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Bleak stories behind failed condom campaigns

Before blanketing the continent with condoms to stop AIDS, why don't you live in rural Africa for a while? 
Chinwuba Iyizoba | 2 April 2009
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Sub-Saharan Africa has two-thirds of the world’s HIV/AIDS cases. So you would think that Western journalists and politicians might condescend to ask us what we think about how to fight AIDS. But they haven’t. A pity, because they would have found that many of us support Pope Benedict XVI’s scepticism about the effectiveness of distributing condoms.

A few days ago, The Lancet, a leading British medical journal which regularly pontificates about public health, slammed the Pope for making “a false scientific statement that could be devastating to the health of millions of people”. I wonder if the editor of The Lancet has ever visited rural areas of Nigeria or South Africa. If he did, he would begin to see why fighting AIDS with condoms is like extinguishing a fire with petrol.

First of all, many rural Africans are illiterate and proper use of condoms cannot be relied upon. In any case, many men think that it compromises sexual pleasure. “Would you eat sweets with a wrapper on?” is a common objection.

Secondly, social organisation in rural Africa is quite unlike sedate suburban life in Sussex, or wherever the editor of The Lancet lives. In villages here there is often a low standard of moral behaviour. Men don’t get married but they do want children, so using condoms does not even come into their minds. They sleep with whomever they like until they are very old and need someone to cook for them. A man might be sleeping with six different women in a year. And the women often don’t mind whether a man will marry them or not.

Day to day life is unlike the West. The huts are open and at night there is no electricity to supply light. Anything can happen. Thus rape of children as young as six is not uncommon. As most of these go unreported, the aggressors go scot-free. Even when the rapist is known, nothing much is done.

In South Africa, which has some of the highest rates of AIDS in the continent, researchers claim that half a million women are raped each year. Journalist speak of a “rape epidemic”. More than a quarter of all the females can expect to be raped at least once in their life, even in infancy. Half of the victims are under 18. It is hard to get hard figures, because most attacks go unreported. Tell me, how do you persuade a rapist to use condoms?

If condoms are so effective why is HIV still on the increase in Africa? One factor is certainly that people with condoms are emboldened to take more risks. Part of the counselling of people living with AIDS is “try not to spread it” -- in a word, to live abstinence. But before they got the disease they were told “hey, no need to curtail your libido, just use condoms.” If personal control is not achieved before contracting HIV/AIDS it is often impossible afterwards. I overhead a chilling conversation once of a boy planning to sleep with a girl. “What if she has AIDS?” his friend asked. “Well then, I have seven years to live and I will enjoy myself to the limit,” he replied.

There are even more basic obstacles. Many villagers are unschooled and know little about modern science. Poisoning or sorcery is suspected when people fall ill. Western medicine is often seen as a last resort after traditional healers have failed. So doctors find it difficult to explain to HIV/AIDS patients the cause of their illness. It is not uncommon for them to go to their graves with the stubborn belief that an enemy cast a spell on them. The more serious and "treatment defying" an illness is, the more it confirms the malignant power of the sorcerer.

Villages are often cut off from distribution networks for goods and services because of difficult terrain. You can’t jump into your car and make a midnight trip to the pharmacist to buy a packet of condoms. In fact, you might be cut off from condom suppliers for weeks at a time. One doctor related to me a typical example. A youth in a village explained why he did not use condoms with his girl: “well, I had to convince and convince, and when she finally said yes, I could not risk going outside to buy condoms since she might change her mind before I came back.”

And people are not just careless, they are ashamed. Here’s another story from the same doctor. A woman came to him for an antenatal check of her second child (the first was a year old). She discovered that she was HIV positive. She was terrified of what her husband would do to her. The doctors called the husband and tried to break the news gently. To their amazement he told them that he was HIV positive and had been on treatment for over a year -- without telling his wife. Why? “Well, someone gave it to me,” he said. Many infected people deliberately spread the disease, thinking; “I can’t be the only one. Since someone gave me the disease, I will give it to someone else.”

Plus, there are other means of transmission of AIDS which are unfamiliar in the West. One treatment you will not find in Cleveland is medical scarification. A traditional healer in a village will make an incision over the affected area to discharge fluid or blood. The healer uses the same implement to cut different people, leading to the spread of HIV/AIDS and other infections. Traditional scarification for aesthetic or cultural reasons also exists and is no more hygienic.

It is true that in rural Africa HIV/AIDS spreads mainly through heterosexual relationships. But it is also transmitted by intravenous drug users. African villagers prefer injected drugs to tablets because, so they think, it is better value for money. So the local chemists (who are seldom trained pharmacists) oblige them. Sometimes they save money by reusing syringes and not swabbing the skin with disinfectant. The resulting infections sometimes create huge abscesses.

The Pan African Health foundation (PAHF), a non -profit HIV/AIDS prevention charity, is building a factory in Nigeria with a capacity of 160 million syringes a year. This will supply  20 percent of Nigeria’s needs and, when fully operational, most of sub-Saharan Africa. Inexplicably, American and British foreign aid agencies which doled out lavish donations for condoms to fight HIV/AIDS were not interested in supporting the foundation. The local state government finally gave some funding.

UNAIDS, the international agency which coordinates research and treatment for AIDS around the world, is a strong supporter of condoms. Its official position is that: “The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.”

Note the stress on the word “technology”. The condom is just a technology. And technology is not much good for changing behaviour.

The West is addicted to technology as a substitute for free will and moral effort. If you eat too much, you get gastric banding surgery. If you’re depressed, you take Prozac. If you’re a smoker, you wear nicotine patches. Here in Africa, this fantasy has collided with the reality of the AIDS crisis. There is no technology to tame sexual desire. There is only self-restraint and faithfulness to your partner. These will eventually rein in AIDS; condoms won’t.

Chinwuba Iyizoba is an electrical engineer in Enugu, Nigeria


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