Chicago Tribune - December 16, 2005
Laurie Goering, lgoering@tribune.com

Then in early 2003, he tested positive for AIDS. He started anti-retroviral treatment but quickly panicked and fled to a traditional healer instead, convinced he was bewitched rather than ill. Within a year he was dead, leaving behind at least five children fathered with five women, an HIV-positive fiance and legions of confused fans.

As South Africa battles to curb a runaway AIDS epidemic, attention is focusing increasingly on how to change men's sexual behavior and expectations in a nation where multiple partners are common, condom use is inconsistent, older men regularly bed much younger women, rape is rampant and women have limited ability to say no to risky sex.

"Notions of men are still very bound up in conquest and multiple sexual partners," said Dean Peacock, an activist with EngenderHealth, an organization seeking to educate men and promote equity between the sexes. "One of the things you always get accolades for as a man is if you disclose you're having lots of sex with lots of people. It's guaranteed, automatic."

More than 1 in 10 South Africans carry the virus that causes AIDS, and the reasons for the disease's spread are evident in a pair of new surveys. According to the country's Human Sciences Research Council, 60 percent of South Africans are not using condoms, and two-thirds of those who do not use them also believe they will not get AIDS. A third of women 25 to 29 years old are infected with HIV, compared with only 12 percent of men of the same age, in part because young women often have older, infected partners. Nearly a third of men believe married men need sex with partners other than their wives, and more than a quarter say women who drink are asking to be raped, according to an August EngenderHealth study.

Misconceptions about the disease are in part the fault of South Africa's government, whose leaders continue to question whether HIV infection leads to AIDS and to suggest that a diet rich in garlic, olive oil and lemon is a suitable alternative to anti-retroviral drugs for those infected with HIV.

"People are dying in droves because they [are] not getting a clear message," charged Tokyo Sexwale, a top South African businessman and former ruling-party stalwart, in a speech this month. "Kids must be told in the streets that they'll die. If you can't abstain and don't condomize, you'll die. This message must be clearer."

But men's attitudes toward women also are clearly a problem in a nation where "socialization, culture, television all say you're superior. You're taught to disregard women," said Dumisani Rebombo, an activist in Johannesburg. "For many men, if not most men, it's a way of life."

Changing attitudes is tough work, but activists at EngenderHealth are trying. The organization's Men as Partners program regularly runs workshops--they reach about 4,000 men a year--aimed at getting men to think about women differently.

At the training programs, men sometimes are asked to list the thing they do to keep safe from sexual violence. Most laugh or are simply puzzled. But that often changes to shock when they see the lists their girlfriends or daughters compile, which include everything from never staying alone with a drunken male relative to never walking at night.

"When you help men understand, they are outraged," Peacock said.

Even men who don't have girlfriends outside marriage and don't beat their wives often are reluctant to admit that, he said, fearing they will be labeled as something less than real men.

"Five out of six men in South Africa are not violent, research shows," Rebombo said. "But where are those men? Why are they not standing up?"

Another way of persuading men to change their behavior, researchers say, is simply to make them more afraid of the consequences. In Uganda, and more recently in Kenya, the HIV infection rate has dropped not only because many with the disease have died but because men have been told that unless they reduce their number of sex partners, they probably will die too.

From 1998 to 2003, the number of men in Kenya reporting two or more sex partners a year dropped by half, while condom use remained virtually unchanged, said Edward Green, a Harvard-affiliated medical anthropologist and AIDS expert who wrote the 2003 book "Rethinking AIDS Prevention."

On a continent where fewer than 5 percent of men use condoms consistently, "the single most important behavior to follow [in combating the epidemic] is monogamy or partner fidelity," he said.

In South Africa, with its traditions of polygamy and men working as migrant miners near prostitutes and far from their wives, persuading men to remain faithful to a single partner isn't easy.

Nkonzo Khanyile, 24, a marketing student from Soweto and HIV peer educator, remembers talking to a group of young men about how the AIDS virus could be spread from partner to shared partner and encouraging them to try fidelity. At the time he had five girlfriends himself.

"I realized we all needed to do some thinking," he said. Today he is faithful to a single girlfriend, even as friends who once called him "The Charmer" now chide him for trying to be a saint.

"There are ways to change norms," Green insisted. "Culture can be changed. It's not easy but it can be done."

Progress is slow, but there are signs of change. Jacob Zuma, the country's former vice president and a leading candidate to become South Africa's next leader, was charged in early December with rape--and promptly lost many of his political backers. "Soul City," a leading soap opera, now includes HIV-positive characters and regular segments on conflict between the sexes.

And at EngenderHealth's offices in downtown Johannesburg, women these days stop by to marvel at the changes in their husbands and boyfriends.

"Ladies come in and report, 'Wow, what you guys are doing is great. He came to a workshop and for the first time he's helping with the household chores, and now I can negotiate with him,'" Rebombo said.

051216
CT051208

Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .