Let's talk about sex, baby.

edit: I'd like to dedicate this post to my wonderful godmother, who, CCD teacher that she has been in her Catholic parish but educated nurse that she is, kindly beseeched me, 'Please change the Catholic stance on condoms while you're over there. I have two doctor friends who donate time in Somalia every other year and they've just brushed their hands of the Catholic church. I think if we air drop oodles of condoms, birth control supplies and antibiotics, we could make a dent in the HIV crisis.'

I'm all for oodles. Note that this post was written after receiving her e-mail, and now back to your featured presentation:

When was your last HIV test? STD test? Anything test? Wait, you’ve never been tested? You don’t know your status? That’s probably because you’re not in an area where the prevalence in black women between the ages of 18 and 45 is 50%. That’s right, 50%. 1 in 2. Every other black woman whom you see on the street is infected. I’m in an area in which the prevalence in black women between the ages of 18 and 45 is 50%.

That’s only because I live in Roxbury.

Here in South Africa, the prevalence in the same demographic is around 30%, or a little under 1 in 3. It’s also much higher here than in the US in the general population. Here’s a sniped slide of some statistics to put things in perspective:


Also, for reference:
HIV/AIDS: Human Immunodeficiency Virus causes Acquired Immunodeficiency Syndrome
HIV/AIDS in South Africa
HIV/AIDS in the United States
NB Infection rate is the rate of new infections; prevalence is the percentage of infected individuals in a given demographic/population.

Unbelievable. How did this happen? How did this virus spread so rapidly? How is it still spreading? Needless to say, there are myriad factors that contribute to this pandemic, and it’s imperative to break them down before rebuilding can begin.

To understand the problem better, let’s understand the course of the disease.
* The HIV virus enters your body through contact with another person’s bodily fluids: primarily blood, semen, and vaginal secretions (and notably also placenta and breast milk, read: childbirth and early rearing by an infected mother).

--I think that you may be able to get it through saliva, but it would take something like 15 gallons to do so, so no, you can’t get HIV from kissing.

--Cuts, infections, and sexually transmitted diseases (STDs, and no, I don’t care what the people with diseases want to be called so that they sound way less gross or serious) all vastly increase the likelihood that you’ll become infected if the virus is present.

--Wear a condom.
--Here is the breakdown (from the Wikipedia article) of your likelihood of becoming infected per 10,000 exposures if:

>>Blood Transfusion: 9,000
>>Childbirth: 2,500
>>Needle-sharing injection drug use: 67
>>Percutaneous needle stick: 30
>>Receptive anal intercourse*: 50
>>Insertive anal intercourse*: 6.5
>>Receptive penile-vaginal intercourse*: 10
>>Insertive penile-vaginal intercourse*: 5
>>Receptive oral intercourse*§: 1†
>>Insertive oral intercourse*§: 0.5†
>>* assuming no condom use
>>§ source refers to oral intercourse performed on a man
>> † "best-guess estimate"

* For the first 3-4 months of infection, you don’t test positive for HIV infection.

--Your viral load, however, is sky high. Your viral load, more or less, is the amount of virus present in your body. It’s given as a concentration, like your blood glucose level. The higher your viral load, the more virus is present in your body, the more likely you are to infect your partner or unborn child.

--So let’s go through that one more time. For the first few months of infection, if you happen to get tested, then you’ll experience the overwhelming relief of finding out that you’re negative. People must have sex just to celebrate. You are, however, infected, and highly communicable, so it’s highly likely that each partner with whom you have unprotected sex will become infected.

* Then HIV takes its course through different stages, which are defined differently depending on the organisation defining, chiefly the US or the WHO. Essentially, stages are defined according to presenting syndromes and CD4 (related to T-cells) count. Advanced stages are referred to as AIDS.


(The blue line is CD4/T cell count and the red line is HIV RNA copies per mL plasma, or the viral load.)

* HIV can be managed effectively through the use of antiretroviral (ARV) medications, which work to lower the viral load in an infected individual. The lower the viral load, the lower the probability of passing the virus on to a partner or a child through childbirth. ARVs oftentimes cause horrible side effects, but nausea, diarrhoea, migraines, and even hepatitis are better than slowly wasting away to your death... NB Taking a course of ARVs are prescribed (usually 2 pills twice a day for the rest of your life, more recently 1 pill once a day for the rest of your life) can bring a person back from the AIDS stage to a more manageable level of HIV.

For more discussion about social and political situations, including what has been done and what needs to be done, and even a prop of sorts to the US government (what!? I know!), please follow the link.

One great thing that I learned was that baby Bush’s presidency wasn’t a complete and utter total fuck up with a ruin of foreign policy on top. He actually passed this bill referred to as PEPFAR: the President’s Emergency Plan for AIDS Relief. It’s the largest monetary contribution to the prevention and treatment of any one disease in the history of ever. To date, over USD 15 million has been contributed. In other words, thank you, American tax payers, for contributing to the fight to stop AIDS across the globe--mostly in sub-Saharan Africa! Of course, you’ve never heard of it, have you? I hadn’t. So much for good press and making the eradication of HIV/AIDS a talking point, right?

Not surprisingly, in order to get a majority in Congress, you have to appease the so-called religious right, whom I’m praying will quit the republican party and start their own ridiculous cult of Congress (with an ambiguous name like the Christian Republican Union, like the German Christian Democratic Union), so that the republican party can get back to its fiscally conservative roots again. Until then, you have to include clauses like this in important legislation:
[I was going to include the clause discussing abstinence and anti-prostitution requirement, as well non-promotion of needle exchange, but the government sites aren't loading, so now for something completely different...]

I resort to quoting a Wikipedian (I encourage you to explore the linked cited sources within Wikipedia articles) synopsis:
"Some critics of PEPFAR feel that American political and social groups with moral rather than public health agendas are behind several requirements of PEPFAR, pointing to the mandates that one-third of prevention spending in 2006–2008 be directed towards abstinence-until-marriage programs and that all funded organizations sign an anti-prostitution pledge. PEPFAR also does not fund needle exchange programs, which are widely regarded as effective in preventing the spread of HIV. The requirement for prevention spending was lifted with the PEPFAR reauthorization in 2008, but some critics worry that some funds could still be spent on abstinence programs."

and supplying you with a link to PEPFAR watch.

Looking at it, whatever percent (spent on abstinence-until-marriage programmes) spread over 15 countries doesn’t sound like a lot. In reality, it isn’t a lot, when you think about USD 2 trillion allotted with no oversight whatsoever to bailing out banks and businesses with horrible plans and unsustainable practices. According to government statistics, too, only 0.3 has been spent on abstinence-only programmes. Good thing our government is tracking something. According to South African government statistics, however, the amount spent on abstinence-only programmes is 10%. Now, there’s quite a difference between USD 45 million and USD 1,500 million (or 1.5 billion). You can recite statistics and make comparisons until you’re blue in the face, but when it comes down to it, how many more free condoms would those millions have provided? How many tests would they have paid for?

South Africa has a landmark programme in which the government provides free condoms to distribute. PEPFAR funds pay for it. The programme has been implemented only recently, however, as Nelson Mandela failed to addresses the AIDS pandemic and Thabo Mbeki, who was just voted out of office by his own party in April, sided with dissidents claiming that HIV doesn’t cause AIDS, and held out for an African remedy for the virus. This was even more disturbing, as he had been a champion of AIDS relief during his stint as deputy president under Mandela.

(In South Africa, the African National Congress (ANC), the party of liberation and democracy, has received over 60% of the vote in each of the 4 elections, held every 5 years, since 1994. The population votes for a party, and the winning party’s leader becomes the president. It’s an interesting notion, as an American, to consider electing a party and not just a man. I would that the electoral college were still functioning… South Africans have a lot of faith in their government to provide for them. They’re an incredibly patient population who declined to seek revenge against the whites after liberation and democracy. Their philosophy of ubuntu is refreshing, and their ability to forgive and not to seek retribution takes perhaps far more patience and far less vengeance than I have. I will say that I find it cute to hear Sizwe, one for the TSiBA students, speak out against the ANC and it’s failure to deliver. I feel like saying, ‘Aw, that’s adorable--you’re just beginning to lose faith in your government and it’s ability to function without entangling itself in ever more labyrinth-like layers of bureaucracy!’ Note that the Western Cape, of which Cape Town is the capital, is the only province of the 9 in South Africa without allegiance to the ANC. Here, the ruling party is the Democratic Alliance (DA). If you haven’t noticed, and as we’ve had pointed out for us, South Africans speak in acronyms. Praps I’ll compile a reference list.)

Now that we’ve all learned about PEPFAR, it’s no secret that the United States is spending some serious money to fight this disease. We also appear to have a guise of transparency and oversight into the spending. Things couldn’t be better, right?

Unfortunately, humans suck.

I’ve already mentioned how the ANC failed South Africa by delaying action again AIDS. Mandela has gone so far as to rebuke himself in public for failing to take action, although early on in his political career he did talk about HIV. Mbeki, well, countless articles and substantial portions of books have been devoted to this subject, and it’s generally incomprehensible to me as to why he wavered on the issue and didn’t just say, ‘HIV is a serious pandemic facing our population. When you have sex, use a condom. Get tested regularly and know your status. If you have HIV, then take your ARVs, which are provided free.’

On top of all this, South Africa is a Christian nation. The Dutch and English invaders, land rapers, and occupiers (let’s call them what they really are, not ‘settlers’ or ‘colonists’) were able to use really interesting religious logic to justify their atrocities. Somehow, this religion spread. South Africa is a conservative nation, and you do not talk about sex.

HIV largely isn’t discussed at home, among peers, or in schools because it’s inappropriate to say words like ‘penis,’ ‘vagina,’ and ‘penetration.’

If we talk about sex and distribute free condoms, then we’ll be encouraging the children to have sex.

I might have screamed. Are you kidding me, South Africa. ARE YOU KIDDING ME!? You have a raging pandemic of an incurable disease that infects 30% of your population and affects 100% of it, and is spread primarily by unprotected sex between teenagers or between migrant mine workers and prostitute, AND YOU CAN’T TALK ABOUT SEX!?

That’s. Genocide.

(According to the Geneva Conventions, whenever ‘genocide’ is mentioned, it’s mandated that something is done about it. Thankfully, I’m not breaking these conventions, because I’m doing something.) [UN Security Council Resolution 1674]

What’s almost worse is what happens when sex is discussed. Between funding sources and the department of education, this is what’s said: abstain, be faithful, comdomise (ABC). According to a health department official, most of the programmes are simply ‘AB’ instead of ‘ABC,’ as most South African provinces don’t allow condoms to be available for free in schools.

Clearly, with infection levels rising, telling children to abstain and be faithful is working.

Listen, children are having sex. Children are having sex as young as 12 and 13, and it’s not just in South Africa. I might say that girls are having sex as young as 12 and 13, as most of the time an older boy is forcing a younger girl into the act (and not just in South Africa). Unfortunately, most girls aren’t as self-assured, outspoken, and confrontational as yours truly, and the boys take advantage of this. If I could, I would slap each official or educator who challenges making condoms available for free in schools and say, ‘Stop fucking kidding yourself. Do you want them all to die?’

Education is a wonderful thing, people. Anything that is attempted to be controlled and run by the government should be treated as the precious freedom that it is. Why else would a government want to control something except to control the very people whom it’s supposed to serve?

Give children tools and enlighten them with education on how to use them, and they will flourish.

Give children guns and teach them how to use them responsibly. Give children alcohol and teach them how to drink in moderation. Give children a vote and teach them about the political process and how to be involved in everything from local government to national representation.

Give children tools and enlighten them with education on how to use them, and they will flourish.

Now, please take everything that I’m saying in context. If you suppose that I support a bunch of alcoholic, gun-wielding kids running amok in the streets and voting wil-I-nil-I, then you’re absolutely wrong. You should already know how I feel about the South. The truth is that education sets people free. Education allows people to fly. It’s very, very dangerous--more threatening than a drunk driver or a loaded gang member. An educated people have the potential to overturn governments, liberate the masses, and change the world, and that’s exactly what I’m supporting.

Give children condoms and educate them about the very real and present dangers of HIV, and you will curb this pandemic.

Thankfully, there are foot soldiers of education. An ex-NGO worker who was getting nothing done from the outside and so joined the South African Department of Education in the Western Cape told us of an alternative to the ineffective ABC mantra: delay, reduce, protect yourself.

He’s not ignoring reality, he’s just trying to change a mindset. Listen, almost all of us are going to have sex. Many of us are going to have sex before marriage. Choose, however, to delay losing your virginity, and when you do, don’t sleep around. If you have multiple partners, then don’t have concurrent multiple partners or at least reduce the frequency with which you have sex with different people. Increase the frequency that you get tested. If you have sex with one partner, then don’t attempt to hit each piece of furniture that you can see in one night. Wear a condom unless you’re in a position to be together for the next 20 years and raise a child.

More foot soldiers: peer educators are trained students who travel to area primary and secondary schools to talk about safe sex and the very real risk of HIV. I had the pleasure of speaking at length with Nqobile, who is a peer educator, which I will chronicle in another post.

There’s still a lot to change, though.

HIV is pandemic not because people are running around having unprotected sex all over the place, although there is a culture of males courting concurrent sexual partners and an aversion to condoms. Both of these, however, stem from the view of what is ‘masculine.’ Thinking, though, that a bunch of undereducated monkey-people have this problem on hand because of their own fault is entirely ignorant.

What would you say to the seven-year-old girl who knows that she was raped, but cannot get tested because she is under the age of consent and her mother, a drug addict who sold her for sex so that she could buy drugs, won’t consent to a test?

What would you say to the two sisters who hid at home but were found by the men barging into their house who raped them because everyone knows that having sex with a virgin will cure you of HIV?

Don’t think that it’s simply lack of education. Cultural standards need to be changed. I can’t fathom this problem completely. I come from a very affluent, white, middle- to upper-middle-class fringe suburban area, where people commute to Boston but others also have summer homes on the lakes. I was very fortunate to receive a top-notch public education at a school that still likes to pretend that it’s private, and indeed still keeps a trust and a board of trustees. My primary education was wonderful as well. I am educated. I strive to learn. I am curious; I am interested. You cannot quench my thirst for knowledge. How do you instil this in a child who can’t concentrate in school because he hasn’t had breakfast or dinner the night before and there’s no heat in his school? Have you ever tried going without food for a day and then attempting to concentrate or complete a task? It’s extremely difficult, and your belly eats at your brain because can’t eat at anything else.

The TSiBA students, all receiving free education because of their disadvantaged status (digression: this makes me think about relative poverty, as I’m also receiving a free education due to my disadvantaged status, and yet I have so much more for which to be thankful than these brilliant learners), are all knowledgeable about HIV. They know that you can’t get rid of it by having sex with a virgin. They know that the herbal remedies hawked by preying medicine men looking to turn a quick rand won’t work. Some of the boys, though, seem to harbour sexist views about females being carriers and other statements that make me raise my eyebrows and inhale in anticipation of speaking out.

There’s so much left to change. The road is long, and winding. The path is treacherous. I don’t know what to do. I retreat into my home sphere of believing that education will eradicate poverty, and when poverty is eradicated, many more diseases in addition to HIV/AIDS will be cured. Right now, the statistics prove me right.

Acronyms learned:
HIV: human immunodeficiency virus
AIDS: acquired immunodeficiency syndrome
STD: sexually transmitted disease
WHO: World Health Organisation
CD4: cluster of differentiation 4
ARV: antiretroviral
PEPFAR: President's Emergency Plan for AIDS Relief
USD: United States dollar
ANC: African National Congress
NGO: non-governmental organisation
ABC: abstain, be faithful, condomise
DRP: delay, reduce, protect yourself