In a nameless mud-walled bar, over a lunch of roast goat, bananas and Bell beer, a group of AIDS counselors gathers to discuss one question: Why is it so hard to practice safe sex here?
The AIDS crisis seems hopeless because of the new infection rate. For every 100 Africans put on treatment, 250 get infected. Globally, 7,400 people are infected every day.
In the 1980s, Uganda earned renown for pushing its infection rate to 6 percent from 18 percent. Many here still remember the pounding drums on the radio and the slogans “Practice ABC” and “zero grazing” — no extramarital sex.
However, infection rates are creeping back up.
Casual sex is on the rise, epidemiological surveys say. Condom use, never very high, has dropped. Even among people who know they are infected, only 30 percent consistently use condoms.
Donors sometimes blame their own flawed efforts. For example, the annual supply of condoms in Africa still amounts to only four per adult male.
The counselors here — all of whom were infected — blamed no one but themselves and their neighbors.
They were all educated, fluent in English — former teachers, a former army officer, a hospital bookkeeper. Though Bwindi, like much of Uganda, is made up mostly of subsistence farmers.
“Many people are just ignorant,” said Gervis Muhumuza, 44. “They have low education, and so many misconceptions. Minus the elite class in Kampala and a few others, nobody is using condoms.”
The 2006 Demographic and Health Survey of 11,000 Ugandans found that 99 percent had heard of AIDS, but only about a third had “comprehensive knowledge” — that is, they could correctly say whether it was spread by mosquitoes, by food or by witchcraft; whether it could be prevented by condoms; and whether a healthy-looking person could have it.
Safe-sex messages have not stopped. If anything, they are harder-hitting.
A recent one features the leering face of a creepy middle-aged man.
“You wouldn’t let him sleep with your teenage daughter,” it says. “Why are you sleeping with his?”
Another shows a frightened child saying, “My mommy is sick because of the sexual network.”
Many Africans, researchers say, are in one or more relationships that may include sex only infrequently, but last for years. Some are open, as in polygamy; many are clandestine, as with old lovers, bosses or even, perhaps, an abusive uncle who cannot be shaken off.
In such networks, infections spread rapidly. Also, men here, like many men everywhere, complain about condoms.
The arrival of AIDS drugs let some go back to old habits.
“When you are sick, you are tired, you are impotent,” said George Bitti, 58. “But when you are on the drugs for a certain period, you become strong, you regain your body. And you start going again for sex.”
Even before drugs arrived, powerful societal forces were arrayed against safe sex.
“According to African culture, the man is the overlord,” said Peace Atwongyeire, 42, a handsome counselor whose face adorns local billboards saying she is not ashamed to be HIV-positive.
“You have to say yes,” she said.
Because a man buys a wife from her father for cows or cash, he “owns” her. If she refuses sex or insists on a condom, he may beat her or throw her out of the house.
Also, condoms thwart pregnancy, and “I prove my manhood by having children,” said Bitti, a father of 14.
“That is how a girl proves she is a woman. In Africa, you cannot tell anyone to stop having children. They will even think, ‘I would rather have AIDS and leave my children when I die. At least I will have produced my three,’” he said.
Prostitutes, too, have disincentives. They typically get US$5 for sex, but US$10 to US$20 more for sex without a condom. (Though it did not come up in Bwindi, prostitutes elsewhere in Africa have complained that some clients secretly bite holes in condoms because they believe flesh must make contact for the sex to be real.)
Labor patterns also contribute. Men disdain cooking and laundry as women’s work, so when they work far from home, as many do here, they often pay a local woman to do both, and sleep with her. Meanwhile, a counselor said, “the wife will find a man to buy salt and soap and roof her house.”
Also, much sex is what social scientists call “transactional.” Young women from all but the wealthiest families are under constant pressure to trade sex for high school tuition, for grades, for food for their siblings, even for bus fare.
“If a woman says to me, ‘Please give me 2,000 shillings to get to the pharmacy,”’ said Topher Kamara, 46, the counselor who is a former officer, naming an amount equal to US$1, “I will say to her: ‘You want 2,000? Lie down and surrender your goods.’”
Atwongyeire described a girl who “found a sugar daddy” because she needed sanitary pads so her classmates would not tease her.
The once-widespread rumor that sex with a virgin cures AIDS has faded (as has a local rumor that sex with a pygmy is a cure). However, men still pay teenage girls because they fear “reinfection,” and, Kamara said, “because older women will make us push them to orgasm, but a young girl will let him satisfy himself and leave.”
Sex education hardly exists. By law, counselors may discuss condoms in high schools but not demonstrate or distribute them.
As a result, rumors abound. For example, they said, many young girls believe condoms can “get lost inside,” causing infections. A government campaign promoting Pap smears backfired when people decided condoms must cause cervical cancer.
Strangest of all, Kamara said, the mix of disbelief and fatalism is so powerful that he and female counselors have been propositioned after giving AIDS-awareness talks in churches, at which they make a point of announcing that they are infected.
“People say: ‘Oh, I don’t worry. Sleep with me and we will all have HIV together,’” he said.
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