News Flash, Pay Attention: HIV Is About Sex

This is a guest post by Clarisse Thorn, who blogs at Pro-Sex Outreach, Open-Minded Feminism.

Today is World AIDS Day. I don’t think about HIV as much as I did a few months ago, when I was still in Africa and my job was to help with the epidemic. But today, I’m thinking about it, and I have something very simple to say:

HIV is about sex.

One of the big lessons I learned about HIV in Africa is that many, many people will do amazing mental and rhetorical backflips to avoid talking about how HIV is actually spread. It’s astonishing. You’d think that when talking about HIV, you’d have to talk about sex; you’d be wrong.

In the areas where I worked, a massive percentage of people were infected with HIV. In a number of places it was about 25%. In some populations, it was more like 40%. Think about those numbers for a second — and remember that many people who had contracted HIV had already died. In other words, uncountable numbers of people had already died of AIDS-related causes, and among the people who remained alive, the percentages still got as high as 25% and 40%.

And yet I got the message over and over and over that we mustn’t talk about sex! For example, I was told by some school authorities that I could not give safer sex information to their students because that might “encourage the students to have sex”. In other words: God forbid we tell students where to get condoms and how to use them, because that might encourage them to think sex isn’t wrong and dirty. What the authorities were really telling me is that it’s more important that we continue to stigmatize sexuality, than it is to protect people from HIV.

Another example of this phenomenon is highlighted when we look at how the USA’s HIV charity money is spent. The President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) places rather elaborate restrictions on how the money is spent, and while there’s nothing wrong with restricting aid money in principle, these restrictions include a provision that states that no PEPFAR money may fund an organization that doesn’t actively oppose sex work. In other words: God forbid we support sex workers and help them stay safe while they do their jobs, because that might make sex workers feel like they’re accepted members of society. What PEPFAR is really saying is that it’s more important that we continue to stigmatize sex work, than it is to protect people from HIV.

PEPFAR also demands that none of its money go towards condoms or initiatives that promote condoms; there are rumors that Obama will fix that, but I haven’t heard any confirmation of that yet. Maybe things are getting better on that score? And in one of my articles about Africa, I wrote that:

I can’t help noticing — with an occasional ironic smile — the phoenixes arising from these ashes. Firstly, it turns out that the best way to shut down sex-negative arguments against explicit sex education is to invoke the specter of HIV. One 2008 report from a well-respected local organization argued that AIDS prevention efforts should include straightforward lessons on pleasurable acts, such as oral sex or sex toy usage!

A 2004 “New York Times Magazine” article on HIV in southern Africa made the case that while “many experts contend that sexual-behavior change in Africa is complicated because women’s fear of abusive partners inhibits private discussions of sex, condom use and HIV,” the crisis also contributes to a better environment for those discussions. One researcher is quoted pointing out that, “young South Africans are much more likely to talk about sex and are developing ‘a vocabulary for discussing feelings and desires’.” Furthermore, southern African movements for women’s empowerment invariably cite HIV as a reason change is necessary now. Because gender oppression is acknowledged as a driver of the epidemic, gender equality is an explicit goal of both governments and major HIV organizations.

In other words, in a weird way, the existence of HIV can be a positive thing because it’s a major factor forcing society towards honest, open, respectful conversations about sexuality. I believe those conversations to be good for a variety of reasons, but here’s why they are crucial to stem the tide of HIV — they make it much, much easier for people to both learn about the disease and take steps to avoid it. (After all: if you can’t talk to your partner about sex, then how are you going to communicate well about condom usage? If you don’t understand your own sexual desires or those of your partners, then how are you going to keep yourself out of sexually vulnerable situations?)

But we are not out of the woods yet. We’re not even close. And there’s ample room to slide backwards. I have read that HIV rates in America were falling for a while but are now rising again. And there are so many issues with which America is not doing much better than Africa — for example, our awful societal ideas about sex work. It seems to me that we Americans marginalize sex workers almost as much the African nations where I worked; and when sex workers are marginalized, they become more vulnerable to HIV. Indeed, just about any population whose sexuality is ignored, stigmatized, and swept under the rug is likely to be more vulnerable to HIV; history has shown this over and over, as for example with the gay community.

As long as we can’t have reasonable conversations about sexuality, we will never understand HIV. As long as we can’t have open, honest, non-judgmental conversations about sexuality, we will be hamstrung when we try to cope with it on both the individual and the community level. HIV is about sex. To deal with HIV, we have to be able to deal with sex.

The image at the beginning of this post shows a model wearing an amazing dress made entirely of condoms; thanks to the gallery at the website for The Wisdom of Whores, Elizabeth Pisani’s incredible book about the HIV epidemic and the international response. Pisani’s book is one of my favorites, ever — there are some valid critiques to be made, but even with those in mind, I just love it. Note that in honor of World AIDS Day, Pisani’s publisher is offering the book as a free download for the next month. Seriously, please read it. I have read very few books that I thought were simultaneously so entertaining, so well-written, and so important.

And, if you’re looking for someone to donate to in honor of World AIDS Day, then may I suggest Doctors Without Borders? Of all the organizations I dealt with in Africa, I was shocked by how little I felt like they wasted time and effort. They’re awesome.


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19 comments for “News Flash, Pay Attention: HIV Is About Sex

  1. RD
    December 1, 2010 at 7:44 pm

    And there are so many issues with which America is not doing much better than Africa — for example, our awful societal ideas about sex work.

    Actually some countries in Africa are better than the US re: sex work…parliament in Rwanda is considering decriminalizing it. Which, would add them to a long list of countries that are better than the US re: sex workers rights.

  2. RD
    December 1, 2010 at 7:45 pm

    And there are so many issues with which America is not doing much better than Africa — for example, our awful societal ideas about sex work.

    Actually some countries in Africa are better than the US re: sex work…parliament in Rwanda is considering decriminalizing it. Which, would add them to a long list of countries that are better than the US re: sex workers rights.

  3. December 1, 2010 at 8:15 pm

    HIV is often about sex. But not always, far from it. In my country, HIV is spreading very fast. Sexual intercourse, however, is not the main cause. Drug addiction (sharing the same needles) and lack of proper hygienic measures during blood transfusions and medical procedures are the main reason HIV spreads so fast in Ukraine and Russia.

    I remember begging the doctor at my high school in Ukraine not to inject me with the same syringe that had been used on 20 other people right in front of me. We had no right to opt out of these injections or to request fresh syringes.

  4. David
    December 1, 2010 at 9:36 pm

    Clarissa:
    HIV is often about sex. But not always, far from it. In my country, HIV is spreading very fast. Sexual intercourse, however, is not the main cause. Drug addiction (sharing the same needles) and lack of proper hygienic measures during blood transfusions and medical procedures are the main reason HIV spreads so fast in Ukraine and Russia.
    I remember begging the doctor at my high school in Ukraine not to inject me with the same syringe that had been used on 20 other people right in front of me. We had no right to opt out of these injections or to request fresh syringes.  

    Nice post (depressing content aside)

  5. December 1, 2010 at 10:08 pm

    David, David, David. That was fifty kinds of inappropriate. Your comments are getting on my nerves in just about every thread. Kindly watch yourself: I’m going to be kind and not ban you outright just yet.

  6. David
    December 1, 2010 at 10:42 pm

    I was actually just making a comment on how I liked the factual detail and interesting perspective that Clarissa brought to the discussion. I thought it was interesting because it came from an eastern european perspective, which isn’t usually mentioned as much. (Also talking about the poor medical care and reusing of needles.) I felt a need to put that it was depressing in parens because I didn’t want to come off as sarcastic – and also didn’t want to imply that it was nice that people were being infected with HIV in eastern europe. I’m sorry if Clarissa took offense – she shouldn’t. She shared an insightful, interesting comment. Is that fifty kinds of inappropriate? By the way, I assure you that you would be 100% right in banning me if I did imply that I found it awesome that people were suffering from a terrible, debilitating disease.

  7. David
    December 1, 2010 at 11:01 pm

    Oh, and I voluntarily revoke my own sarcasm or snark license. I used it way too much yesterday without remembering that it is essentially impossible to distinguish the normal from sarcasm unless you explicitly wrote a tag into the post. Back to normal long posts for me.

  8. Esther
    December 2, 2010 at 1:03 am

    In other words, in a weird way, the existence of HIV can be a positive thing because it’s a major factor forcing society towards honest, open, respectful conversations about sexuality.

    That’s extremely callous to the millions of dead and their families.

  9. December 2, 2010 at 1:37 am

    A fair point, Clarissa. In my zeal to re-emphasize the sexual aspect of HIV, I lost some nuance and didn’t cover some other perspectives.

  10. December 2, 2010 at 7:20 am

    Clarissa makes a very good point. I also went to school in Ukraine for a while, and although I don’t remember any horrific incidents of people using an already used syringe on me, my grandmother was an infectious diseases expert in Kiev for 56 years, and she has many stories of how lives were and are sacrificed because, really, who gives a crap about ordinary people’s health and safety when the bureaucracy is so horribly corrupt?

    The high rate of heroin addiction is another huge problem. Many people of my generation are dead or dying now, because of illnesses they got through dirty needles, never mind the effects of the drug itself.

    And there’s also the fact that many men still view putting on a condom as some sort of “assault on their masculinity”. And sex-workers particularly are in danger, because while the trade is huge, it’s also completely illegal, and the majority of the workers, including both women and men, are in no position to demand that clients wear condoms. The government doesn’t want to make it legal, because it’s already steeped in corruption and business dealings with the illegal sex industry – and nobody wants any pesky labour laws cutting into their profits.

    I just took an instant HIV test over the summer in Kiev when I was applying for a Russian visa, and wound up having a conversation with one of the doctors at the testing clinic while I waited for my taxi. The stories these people give you goosebumps – the bad kind.

  11. December 2, 2010 at 1:36 pm

    @Natalia — I agree, and I don’t want to disappear the problem of injecting drug users and gender dynamics you’re talking about, but I do think that problems of sexuality are still very relevant even when we note those issues. For example, men who refuse to wear condoms are certainly under social pressure to perform manliness, but there are definite sexual factors there as well — and it seems to me that those factors are all-too-rarely acknowledged. Such as the fact that condoms simply don’t feel as good for the vast majority of men; that’s undeniably a sex problem, so why does it always seem to get boiled down to a more theoretical question about masculinity?

    And of course, injecting drug users often end up having sex and spreading HIV that way once they’ve contracted it through a needle. In fact, Elizabeth Pisani — whose book I highlighted in the original post — included some notes in the book about how she found that injecting drug users were much more likely to be having risky sex than non-drug users.

  12. December 2, 2010 at 6:55 pm

    “injecting drug users were much more likely to be having risky sex than non-drug users.”

    Took the words right out of my mouth. Great post, Clarisse, thank you. The life-affirming vision of AIDS activism is inextricably bound up with the pleasure-affirming vision of sex-positive feminism, for the reasons you articulate so well. Brava!

  13. PrettyAmiable
    December 3, 2010 at 11:42 am

    … I really like the dress that girl is wearing in the photo. If it were anything other than condoms, I would totally wear that out. I didn’t realize they were condoms yesterday when I looked at this post, haha

  14. nubianpanna
    December 6, 2010 at 9:15 am

    Clarissa, thanks for an interesting post…. I just have one (kind of major) issue with the fact that throughout the post you talk about “Africa” and it’s attitude towards HIV/AIDS as if it were one monolithic entity… which of course, it is not. The experiences and observations you describe may very well be valid for the country (or countries) you visited but that does not make it true for an entire continent. Especially, when different parts of the continent have had vastly different experiences with HIV/AIDS.

    I’ve recently returned to the US after 3 years working in Uganda and I can tell you that Ugandans for the most part do not shy away from talking about sexual networks & it’s role in spreading HIV. I know from my colleagues that this is also true in several other East African & West African countries (I’m less familiar with Southern & North Africa).

    So again, I agree with much of what you said but I urge you to refrain from making gross generalizations — especially when those generalizations are inaccurate.

  15. Neets
    December 6, 2010 at 10:51 am

    You took the words right out of my mouth…I’m sorry Clarisse, but just the simple fact that you wouldn’t even specify which ‘African nation’ you had worked in, while simultaneously blathering on and on about how the U.S. needs to change its stance on discussing HIV prevention due to the fact that it is one of the many “issues with which America is not doing much better than Africa” just makes you sound incredibly obnoxious.

    nubianpanna: Clarissa, thanks for an interesting post…. I just have one (kind of major) issue with the fact that throughout the post you talk about “Africa” and it’s attitude towards HIV/AIDS as if it were one monolithic entity… which of course, it is not. The experiences and observations you describe may very well be valid for the country (or countries) you visited but that does not make it true for an entire continent. Especially, when different parts of the continent have had vastly different experiences with HIV/AIDS.I’ve recently returned to the US after 3 years working in Uganda and I can tell you that Ugandans for the most part do not shy away from talking about sexual networks & it’s role in spreading HIV. I know from my colleagues that this is also true in several other East African & West African countries (I’m less familiar with Southern & North Africa).So again, I agree with much of what you said but I urge you to refrain from making gross generalizations — especially when those generalizations are inaccurate.  

  16. kate dingani
    December 8, 2010 at 7:29 am

    I was wondering about this as well–I’m guessing you were in South Africa based on the very high rates of infection you are mentioning–guess Western Cape and KZN.

    I dont doubt that there was some shyness in schools regarding frank sexual discussions, but in my experience there are lots of contexts in which this is not the case.

    Neets: You took the words right out of my mouth…I’m sorry Clarisse, but just the simple fact that you wouldn’t even specify which ‘African nation’ you had worked in, while simultaneously blathering on and on about how the U.S. needs to change its stance on discussing HIV prevention due to the fact that it is one of the many “issues with which America is not doing much better than Africa” just makes you sound incredibly obnoxious.
      

  17. December 18, 2010 at 7:58 pm

    Sorry it took me so long to get back to these comments — since there’s no way to subscribe by email to Feministe comments, I sometimes lose track.

    To the last few commenters: I’m sorry about how unspecific I am about my previous location in Africa. I recognize that this is a problem due to the “Africa is a country” stereotype, but I write under a pseudonym, and I have to speak without specificity due to concerns about revealing my identity. I did try to be careful about how I represented Africa by using clauses like “In the areas where I worked” (paragraph 4) and “in the African nations where I worked” (paragraph 11). If you have specific ideas about how I might have worked to be even more careful about this, without speaking directly about my location, then I would love to hear them.

    It is correct that I was based in southern Africa.

    Respectfully, I would also like to note that while in my experience many people were very willing to talk about sexual networks, but that doesn’t mean that people were willing to talk about sex. Sexual mechanics, for example, were pretty much off the table. Sexual pleasure was also pretty much never discussed.

    In my experience, when sexual networks were discussed among the people I worked with in Africa, it was in highly theoretical and sociological terms rather than personal or sexual ones: usually, “Here’s a Venn diagram of partners” or something like that, rather than something like “This person’s sexual needs are not being met by her partner, so she goes to this other person.” I find those types of conversation less than useful because they put all the sexual issues in an airy theoretical box that doesn’t feel relevant to the actual people who are engaging in multiple concurrent partnerships.

    Granted, there are some advertising campaigns (“Undercover Lover” and such) that took a slightly more personal approach. But even with those, I was frustrated by how little emphasis there was on actual conversations about sex. If you worked with organizations or groups that were teaching specific sexual communication skills or encouraging straightforward discussion about sexual pleasure, then I would love to hear about them.

  18. December 18, 2010 at 8:06 pm

    Clarisse Thorn: If you have specific ideas about how I might have worked to be even more careful about this, without speaking directly about my location, then I would love to hear them.

    Including a brief disclaimer explaining why you need to withhold this information would be helpful, so that readers know it’s done with an overriding purpose and not out of ignorance. I’ve read a lot of your writing on this, and I still managed to miss that there were privacy concerns involved! I did wonder why you were always so vague and generic.

  19. December 19, 2010 at 12:28 pm

    Thanks Jadey — that’s really helpful.

Comments are closed.