Published in 2007, the book examines the complex nature of humanity’s sexual relations in Africa and how that is an efficient transport system that carries HIV infection from one to many. Helen Epstein, a molecular biologist was working on an AIDS vaccine project in Uganda, east Africa, in the 1990s when she started asking questions about why AIDS was spreading faster in Africa than anywhere in the world.
‘I began to notice, along with many others, that the prevailing explanation for the spread of HIV in this region was that there was a theory that HIV was spreading largely because of the behaviour and activities of so-called high-risk groups ‘ prostitutes, truck drivers, mine workers, and so on ‘ people who were assumed to have very high numbers of sexual partnerships. It was thought they were driving the epidemic in the region’, Epstein says.
But studies and observations over years proved the argument to be without merit.
‘It became clear that people in this part of the world aren’t more likely to visit prostitutes than people in other parts of the world, nor do people in this part of the world have more sexual partners over a life-time than people elsewhere do. So, that explanation didn’t seem to make sense’, she says.
There is no complete answer as to why HIV infection is worst in Africa. But, in her book, Epstein discusses a phenomenon which many experts now think facilitates the spread of HIV in the region, and that is having multiple and concurrent sexual partners. Contrary to conventional wisdom, it has been found that it’s easier to transmit HIV infection in sexual relationships that have been maintained over a period of time, than through casual once-off sexual liaisons.
‘One possible hypothesis began to intrigue me, which was that it had to do with the fact that there is a greater tendency for men and for women in this region to have over-lapping long-term relationships where people sleep regularly with more than one person’, Epstein says.
‘And if enough people are doing that it can give rise to a kind of a network of sexual relationships that accesses a sort of super highway for the spread of the HI-virus, even if most people are only having one or two, or at most, three sexual partners. The more I looked into that and the more I talked to Africans themselves about whether this hypothesis made any sense, read studies by anthropologists and others, the more I began to realise that this could be, at least, part of the explanation for what’s going on here’, she continues.
In these particular networks, where people have more than one regular sexual partner at a time, the use of condoms is likely to fall by the wayside.
‘Yes, if they were ever there to begin with. The tragedy of this epidemic in this part of the world in particular is that people are becoming infected in many, many cases by the people they are closest to ‘ their long-term partners, their spouses, the people they trust the most and respect the most’, says Epstein.