"We have a new Manto," a white HIV-infected friend observed.

"Who?" I asked. But I already knew: Helen Zille. One would have hoped she would have learnt from the battering former president Thabo Mbeki received that AIDS is a frontier politicians should stay away from especially if they have hang-ups around sexuality (Mbeki) or want to penalise (Zille). Uganda's Yoweri Museveni did brilliantly a decade ago when he encouraged a culture of openness.  Helen Epstein, the U.S. health writer appears to have given short shrift to how important political leadership is in her letter to the Cape Times objecting to Zille misunderstanding Epstein's book, The Invisible Cure.

But it is curious that Epstein, whose book came out in 2008 relies on the research of Stoneburner and Low-Beer who wrote a paper accepted by Science in 2003 and printed in 2004, of what worked in Uganda and what didn't in South Africa. Without the benefit of reading her book, I am going to do what she has done with Zille (who I don't agree with by the way on HIV) and rely on what she has written in her rebuttal.

Epstein notes that Stoneburner and Low-Beer found that in South Africa most "had heard about the epidemic from posters, radio, newspapers, and clinics, as well as from occasional mass rallies, schools, and village meetings; but they seldom spoke about it with the people they knew. They were also far less likely to admit knowing someone with AIDS or to be willing to care for an AIDS patient. It may be no coincidence that the HIV rate in South Africa rose higher than it ever did in Uganda, and has taken far longer to fall." It's interesting that she relies on this research because Epstein, a meticulous researcher, was often travelling to South Africa at the time.

Without discussing the corrosive effects of Mbeki's AIDS denialism that was in full swing by 2003, and ramping up in 2002 when Stoneburner and Low-Beer conducted their research, Epstein comes close to mirroring Mbeki's denialism (and I know she is not a denialist) when she writes that high incidences of HIV in South Africa: "May have to do with the legacy of racial oppression, and the long shadow of the poisonous ideas that justified it: that blacks were inferior, oversexed beings."

She observes: "Surveys show that Americans have more partners over a lifetime than people in Africa do. So why are HIV rates so much higher in Eastern and Southern Africa than in America?" She doesn't cite the studies and I could find none. What I did find was a 2006 study HIV and Sexual Behavior Change: Why not Africa? by Emily Oster of the University of Chicago. Oster notes:

"Despite high rates of HIV in Africa, there has been little widespread change in sexual behavior in response to the epidemic. This is in contrast to large changes in behavior among high-risk groups in the United States... Since, on average relative to the United States, individuals in Africa are poorer and have lower non-HIV life expectancy we expect lower responsiveness to the epidemic... responsiveness is higher for richer individuals and those who should expect to live longer."

Oster writes: "In Africa, there seems to be virtually no change in the share of single men having premarital sex between the early and late 1990s. Even in the more recent period, between the late 1990s and early 2000s, when HIV was becoming a much more salient issue in Africa, we still do not see movement in the share of men having extramarital sex. In contrast, among gay men in the US, the probability of having multiple partners falls 30 percentage points in the four years between 1984 and 1988." (The years immediately after the disease was identified.)

Epstein basically says apartheid trauma and discrimination led to people in South Africa having high rates of unprotected sex (and curiously she writes as though it were only black people who become HIV+). Oster is a little closer when she points to poverty and expectations of living longer as determinants of safer behaviour. Epstein, who I know personally, will not be happy with my encapsulation, but I believe both Helen's are on the wrong track.

Frankly, now that treatment is available in South Africa there is still too much of a hoop-la about HIV. It is a treatable, chronic disease. So is diabetes and hypertension, which affect significant numbers of Africans and North Americans.  Zille is running a competition with cash awards for people to get HIV-tested in the Western Cape (what is it with the air in Leeuwenhof?). If you included diabetes and hypertensive tests too, then you might be getting somewhere Helen Z, but your messaging is wrong.

Epstein claims that (north) Americans have more sex than South Africans. After a year of living in the U.S. I somehow doubt it, sorry guys, you're lovely but you're more aloof than South Africans and that Puritan streak runs deep. Passion is considered with affection in Mediterranean's, why not in Africans?

Zille wants to criminalise those who are HIV+, and know it and then allow unprotected sex with a partner. She pontificates: "We must begin by challenging the pre-modern notion that unprotected sex with multiple, inter-generational concurrent sexual partners is a cultural right. It is not... it wreaks social devastation... It is a key reason why our health system is so overburdened. It must stop. It is not merely a moral issue. It is a developmental issue. And we shouldn't pussy-foot around the subject."

The "It must stop" part gets to me. So does the part about "a cultural right" - since when did promiscuity have anything to do with culture? Is she saying white boys don't pomp?

And this is where the problem lies with both Helen's they're transfixed by the sex in HIV-transmission. Do I consider unprotected promiscuous sex a good idea? No. But I also don't think that eating junk food and becoming obese is a good idea, it too creates huge strains to the health infrastructure of South Africa, the USA and other nations with diabetes, cardiac problems and a range of costly health issues. Should we criminalise those who eat five or more Big Macs a month?

How do we legislate against greed? We have a hard enough time bringing bankers to book for devastating the world's economies with their greed. Now we want to criminalise sexual greed between Joe and Jane Public? Are there not more pressing problems for politicians to apply their minds too?

Let's get back to my HIV+ white Afrikaner, gay, male friend in Johannesburg (I list all his details to cover every box for the bigoted), he says, "HIV transmission runs non-stop in this country, it's linked to drugs, alcohol, people don't think when they are high. Then there's rape... We can stop AIDS, but we can't stop HIV." And he is right, treatment can stop, or delay, a killer Syndrome, but it can't stop people being fools and not requesting a condom.

Zille quotes a Canadian case: "Edmonton police arrested a 17-year-old girl on charges of aggravated assault after she had sex with two men without disclosing her status. The police issued a public safety warning, and released the girl's name, photograph and personal details. This led to a third complainant coming forward." Can you imagine how happy those three guys were to have unprotected sex with a 17-year-old? I am prepared to bet that they are probably at least double her age.

A friend in Boston told me of how her plumber recently confided to her that he is into S&M. "He is in his 60's and grubby," was how she described him. He posts ads on Craigslist here, a free ad service where people post jobs, furniture for sale, or sex-wanted ads. It's not dissimilar to dating and sex sites in South Africa. "He told me recently packed all his S&M kit together for a tryst in a motel with a young woman he met online. He only realized how young she was when she told him her mom expected her home by 10pm." I wonder if he remembered to pack or use condoms along with the whips, leather and chains?

And here I want to address a final point from Helen Epstein; she says that Americans have more sex and lower rates of HIV. I doubt that the U.S. knows its real rates of HIV: I believe they would be lower than South Africa, but higher than they believe. A significantly lower percentage of the population get tested for HIV here than in South Africa. Health care is unbelievably expensive, I pay the equivalent of R4,500 a month for a health plan that is not as good as mine in South Africa, and which cost a quarter less. Seventeen percent of the population in the U.S. has no health insurance.

There is not the prevalence of free clinics for testing and treatment of HIV that there are in South Africa and HIV is not on anyone's discussion agenda here. In other words, it is behind South Africa in the progress our much-maligned nation has made since the dark days of Mbeki.

Let's get back to a partial solution from Ostner: "responsiveness is higher for richer individuals and those who should expect to live longer." And there it is, if you have opportunity, if you have a reasonable expectation of a decent life you will do more to protect yourself from becoming infected, or co-infected. HIV is not like other diseases you don't just get it once, if you have unprotected sex with another HIV+ partner you re-infect yourself, it pushes up your viral load, and increases your risk of an early death.

In countries where these risks are explained, where there is openness about the disease, as I believe there is in South Africa, but too, where people have jobs and opportunity, then the rates start dropping. But still, as another HIV infected friend, a heterosexual white male who is in a loving long-term relationship with an HIV negative woman (who knows his status, and yes, they always have protected sex) says: "I know who infected me, and I was using her as much as she was using me. It was at a time when I didn't care about anyone, including myself. At first I was angry with her, and then I thought, why couldn't I have insisted on a condom? HIV has taught me to become more focused, to take care of myself, and have open, respectful partnerships."

Blame is easy: apartheid, loose women/men, drugs, sex websites, and poverty. But solutions come only when we take personal responsibility. And greed? It's part of the human condition, if I could have Haagen Daz Dulce de Leche every day and not gain an ounce I would - but I can't, so I don't even make eye contact with the container as I walk by the fridge.

If you're going to criminally charge those who gorge themselves on food, then arrest those who don't reveal their HIV status (remember the other person has a choice to demand condom use too). But if you have political power, rather create jobs and go after the corrupt in banks and government. There is greed that harms individuals, and then there is greed that harms millions. The latter are the ones I want to see in jail.

Remember this too, the highest rates of infection are in married women, and not because of their own infidelity, they trust the man they love.

* Charlene Smith is an award-winning South African-born journalist who lives and works in Cambridge, Massachusetts.

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