UNAids and most experts believe that 90% of HIV transmissions in Africa are caused by sexual contact, but in February 2003 some privately funded US researchers published a report in The International Journal of Sexually Transmitted Diseases and Aids that contradicted this. Their research is based on a re-examination of infection statistics and they suggest it is that unsafe medical care, especially the use of contaminated needles, that is responsible for about 60% of new HIV infections in Africa, but UNAids estimate this at nearer 5%. If the idea that HIV is mainly transmitted by medical treatment was accepted, it would undermine all the efforts to change the way women and men negotiate sexual encounters and to establish safe sex practices.

The four men who produced this report, (John Potterat, David Gisselquist, Ernest Drucker and Richard Rothenburg), seem to be well-intentioned, arguing, for example, that more resources are needed to provide sterile medical care in all countries, not just the industrialised ones. Another motivation is to counter stereotypes about what they call ‘African sexuality’, and in American terms, they clearly see themselves as ‘liberals’. The important fact to grasp about HIV in Africa is that more than half of all new infections are of women. In 2002 UNICEF said that women accounted for more than 66 per cent of HIV-positive people in Sub-Saharan Africa between the ages of 15 and 24, with the ratio of infected girls to boys climbing to 5:1 in some parts of eastern and southern Africa. Potterat et al. Say this is due to the medical treatment given to women when they attend anti-natal clinics.

Previous research by John Potterat examined the transmission of sexually transmitted diseases in the US by looking at the links between infected people. The sociological approach this is based on is called ‘network theory’ which makes sense for tracing infections since it looks at the patterns of connections between people. Typically these models reveal that certain individuals have a far greater number of links than others and so play a more important role in the spread of infection. But conceptually each person in the network is socially equal and this makes network theory blind to social inequality. This means that it fails to look at the gross inequalities between women and men, crucial in understanding HIV transmission, and the researchers’ apparent desire to counter prejudices about ‘African sexuality’ could be a way of defending men’s sexual behaviour.

Indeed, far from criticising the behaviour of the men who form ‘nodes’ of transmission, there is even a covert message of admiration for these since they seem to be getting more sex than others. Malcolm Gladwell, in ‘The Tipping Point’ (2000), gives an account of John Potterat’s work on syphilis transmission in the mid-1990s and goes on to describe the case of a man living near Buffalo, New York called Nushawn Williams. « He juggled dozens of girls, maintaining three or four different apartments around the city, and all the while supporting himself by smuggling drugs up from the Bronx… He is known to have infected at least sixteen of his former girlfriends with the AIDS virus. … One epidemiologist familiar with the case told me flatly, "The man was a genius. If I could get away with what Williams did, I'd never have to work a day again in my life." » This is a clear expression of deeply-held male attitudes, since men’s ability to get access to sex is the critical factor for their reproductive success, so is one of the main ways in which they rank themselves against one another.

Throughout human history there has always been far greater differences in reproductive success between women and men. This is not due to genetic factors but is strongly influenced by political and social dominance; the more hierarchical a society, the greater these differences. Although in modern times social inequality has decreased in many societies, and there has been some improvement in the status of women, the broad picture has not changed. More men than women never have children. The differences in reproductive success are still greater for men than for women, which still means that a few men have many partners and many have few or none.

This can be seen in the statistics for contemporary Britain, for example, where the number of men who never have children or who live with a partner is actually increasing. Of people born in the1940s, 4 per cent of women and 8 per cent of men never married and were not living in a permanent cohabiting union by the time that they reach the age of 50, but an estimated 10 per cent of women and 16 per cent of men born in the 1960s. Over the last 25 years the proportion of people living in ‘traditional’ family households in Britain has fallen by 25 per cent, and the proportion living in couple households without children has increased from one fifth to one quarter. Again over 25 years, the number of women over 65 living alone has nearly doubled, but they have now been overtaken by the number of men under 65 living alone. Since 1971 the numbers of these men has increased threefold, and more men now go on living with their mothers even when they are grown up. Despite living in societies flooded with sexual imagery, it seems that more men are not getting access to sex, unless, of course, they pay for it. Hence the male admiration for those who seem to be getting more than their fair share.

Potterat et al. support their argument about infection being due to peri-natal medical care by citing research on 12 African countries that shows that 91% of women aged 15-49 years had no non-regular sex partners in the past year, and only 3.7% of men and 0.7% of women had more than four non-regular partners. But a study of adolescents in Nairobi that found that they are becoming more sexually active and that 25% of women aged from 12-24 lost their virginity through forced sex. Accounts by women themselves confirm this picture, and the high incidence of rape in South Africa is well known. The researchers’ thesis is weakened by additional evidence on the importance of sexual behaviour in transmission of HIV. This shows that there is a close association between the HIV virus and the herpes simplex virus (HSV-2). “In Kenya and Zimbabwe, for example, over half the adult population is infected with HSV-2 … In Africa as a whole, genital herpes is responsible for as much as 40 per cent of HIV transmission, according to some estimates.” (New Scientist, 12 April 2003.)

Understanding the inequalities of gender relations in Africa is critical to understanding HIV transmission, something network theory fails to do. Potterat et al.’s report was based on statistical evidence and ignores what women have to say on the matter. This can be seen, for example, in an International conference on AIDS held in Burkino Faso in December 2001. The BBC’s Fiona Werge reported that African women delegates strongly criticised African men’s attitude towards sex. They said that this is what is putting women’s lives at risks and helping to spread HIV throughout Africa.They blamed the male-dominated culture, citing in particular practices such as a refusal to wear a condom, intimidating young girls into having sex, polygamy, and rape. They also mentioned superstitious beliefs such as purification through having sex with a virgin. Other African women report, for example, that men say that if they wear a condom, women could use their sperm to practice sorcery on them. Some women also report how they feel unable to complain about their situation because of threats that they may die through sorcery, a method also used by those who control the women trafficked for prostitution. We should note how conveniently these supernatural beliefs act in men’s interests. Women delegates at the conference also said that to get access to HIV tests and the simplest drugs many African women had to run a gauntlet of taboo, male opposition and financial worry.

Other research in this area shows a different picture. For example, Dr Simon Gregson of the Department of Infectious Disease and Epidemiology, Imperial College, London has been looking at HIV transmission in Africa for many years. Unlike Potterat et al., he has been working in the field in Zimbabwe. In 2002 he published a paper called ‘Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe’ (The Lancet, 359). Here he concludes that what is driving this epidemic along is what he calls sex between different generations. He notes that women in their teens often date and marry men five to ten years older because of their increased wealth and status, that older men have had more partners and so are far more likely to be HIV positive.

He calls this ‘intergenerational sex’ because of the age differences, but this is in fact a pattern common to polygynous or polygamous systems where a man’s higher wealth or status permit him to have more than one wife. Called ‘harem polygyny’, this is a pattern typical of human beings throughout their evolutionary history. 80 to 85 per cent of the human societies that have been studied have allowed polygamy, and it is still practised in at least 39 countries in the world. The system in which one woman has more than one husband, polyandry, is found in only five ethnic groups and the men are usually brothers. It tends to be found in difficult environmental conditions where there may be a shortage of women, while polygamy not specific to any region of the world. Since the men who acquire additional wives want them to have children, these additional wives will be young women, which set up the link between polygyny and greater age difference at marriage. But polygamy is also a major cause of low status for women throughout society, affecting not only forms of marriage, but the way sexual relationships are negotiated.

We can see how polygamy lowers women’s status by looking at how this operates in the United States among the Mormons of Utah. Bigamy has been a crime there for more than 100 years; punishable by up to five years in prison, but the number of people in polygamous families is estimated at perhaps as high as 50,000. An investigator in the state attorney general's office, Ron Barton, said that some fundamentalist groups believe that a girl's first menstruation is a sign that she is old enough for marriage, and officials say that some girls are believed to be married as young as 11. A Salt Lake City lawyer, Paul Kingston apparently has 24 to 26 wives and at least 145 children and possibly more. A child of this family, who left at the age of 15 when they tried to force her into marriage, said she believed there are hundreds of girls in the same situation, trapped in polygamist enclaves, some of which deny women the right to education beyond middle school.

Thankfully, in Africa age differences at marriage are generally decreasing, which may bring with it some reduction in the acceptability of polygamy. But since many of these countries are experiencing severe economic difficulties, women sometimes have to do things they dislike in order  to survive. Against the trend, three African countries, Rwanda, Burundi and Botswana have shown increases in age differences at marriage. The UNAids estimates of the percentages of adults (15-49) living with HIV/AIDS at the end of 2001 8.9% in Rwanda, 8.3% in Burundi but 38.8% Botswana, the highest in Africa. While the increased age difference in Rwanda and Burundi could be explained by political and economic difficulties, this cannot be true of Botswana. It also has one of the greatest degrees of social inequality in Africa and a history of polygamous marriage, with half of the country described as Christian and half as having 'traditional' beliefs. Research would be needed to be done to examine precisely what the connections are here.

The new ‘theory’ suggesting a medical model for the transmission of HIV should be rejected. Instead, efforts to raise the status of women should continue, to help women to resist unwanted sexual encounters, to negotiate those they want on equal terms, not to marry against their will and to have children when they choose. In countries with high rates of infection, this leaves many complex problems such as condom use within marriage, but here again, the answer is equal status for women.

Caroline Hubbard, (SOS SEXISME) April 2003.

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