In her book, public health specialist and author Helen Epstein looks at the hypothesis that societies in which large numbers of people have over-lapping long-term sexual relationships with more than one person are more prone to contracting HIV. She writes that these relationships can give rise to a giant sexual network that serves as a super-highway for the spread of HIV, even when most people have only one or two partners whom they sleep with regularly and know and trust. Condoms are less effective in these networks because people in long-term relationships often overlook the importance of using protection as they get to know each other over time. This, then, opens them up to infection and puts their other partners at risk and the partners of those partners too. Epstein says that men are most likely to have multiple sexual partners owing to established norms of patriarchy. But, she says, women tend to knowingly get involved with such men.
‘Girls who may be with guys who have older partners or partners who have multiple partners told me that they also thought it was natural. Sometimes they would feel sad, wondering if this guy cared more about the other woman. But, sometimes, they would say: ‘Well, when he’s me, he’s with me and that’s what counts’,’ Epstein says.
She adds that women also have over-lapping multiple and concurrent partners, themselves, saying ‘they are not just victims of unfaithful men’.
‘And that’s when the network becomes particularly dangerous, when the links from men to women to women to men to men, etc, become linked up’, she says.
Taking time to explain the current phenomenon of women acquiring more sexual partners, Epstein said:
‘It’s happening everywhere in the world. It’s particularly dramatic here. There’s a very rapid shift in gender relations and gender norms and it has to do with the broader social and economic changes that are happening in this region, where traditional livelihoods and ways of life have shifted dramatically in the past 100 years. And this has had a very complex effect on gender relations. The expectations that men and women have of each other have been changing. Women have greater freedom. Women are now saying: ‘Well, if you’re going to be doing that, I’m going to. If you’re going to mess around, I’m going to mess around, too’.’
Shifting the focus from women, some tend to think, somewhat controversially, that people in polygamous marriages are safe from HIV infection. But that is not true, says Epstein.
‘There are about eight or nine studies, actually, that have been carried out in different populations in east and southern Africa, from Malawi to Zimbabwe to Uganda and Tanzania, looking at the risks of HIV infection in monogamously vs polygamously married people. And all other things being equal, such as male circumcision status and rural vs urban residence and all the things that we know affect the risk of HIV, it does seem as though being in a polygamous union is somewhat more risky almost everywhere than being in a monogamous union’.
She says that makes sense for one significant reason.
‘When you are in a polygamous union and people are connected to each other by regular sexual contacts, it’s not just your behaviour that puts you at risk or your partner’s behaviour that puts you at risk, but the behaviour of all the other people in that marriage’.
Epstein acknowledges that polygamy is an established part of African society and it cannot be eliminated overnight. She says eliminating HIV risk is the real challenge.
‘What I think people need to do is speak more openly about it; talk about their risks, and so on. In order to avoid and reduce the spread of HIV, the entire South Africa does not instantly have to become monogamous, but need to be very careful about taking on extra partners. People need to circle the wagons around their relationships and around their families, however extensive they may be. They have to make sure that, at some point, there are limits. That’s really why discussion and openness is so extremely important because there is no way to have that kind of safety mechanism without talking about your relationships and how to make them safer’, says Epstein.
Helen Epstein’s ‘The Invisible Cure: Africa, the West and the Fight against AIDS’, touches on aspects of our lives that we seldom scrutinise. You can get a copy through Amazon Books.