason: concurrent relationships.
In Zambia we were told that all the men who could afford to have several relationships did. They called it “having a spare wheel”. It was the management level people that were most effected by AIDS, those who could afford the spare wheel. Most of the world tend to move from one relationship to another, usually with very little overlapping of sexual activity. In Africa it is very common to have more than one relationship at the same time, thus the phrase “concurrent relationships”. The number of sexual partners and the initial age of sexual activity in Africa do not differ from the West. What is different is the prevalence of “concurrent relationships”.
She calls the existence of concurrent relationships the AIDS super highway. I won’t get into all of her reasoning or her rebuttal of the other theories given to answer the question. Her key piece of understanding came from looking for the reason for the drop in HIV transmission that took place in Uganda between 1988 and 1993. She had to play private eye to find a copy of a study done about the sexual practices of Ugandans in 1988. This report had been compared to another report done in 1993. The UN conclusion was that the difference that brought down the rate of transmission was condoms.
This is where she throws out a few conspiracy shots towards the UN. Basically, the comparison of the studies was flawed. What the study did show is that the main change in sexual practices concerned people ending their “concurrent relationships”. This was before massive funding was available. The entire country of Uganda got involved to overcome AIDS. The main theme was for Ugandans to stop “grazing” where they shouldn’t be.
I sit here sensing that she is right. The book is worth reading. The dynamics of AIDS has changed since Uganda tackled it alone in the early 90’s. Now it is a race for the funding.