09/02/10

Zuma shows you get the HIV epidemic you deserve

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So Jacob Zuma is sorry about having unprotected sex with someone three decades younger than himself, who is not one of the five women he’s married. That’s a little better than last week’s “You should be proud that I’ve admitted paternity and paid a fine. What are you all so uptight about?” HIV activists are pretty upset. Me, I prefer to see what he’s done as a good thing.

I’m not one to get uptight about extramarital sex. But I am not president of a country where one in five adults is infected with a still-fatal sexually transmitted virus. Mr. Zuma has rubbed South Africa’s nose in the fact that he racks up as many sex partners as he can, and he doesn’t use condoms.

How is that a good thing? Well, it allows us to say the unsayable: countries get the HIV epidemics they deserve.

Want a hyper-epidemic? All you need is a tradition of polygamy AND high levels of female autonomy. Big Men have their little network of wives and/or lovers. Women buy in to duty sex for the status and security, but get to run their own little networks on the side, for the fun of it. That has been the pattern in South Africa, Swaziland, Botswana, Zambia, Zimbabwe and a number of other countries where more than one adult in seven has HIV.

But woe betide anyone who points this out. At best, you are insensitive to cultural traditions. At worst, you are perpetuating racist myths of the hypersexualised African male, blah, blah, blah.

Now South Africa’s president is unrepentantly living the myth. He has been married five times, and is currently shared by three wives (one of the others killed herself). He’s got another fiancée in the wings for good measure. In 2006 he was acquitted of rape charges, and now we find he’s bonking the daughter of an old mate who’s running the World Cup organising committee. This puts him in good company. In neighbouring Swaziland, where one adult in three has HIV, the king sets an example by taking a new teenaged wife every couple of years — a baker’s dozen so far.

Here’s another thing that Mr. Zuma’s behaviour has laid bare: HIV is a preventable infection. Good governments prevent it. Bad ones hide behind the very culture, tradition and customs that allow the virus to spread, and then throw their hands up when prevalence get so high that HIV will continue to spread even if behaviour does change.

The saintly Nelson Mandela was unforgivably slow to do anything to address the sexual behaviours that were spreading HIV. His successor Thabo Mbeki compounded the problem by simply denying that the sexually transmitted virus was in any way linked to a four-fold rise in death rates among young adults. Besides spotlighting his sexual escapades, Mr. Zuma used his 2006 rape trial to give us a new perspective on how to stay HIV-free. Sorry I had unprotected sex with an HIV-infected woman he said, but don’t worry about me, I had a shower afterwards, so I won’t catch anything.

Unfazed by his flagrant disdain for his own health ministry’s HIV prevention efforts, (or by the pack of corruption charges that stalk him, or by his growing posse of wives) the people of South Africa support Jacob Zuma anyway. It’s a healthy democracy, and that’s their right. But I think it is time that voters in other countries stopped subsidising the fatally bad behaviour of South African leaders. Why should Americans give South Africa over half a billion dollars of PEPFAR money a year, in part to promote abstinence, monogamy and condom use, when the electorate of the country supports a man who is the embodiment of the behaviours and attitudes that spread HIV? Because, you might argue, the government of the richest country in Africa, which is also pocketing over US$ 160 million for HIV from the Global Fund, can’t even organise itself to keep anti-retrovirals in stock. I’d say that’s all the more reason to stop propping up bad leadership on HIV.

This post is for Dot and the thousands of other hard-working health care professionals in South Africa who have to pick up the pieces.

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This post was published on 09/02/10 in Ideology and HIV, Pisani's picks.

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  1. Comment by Zoo Ma, 09/02/10, 03:59:

    As a former journalist you know that editors used to muck up the headlines for articles you wrote. Now that you are in charge you don’t have that excuse for your misleading headline. “Zuma shows that the country gets the epidemic it deserves”. Please keep ‘you’ out of this unless you are speaking to me or the millions of people infected and affected in South Africa.

    We all love evidence. Can you please show us the evidence for your female autonomy assertion?

    And your response to this: http://papers.ccpr.ucla.edu/papers/PWP-CCPR-2009-043/PWP-CCPR-2009-043.pdf ?

    Zoo Ma

  2. Comment by mister decent, 09/02/10, 04:36:

    while i understand the rage and sentiments… the statement “countries get the HIV epidemics they deserve” is a misguided turn of phrase.

    nobody ‘deserves’ hiv – especially not dis-empowered people under the rule of a tyrant.

  3. Comment by Cato, 09/02/10, 08:11:

    Plainly true. The depth of this truth came to me when I befriended a corn trader in Botswana, whose grandfather had passed away. The family was settling his estate. The number of formally acknowledged children came in at something like 43–and those were just the ones they knew about! It seemed to me then that HIV was essentially a race between our behavior and the ability of the virus to mutate. In much of Africa, it is simply faster than we are.

    Paul Romer of Stanford University has called for charter cities, run in the developing world by developed countries (think something like the old Hong Kong). That will strike a lot of people as a kind of thinly disguised colonialism. And it is, based on the notion that politics in the developed world are somehow better than in Africa. And they are.
    The question would appear to be: “How many African lives are worth the appearance of colonialism?” Well, I suppose that depends on how much you value African lives, but I’ve said too much already.

  4. Comment by elizabeth, 09/02/10, 08:46:

    Re female autonomy: Many countries have traditions of polygamy — virtually all of the Middle East and many other Moslem countries also. But in most of those societies, women are very severly restricted in both the social and the economic spheres. There’s very little HIV because for multiple concurrent partnerships to work as a driver for the epidemic, women as well as men have to have multiple partners.

    I accept that women have less power in virtually every society, including those of southern Africa, than men do. But they still have far more autonomy, relatively, than women in Saudi Arabi or Bangladesh. At a national level, HIV is highest in the countries of sub-Saharan Africa which have the highest levels of female literacy, the longest years of schooling and the highest participation in the workforce. Within any given country in sub-Saharan, HIV is highest among women with the highest levels of education.

    I’ve got graphics showing these, as well as evidence of that women (as well as men) in sub_Saharan Africa are more likely to have several partners at one time than they are in other parts of the world. For some reason I can’t post graphics to a comment; if I can’t resolved within 24 hours I’ll put them in a new post.

  5. Comment by Otto Namy, 09/02/10, 11:15:

    Aaah. You have skipped a couple of steps. I think you are equating “high schooling, literacy, and workforce participation” with “autonomy”. Unless you have secretly developed and tested a ‘Pisani autonomy index’ then you have very weak evidence. I know you are TED bound and all but please slow down and take this stuff seriously. All concurrency is not equal. And your headline is disrespectful.

  6. Comment by Will, 10/02/10, 04:58:

    The headline is disrespectful to whom, “Otto”? The article attacks a culture that Zuma is clearly supporting to the detriment of his contstituents’ health.

    While the author can defend herself, it seems like a wild mis-read of the article to assume that women’s autonomy somehow shares _blame_ for the epidemic. The finger could not be pointed more squarely at Mr. Zuma. The increased span of the networks would be the real source of correlation, and how could those networks be expanded, if not by an increase in autonomy?

    It’s plain that Mr. Zuma can not effect a rational health policy, while publicly engaging in the exact opposite behaviour that a rational policy would try to effect. If there is a time for cultural insensitivity, it’s when suffering eclipses the mild discomfort over things that are not socially expedient.

  7. Comment by Kim Dionne, 10/02/10, 05:18:

    Elizabeth, I’m also curious what you thought about Reniers and Watkins’ recent piece on polygamy and HIV…

  8. Comment by joya banerjee, 11/02/10, 01:15:

    Hi Elizabeth,

    I enjoyed your article (and your awesome presentation at harvard in Daniel Halperin’s class!) I agree with everything except your statement, “countries get the HIV epidemics they deserve.” To me, that’s somewhat like saying that New Yorkers deserved 9-11 just because Bush is a monster and America elected him.

  9. Comment by Steve Sailer, 11/02/10, 07:25:

    No, a big difference in female autonomy between polygamous but low HIV Saudi Arabia and polygamous but high HIV sub-Saharan Africa is whether women are allowed out of the without a male relative to chaperone them. In Arabia, wives are kept locked up in the house. In Africa, they go out to work.

  10. Comment by Dee Zerve, 12/02/10, 07:00:

    Or we all get the economy we deserve because Larry Summers left Harvard for the White House.

    It would be good to have a serious conversation about polygyny, Renier and Watkins and this … http://cl.exct.net/?qs=7fa55f686346aba3739272ba4bf691a04aae648dad102f48ebc8ce5acf8f27bb

    But the WoW comment section is not the place to do it. We all just react to Pisani’s generalisations.

  11. Comment by Lee Rudolph, 13/02/10, 04:11:

    >It would be good to have a >serious conversation

    >But the WoW comment section
    >is not the place to do it.

    I don’t see why not; Elisabeth’s moderation is (as far as I can tell) very light-handed, and so long as the “serious conversation” remained reasonably on-topic (which it certainly could), this would seem to be a fine place for it. (It might spin off into a new thread, if EP chose in some instance to continue the theme or a sub-theme in a blog post rather than by adding a comment. That would surely be a good thing, not a bad thing.)

    >We all just react to
    >Pisani’s generalisations.

    I don’t think that’s true; but supposing it were, again surely it isn’t *necessarily* true! (For instance, here I am reacting to a generalization of yours, not of hers.)

    So, say something serious about polygyny, and we’ll see where things go from there.

  12. Comment by poodle, 17/02/10, 03:24:

    “I’ve got graphics showing these, as well as evidence of that women (as well as men) in sub_Saharan Africa are more likely to have several partners at one time than they are in other parts of the world. For some reason I can’t post graphics to a comment; if I can’t resolved within 24 hours I’ll put them in a new post.”

    I’m waiting for this too. As well as the Renier and Watkins piece there is a lot of other stuff pointing to lack of evidence to support the multiple and concurrent partners/ behavioural thesis too. See Mark N. Lurie • Samantha Rosenthal, The Concurrency Hypothesis in Sub-Saharan Africa:
    Convincing Empirical Evidence is Still Lacking, AIDS Behav (2010) 14:34–37

  13. Comment by Paddy, 17/02/10, 03:05:

    Elizabeth,

    Your thesis falls down at its conclusion:

    > But I think it is time that voters in other countries stopped subsidising the fatally bad
    > behaviour of South African leaders. Why should Americans give South Africa over half a billion
    > dollars of PEPFAR money a year, in part to promote abstinence, monogamy and condom use, when the
    > electorate of the country supports a man who is the embodiment of the behaviours and attitudes that spread HIV?
    > Because, you might argue, the government of the richest country in Africa, which is also pocketing
    > over US$ 160 million for HIV from the Global Fund, can’t even organise itself to keep anti-retrovirals in
    > stock. I’d say that’s all the more reason to stop propping up bad leadership on HIV.

    If you suddenly suspended funding on the basis of Zuma being a c**p leader, you’d deny millions life-saving interventions, and at the same time be far more likely to make South Africa’s general leadership behave worse than better. If it was someone less important than the leader who was the problem, e.g. a health minister, then suspending some funds might get them out (as happened in Uganda) but who exactly are you expecting to oust the top man? South Africa’s electorate have no other serious candidate to vote for, and he’s got a very tight grip on the ANC leadership.

    Some linking of future funding to improved logistical performance can be made, and there may well be a case for it. But it can’t be an all-or-nothing deal, because cutting funding is a serious business, with lethal consequences. And I seriously doubt that linking funding in any concrete way to better personal behaviour by a country’s leadership is going to yield any fruit at all.

  14. Comment by Stephen Ntburi, 15/03/10, 04:45:

    I think the articles hits the nail on the head. And am african living in a country that has just managged to come form over 10% prevelance to 6%. The ‘networks of wives and/or lovers’ are real. Africa is as good as doomed if they dont address this.

  15. Comment by Rajiv, 26/03/10, 06:17:

    I disagree with Pisani that people of South deserve the epidemic. Election of Zuma is much more complex than merely solving the HIV and AIDS problem.

    We have not factored in the apartheid regime that neglected the disease initially and spread the rumour that it is a black plague?? And then you had Mandiba who was more concerned to build the nation a stop the blood bath that would have followed had he not personally intervened in some of the occasions. Not that he did not want to address the epidemic – just that country would have plunged into far horrific chaos than HIV is creating today.

    Thabo Mbeki and Manto had the opportunity but they wasted it. But Manto was not a totally wasted regime. We forget that she did bring the big pharma companies to their knees in terms of pricing of drugs.

    But Dr Beet Root has her weaknesses and one of them was that once she took a stand she vehemently followed and believed in it. Though that trait worked for bringing the prices of the drugs down in South Africa considerably, also worked to keep south Africa free of most vector borne diseases like Malaria, she neglected HIV completely. History will not forget her for this gross neglect.

    With rising crime and HIV, people of South Africa believed that they would die of a bullet in a crime before HIV took their lives. And that is how Zuma was born. A person who promised to bring crime down. History will judge him if he is able to deliver on this promise or not.

    Amidst all this HIV continues to be a neglected. For example The epidemic amongst ethnic south African Men who Have Sex with Men (MSM) continues to rage. There are able organisations which can deliver a change on this but SANAC rather than partnering with LGBT groups take a sanitized approach of partnering with women organisation to control epidemic for MSM. Goof ups like these are plenty.

    Can we say that all South Africans deserve an epidemic in this scenario when the choice sometimes is between dying by a bullet today or by HIV tomorrow…

    As a person who has made South Africa his foster home, I would say Elizabeth; you do raise some pertinent points. But we definitely do not deserve HIV.

  16. Comment by Veritee UK, 15/04/10, 11:50:

    Hi Elizabeth P

    Hope you are well?
    You have had contact with me before – Veritee

    I do appriciate the point you are trying to make but it is with all due respect very out of date.

    Thinks have moved on, form this . Yes, much HIV initial spread may have been at first via those who were sex workers or took other risks but it has now moved on to the ordinary population in all parts of the world.

    I think you need to catch up with this fact!

    I have tried to understand your point of view but now a year or so on from finding I have HIV

    – as a woman in my 50s who has never used drugs, never been a prostitute or promiscuous and got it from my husband who I have been married to for over 20+ years and who only had ever one brief sexual encounter in all that time with a woman and got HIV from just that one encounter

    I find your ‘take ‘ on HIV increasingly out of date and entrenched.
    Things move on

    Blame has no place in HIV
    It is a virus
    A virus that we are all incressingly at risk from whatever country we live in and whatever our lifestyle.

    With due respect why don’t you at least try to write another book that catches up with how HIV is now

    Veritee

  17. Comment by Veritee UK, 15/04/10, 12:03:

    I also do not condone or like the behavior of Jacob Zuma or anyone man or woman who behaves like this – and I am not moralistic either.

    Iagree his behavior is not the best and as a powerful man in politics it can have an influence on the sexual behavior of a nation
    But he is just one person.

    His behavior – or any examples you have offered – does not support your arguments in general on HIV
    Anyone can get HIV – anywhere.
    You are not black, not indigenous south African or African at all!

    You are plainly very white

    I am not bringing race or colour into this as I feel we are all at risk whatever our colour and where ever we live. But you seem to be

    I am white, live in the UK, I have HIV so do millions of white people around the world as well as black and those of every race colour or creed

    – it is time all this took a back seat and we looked at HIV prevention as a worldwide issue for everyone whatever their country or colour or race or creed.

    You are NOT helping this to happen right now

    Veritee XX

  18. Comment by steve, 15/04/10, 08:09:

    Loaded article and very interesting. Was especially shocked by his take a shower line, dangerous thing to say when president.

  19. Comment by maSithole, 01/03/13, 12:40:

    Being a young Southern African woman who comes from a people that embraces and celebrates polygamy, I do fortunately agree with Elizabeth. Why, you may wonder?

    You might understand maybe if you came from a place were:

    i) Having full blown AIDS is more common than getting a flu virus in the peak of a Minnesota flu season.

    ii) You have buried so many loved ones and have a list of pending burials and funerals because of HIV/AIDS

    iii) You have hypersexualized society of men who think they are entitled to have any woman they want and as many of them as they can potentially afford.

    iv) 2 of 3 of your female friends were sexually abused as kids by someone close to them and young girls are introduced to sex at such a young age.

    v) A society that has become so close minded that they don’t understand why our ancestors practiced polygamy in the first place.

    A little history lesson here 🙂 Our Southern African ancestors lived off of hunting, gathering and farming to survive for centuries. Marrying multiple wives was in many aspects a smart idea because they would bare lots of offspring hence more labor for hunting, gathering and farming. Polygamy was eventually adopted as a sign of power and strength. As we all know things in Africa have changed a great deal over the past centuries. Africans don’t predominantly live on hunting, gathering and farming anymore, hence there is really no need for a large brood.

    How are we the region in the world most struck by HIV and be the same region that idolizes polygamy? I mean 90% of all HIV/AIDS orphans are from sub-Saharan Africa and people still want to hide their habits behind culture? Southern Africa houses the biggest population of those diagnosed with HIV/AIDS.

    But wait a minute; Southern Africans seem to not have caught on. Men still want to convince themselves that they are honoring culture by marrying multiple women and since marrying multiple women these days is no longer economical, if they can

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