It is common knowledge that the African continent has been hit hardest by the  HIV and AIDS epidemic. Over the past 25 years, Africa has been the prime victim of a small, but highly intelligent virus, which has infected and killed millions of people, and significantly hampered the growth and development of a land with abundant potential. The epidemic has ravaged Africa far more viciously than any other continent, and the reasons for this continue to be explored in an array of research. A primary reason, which has been confirmed by a small library’s worth of literature, is that various African cultural beliefs and traditions encourage risky sexual practices, which in turn increase the risk of exposure to HIV. A recent study in Tanzania, for example, describes the unfortunate “peer pressure” that is regularly placed on the youth to have multiple concurrent sexual partners, with men who limit themselves to just one partner being ridiculed, and called “domo zenge”, meaning “slow to move”. On the contrary, men who succeed in having concurrent sexual relationships with several women are commended, and referred to as either “mshua” (the connoisseur) or “kichwa kikali” (the gifted).

A recent Kenyan study, published in AIDS (1), discusses how the tradition of “disco matanga”, or “disco funerals”, put people at a significant risk of becoming HIV-infected. These parties are held by the relatives of a person recently deceased, in order to raise funds for the funeral. The “disco funerals” are characterised by loud music, singing, dancing, bidding games and risky sexual behaviour. These studies are just two examples, drawn from an abundant amount of research that has confirmed the fact that high-risk sexual behaviour is prevalent in Africa, and is often supported by beliefs and traditions. These behaviours are subsequently far more difficult to change than if they were instead inconsistent with the beliefs and moral standards of the people. It is for this reason, and many others that I will not delve into in this newsletter, that an abstinence and faithfulness-only stance to HIV prevention in Africa is nonsensical, and should have been completely ruled out as an option many years ago.

A necessity to approach from all angles

It is important to note here that a condom-only stance to HIV prevention in Africa will not work either. Similarly, neither will education campaigns, implemented as a single pronged approach. HIV prevention in Africa must be tackled from different angles simultaneously, due to the sheer magnitude of the issue and the wide variety of circumstances that people become infected. Attempts to stem the tide of the epidemic using approaches that rely on just one method of prevention have consistently failed, and will continue to fail. Approaches that address HIV prevention on multiple levels have proven to be far more effective. The ABC approach, for example, promotes abstinence, being faithful and using condoms, and has had a definite positive impact when implemented correctly.

Despite the overwhelming evidence confirming that single-pronged prevention campaigns do not work, there are still those who believe that a narrow-minded and ill-informed approach to HIV prevention is the way to conquer an epidemic that has now taken the life of more than 25 million people. In the past, there have been a number of people in positions of influence who have unnecessarily complicated the path of HIV prevention, funding and policy. There are researchers working in the field, studying the epidemic and all aspects associated with it, making recommendations for funding and policies that will assist in fighting this mammoth epidemic. These decisions and potential progresses have been consistently delayed by people who often have far inferior knowledge on the subject, and are guided not by insight and understanding, but instead by their positions of power and influence, and their own beliefs, traditions, morals and personal motives.

The Roman Catholic Church – maintaining a position of ignorance

A perfect example, and undeniably pertinent to the topic, is the recent statement by Pope Benedict XVI. The Roman Catholic Church has continued to promote an abstinence and faithfulness-only approach to HIV prevention in Africa, despite the evidence that confirms that this strategy cannot work within such a context. The African continent is the fastest growing region for the Roman Catholic Church, and is therefore significantly influenced by the position of the Church on matters such as HIV and AIDS. At the same time, the continent is also desperate for progress in the area of HIV prevention, which can only be achieved through the large-scale implementation of proven-to-work strategies.

On the eve of his trip to Africa on 17 March 2009, Pope Benedict XVI once again expressed the Roman Catholic Church’s rather narrow-minded view that abstinence, and not condoms, is the answer to preventing the spread of HIV. In fact, the Pope stated quite unequivocally that the promotion of condoms actually “increases the problem” (2). While this is the first time that the current Pope has publicly discussed his position on the issue of HIV prevention, his standing echoes that of his predecessor, Pope John Paul II, who often preached sexual abstinence as the key to stopping the spread of HIV in Africa. Pope Benedict XVI was travelling to Africa to talk to young people about the HIV and AIDS epidemic, and discuss the position of the Catholic Church.

The position held by the Catholic Church, and a statement made by the Pope such as this, can have huge repercussions for the African fight. For many years, people working in the field of HIV and AIDS have been battling the stigma and discrimination associated with HIV-infection, the resistance that so many men hold towards condom use, and the management of the epidemic in general. Statements by the head of the Church, in direct contrast to a myriad of work and progress that has been done in Africa, may have severe after-effects, for women in particular. Infidelity is common, and thousands of women around Africa are in relationships with men who are unfaithful. This fact cannot be argued. The men that are being unfaithful do so because the majority have been raised to believe that infidelity is acceptable, and in fact often rewarded. They are also often in a position where they are working long distances from their homes and families, and sometimes do not see their partners for weeks or months at a time. Preaching faithfulness and abstinence will not help the partners of these men, or their children.

The complex interplay makes prevention difficult

The Pope’s comments have been met by a mass of displeasure, with statements of criticism streaming in from various aid agencies, governments and the United Nations. Several priests and nuns who are working with HIV and AIDS in Africa have also spoken out against the Church’s position and the Pope’s recent comments. According to Rebecca Hodes, the Director of Policy, Communication and Research for the Treatment Action Campaign (TAC) in South Africa, the Pope’s message strongly suggests that, “religious dogma is more important to him than the lives of Africans” (3). Hodes agreed that condoms are not the only necessary intervention, but said that they are one of only a handful of proven prevention strategies, and should therefore not be downplayed. Steven Lewis, head of AIDS Free World, commented in a similar vein. “Every stitch of scientific evidence says condoms are the best preventive measure we have against the virus” (4). According to the President of the World Health Assembly, Guyana Health Minister Leslie Ramsammy, the Pope’s views are “absolutely and unequivocally wrong” and “inconsistent with science” (5).

The complex interplay that exists between religious beliefs, cultural and traditional practices, and scientific fact, has made the task of preventing the spread of HIV in Africa a difficult one. The Pope quite correctly pointed out that a responsible attitude towards sex will help the fight against HIV and AIDS, but it must be understood that a responsible attitude towards sex does not equate only to abstinence and faithfulness, although these are obviously needed. Perhaps in the long run, campaigns to promote abstinence before marriage and faithfulness in marriage will have a more profound impact on the epidemic in Africa, as beliefs and attitudes start to change. It is therefore still important to include such strategies in current prevention programmes, but it would be ridiculous to believe that these strategies alone are the key to halting the spread of the virus. In the short-term, the distribution of condoms and the presence of awareness campaigns are essential. The Pope commented that, “this problem of AIDS cannot be overcome with advertising slogans”, and this is also true. AIDS cannot be overcome by such campaigns, but advertising slogans are still important, because knowledge and awareness is critical in prevention, but need to be implemented in combination with other proven prevention strategies.

Africa is currently making good progress in fighting the epidemic, which has for so long been running rampant through the continent. Research has provided abundant evidence on the strategies that need to be prioritised in the fight against the epidemic, and it is critical that we use the results of such research to our benefit. Now is definitely not the time to be downplaying the importance of condoms. I hope that while on his trip through Africa, Pope Benedict XVI saw the true reality of the AIDS crisis, and understands the possible negative implications that his comments may have had. The Pope stated while in Cameroon that “a Christian can never remain silent”, but perhaps on this occasion, it would have been better if he had.

NOTES:

(1) Njue, C. et al. (2009). Disco funerals: a risk situation for HIV infection among the youth in Kisumu, Kenya. AIDS, 23:505-509
(2) Pope Says Condoms Worsen HIV Problem, Victor L. Simpson, 2009
(3) Pope claims condoms could make African Aids crisis worse, Riazat Butt, 2009
(4) Condom Distribution Not Answer to Curbing Spread of HIV in Africa, 2009
(5) World Health Assembly: Pope Benedict “wrong”, 2009

Jonathan Mundell is the Director: HIV & AIDS Unit at Consultancy Africa Intelligence. Write to him at jonathan.mundell@consultancyafrica.com

The April edition of the HIV & AIDS in Africa Newsletter is republished here with permission from Consultancy Africa Intelligence (CAI), a South African-based research and strategy firm with a focus on social, health, political, and economic happenings in Africa. For more information see http://www.consultancyafrica.com or http://www.ngopulse.org/press-release/consultancy-africa-intelligence. Alternatively, visit http://www.consultancyafrica.com/promo2 to take advantage of CAI’s free, no obligation, 3-month trial to the company’s Standard Report Series.