Liaisons Fuelling AIDS in Africa

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Liaisons fuelling AIDS in AfricaWashington Times, Dec. 28, 2003By C. Green and BermanTeenage girls are at the very center of one of the most heart-breaking scenarios now playing out in many parts of Africa.Young girls have up to 6 times the rate of HIV infection as boysof comparable ages. In parts of eastern and southern Africa,more than one-third of teenage girls carry the virus.As deeply troubling is the way they are becoming infected -through what AIDS experts call "cross-generational sex." Older,typically married, men seek young girls for sex in the beliefthat the younger they are, the less likely they are to carry theHIV virus.Having a young girlfriend has come to be a sport, a way to gainstatus among men. Cross-generational sex has become a new cul-tural norm in parts of sub-Saharan Africa, and not just becauseof one-time seductions or coercions. Sometimes it is the girlswho seek the "sugar daddies," who reward girls with clothes,school tuition, food or small gifts.One of many problems with this is that the younger the female,the more biologically vulnerable to HIV infection she may be.This seems to be due in part to the delicacy of the vaginal lin-ing in immature females. Tiny tears and lesions occur during in-tercourse, especially if male partners are full adults and/orintercourse is coerced or forced.Young girls are not only more likely to be HIV-infected, theyare also more likely to infect others, in part because they arelikely to be recently infected, meaning they will have higher"viral loads" and will be shedding viruses. Their partners thenpass the virus on to their wives and perhaps future children.Therefore, any action that protects girls from infection willpay great lifesaving dividends in the broader population.It's past time for our government leaders to get involved. Thecross-generational sex issue cuts across the politics of moral-ity that color the current highly polarized debate on how bestto combat AIDS in Africa. Both faith-based organizations andothers who champion abstinence programs, and organizations well-known for condom marketing like Population Services Interna-tional, are in fact equally outraged by and concerned aboutthese dangerous relationships and their tragic consequences.President Bush's global AIDS initiative will finally make anti-retroviral drugs available in the countries targeted by thisinitiative (all but two are in Africa). But there still needs tobe major emphasis on AIDS prevention, since many more lives willbe saved through effective prevention than through treatment.Yet there cannot be effective prevention if we continue to tip-toe around sexual behavior and simply rely on risk reductiontechnologies.We urge the Bush administration to include the prevention ofcross-generational sex as a central component of its AIDS ef-forts, no matter how uncomfortable the idea makes some people.Defenders of the current, unspoken hands-off policy worry thatwe must not become "moralizers." Yet like it or not, rape, coer-cion and seduction of minors take us into the realm of right andwrong.Ellen Goodman has wondered whether in the American transitionfrom a more religious to a more secular society, we have somehowgiven ourselves a "moral lobotomy." She asks whether our reluc-tance to being considered judgmental has "disabled [us] frommaking any judgment at all." To advocate protection of highlyvulnerable young girls is not unwarranted moralizing. It is bothethically right and life-preserving.Changing sexual behavior is never easy, yet change is occurringin some African countries, notably in Uganda, the country withthe greatest decrease in HIV infection rates.Efforts must take place on at least three levels: individual,social normative, and legislative. This translates into communi-cations campaigns that stress abstinence (for youth) and faith-fulness to one partner (for everyone else), and implementationof a new generation of programs aimed at changing social normsthat perpetuate cross-generational sex.Uganda has dealt with the "sugar daddy" phenomenon in partthrough communications campaigns designed to bring public shameon middle-aged men who try to seduce or entice schoolgirls.Third, governments need to impose tough legal penalties againststatutory rape and seduction of minors. African governments al-ready have legal prohibitions addressing this, but laws are sel-dom enforced adequately. Yet in Uganda - prisons are filling upwith "defilers," the biblical sounding term used in Africa todenote seducers of young girls.On Capitol Hill, some lawmakers have a dawning awareness of thisdangerous situation, and briefings have already taken place withstaff from the offices of Sen. Lugar, Indiana Republi-can; ph Biden, Delaware Democrat; and Lamar , Ten-nessee Republican.We must keep up the momentum. It is critical that we hard-wirethe issue of cross-generational sex into the U.S. global AIDSstrategy. We must stop haggling over abstinence vs. condoms andget on with the business of saving lives.-- C. Green, is a research scientist at Harvard University'sSchool of Public Health, author of "Rethinking AIDS Prevention,"and a member of the Presidential Advisory Council for HIV/AIDS. Berman is senior director of the global AIDSMARK HIV pre-vention program, managed by Population Services International.He recently completed research on cross-generational sex inKenya._______________________________________________