Wall Street Journal - June 29, 2001

Yet listening to many African leaders speak at this week's U.N. special session on AIDS, the uninformed would be justifiably confused as to just how this virus is communicated. It's wildly infectious, so is it airborne, like tuberculosis? With much despair about "poverty," perhaps it's carried in a fouled water supply, like hepatitis. Or since three-quarters of the world's 36 million HIV-positive people are African, maybe it's related to hot weather and mosquitoes, like malaria. On the other hand, the epidemic is a "political problem," so might HIV be a vicious laboratory contrivance of Western governments (as many Africans do believe), like Agent Orange?

Then, most contemporary Westerners would never be so innocent. We all know that HIV spreads though contaminated blood transfusions, needle-sharing in intravenous drug use, and -- and --

Well, we're not supposed to say it, are we? Not when talking about Africa. It's impolite.

Tellingly, as Wednesday's 16-page U.N. declaration was drafted, a great controversy arose over the inclusion of the words "homosexuals" (ostensibly Africa doesn't have any) and "prostitutes." Ultimately the offending groups were identified as at risk from "sexual practice" -- one of the few references to S-E-X in the document -- and "livelihood."

Unfortunately, this don't-mention-the-war approach does not merely entail decorous rhetoric. True, the U.N. declaration does admirably commend "prevention" as a policy "mainstay." But unease with the nitty-gritty of (largely heterosexual but through the bloodstream) transmission has helped to encourage many advocacy groups and aid agencies to shift their emphasis in Africa from public education and condom supply to the provision of impracticably costly and complicated anti-retroviral regimes -- which extend lives, but cannot save them.

South Africa's president serves African modesty by promoting willfully ignorant theories that AIDS is simply the consequence of poverty.

Meanwhile, popular embarrassment stigmatizes the ill, discourages Africans from getting tested and impairs health education. Accordingly, rumors run rife, like one doing the rounds in South Africathat AIDS can be cured through intercourse with a virgin -- a superstition that is worse than misguided.

Let's put this squarely on the table: In Africa, neither needle-sharing by addicts nor blood transfusion is widespread, although the use of unsanitary needles to administer legal drugs may be a problem. But the root cause of AIDS is almost entirely the result of promiscuity. If you have relations with only one healthy partner, you don't get sick. This awkward fact makes everybody concerned with Africa's AIDS epidemic squeamish. It's the elephant in the living room we can't ever mention, because the elephant sleeps around.

The more cheerful corollary is this: Barring some miscreant sticking an infected syringe in your arm, an emergency transfusion of bad blood or outright sexual coercion -- admittedly all too common for African women -- you don't have to get AIDS. You can protect yourself.

Yet this disease is repeatedly regarded on and outside the continent as one more act of God, like 1999's floods in Mozambique that its denizens are helpless to resist.

A powerful fatalism prevails in most African cultures, and it's easy to see why. Poverty, corruption, political tyranny and harsh climates all contribute to a widespread sense of being buffeted by forces larger than the will of one person. So it's hard to convince such a populace that, as T. H. Lawrence would say, "Nothing is written." The attitude toward AIDS, "If I'm going to get it, I'll get it" is more the norm than not.

But we do Africans no favors in playing to endemic fatalism, and portraying the containment of this disease as primarily the job of Western governments -- which are yet more powers bigger than one person. Africans can avoid HIV. It doesn't take the West, it doesn't take money, and it doesn't even take condoms. It just takes sexual fidelity.

When the infection rates rose again among American homosexuals in the late 1990s, health providers and gay activists didn't merely demand that AIDS "cocktails" be reduced in price.

Instead another drive got underway to convince young gay men not to be complacent, to remember that there is still no cure, and to practice monogamy or at least safe sex. America's AIDS infection rates are stabilizing largely due to personal responsibility. To fail to press Africans to exercise that same 100%-effective discipline is devastatingly counterproductive, and not a little condescending, either. That old rap standard, "I Got the Power," will save more lives in Africa than an oil tanker's worth of anti-retrovirals.

-- From The Wall Street Journal Europe

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