Helen Zille's recent very public foray in to HIV prevention and treatment - ‘why should we be pay for irresponsible sexual behaviours?'- is only a more recent example of this popular wisdom; the formation a decade ago of the Moral Regeneration Movement, ironically lead by Jacob Zuma, Thabo Mbeki's reflections on black male sexuality in an address at Fort Hare University, the various politicians that have lectured the nation on ABCs (often hilariously getting caught subsequently with their pants down in the wrong bedroom) have all pandered to popular wisdom. Sex moral panic periodically infects politics in South Africa, like it does everywhere else in the world.
I sit in my HIV clinic with my frightened, bewildered patients who have to endure the headlines screaming for their punishment. These people look pretty normal to me. When I ask about their sex histories, it doesn't feature the rampant sexuality conjured up in the fevered brains of politicians, letter writers and corridor conversationalists I have to endure. Their sexual history is of a couple of boyfriends or girlfriends, a marriage, children, pretty mundane-sounding sex lives, and shocking and unexpected positive test.
The weirdness of HIV in South Africa started during the Mbeki regime, where a counter-science movement, with a cast of supporting international crazies, distracted us from the single biggest question: Why is HIV so bad in such a small area of the globe? Southern Africa, from Zambia down, accounts for over half the global HIV numbers. South Africa alone houses 1 in 5 of the world's HIV infected population.
The underlying common-sense premise is that ‘different' sexual behaviours power the epidemic. Southern Africans shag more, shag too many people, or shag differently, in a way not seen anywhere else in the world. HIV prevention billboards implore us to be ‘responsible', to cut down on our number of partners, and to consider abstinence. In the background is a moral disapproval of sex for fun, which conveniently allows conservative messages to be dressed up as public health.
HIV is actually not terribly transmissible when looking at risks per sex act measured in developed countries, when compared to other viruses like herpes. Despite this, a young woman in KwaZuluNatal has an almost 1 in 3 chance of being HIV positive by the age of 21 years. Her counterpart in Toronto, Rio or Paris has a lifetime chance of well below 0.5%.
If it is something about sexual behaviour only, it must be something seriously different. The alternative explanation, which seems to me so much more plausible, even when you haven't reviewed the data, would be that there is something biological that makes sexual transmission far more efficient. The data is starting to emerge.