Zuma shows you get the HIV epidemic you deserve

09/02/10

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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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14 comments

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Tags: extramarital sex, HIV prevention, Jacob Zuma, racism, South Africa.

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
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.
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.
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.
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.
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.
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…
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.
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.
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.
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.
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
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.
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.

The Wisdom of Whores

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09/02/10