AIDS: Whose Problem?

First it was a problem supposedly only for gay men, drug users, and the promiscuous, then for Eastern Europeans and Africans, and now it is women who are said to bear the brunt of the virus and be the ones who should empower themselves and stop the virus in its tracks. Women taking responsibility for men’s behaviour. Sound familiar?

December 1st is World AIDS Day, time to remind ourselves that more than 33 million people are infected with an entirely preventable virus. When public attention to the HIV virus was first drawn, it was portrayed as something which concerned drug users and gay men. Then, only the promiscuous. Not the dominant, majority “us”. Now with anti-retroviral drugs available it is a problem for poor nations, not us. For Eastern Europeans and black Africans, not us. And the final twist has been a concentration on women as bearing the brunt of the virus, and as the ones who can turn things around. (Women taking responsibility for men’s behaviour. Sound familiar?)

This focus on women as bearing the brunt of AIDS is challenged in an article in The Guardian by Elizabeth Pisani, an epidemiologist who works on HIV in developing countries.

The crux of her argument is that while empowerment of women is an important goal in its own right, the onus for the immediate prevention of the spread of HIV lies with men, who are not only more likely to inject drugs and have anal sex, the easiest transmission methods, but vastly more likely to buy sex (those who buy outnumber those who sell) and generally hold the power. Although six out of ten Africans with HIV are women, they are mainly infected by men.

Pisani cites the success story of Thailand, which started a male-focused campaign for condom use in paid sex starting in 1989. It was, at the end of the day, the brothel owners, mainly male, who had the power to enforce the campaign, which Thailand estimated prevented 5.3 million infections between 1990 and 2007.

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It is not the case that if women were better educated, more affluent, more empowered to refuse sex or insist on condom use, then they would single-handedly stop the epidemic. Pisani claims that in 16 out of 17 African countries, HIV infection rates are highest among women in the richest households. In two-thirds of those countries, educated women are more likely to have HIV. We can only speculate why this is. But why, in any case, should it be women who are responsible for all elements of contraception and sexual health? Why are they seen once more as the more responsible ones who need to look after the poor stupid guys who have only their instincts to guide them? This underlying message is offensive to us all.

It seems obvious that any campaign specifically focused on AIDS in Africa has to concentrate on the men who choose to put the condom on or not. Empowering women, or rather removing the barriers to their own empowerment, is equally necessary but not as a quick fix for the 7000 daily new infections.

And closer to home, the problem is ours — men and women, whatever our ethnic or social group or sexuality, and however promiscuous or monogamous we may be. The solution is really simple: talk about safe sex to children and young people, and — men — always wear a condom.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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