Friday, February 12, 2010

HIV and Sexual Behaviour

It sometimes appears that it is difficult for big HIV donors and NGOs to accept that they can waste a lot of money concentrating solely on trying to influence people's sexual behaviour with a view to cutting HIV transmission. They seem to have the attitude that sexual behaviour takes place in a kind of social vacuum and that it is completely unrelated to the way people live their non-sexual lives. Perhaps these organisations don't view gender inequalities, economic inequalities, differences in educational status or social status or intergenerational differences as having any bearing on sexual behaviour.

A paper entitled 'Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland' is part of a whole body of research that challenges the view that targeting individual sexual behaviour should be the main approach to cutting HIV transmission. This 'behavioural' view tends to imply, without arguing or demonstrating, that the cirucmstances in which people live and work are irrelevant to their behaviour, their sexual behaviour and, therefore, their relative risk of becoming infected with HIV, or of transmitting it if they are already infected.

The paper finds that food insufficiency results in increased sexual risk taking, especially among women. The sorts of sexual risk are inconsistent condom use with non-regular partners, transactional sex, intergenerational sex (usually where the female is the younger party) and lack of control over the circumstances of the sexual relationship. The paper recommends targeted food aid and income generation programmes and also an improvement in women's social and legal status.

The fact that HIV is sexually transmitted does not mean that transmission can successfully be reduced merely by 'teaching' people about safe sex, by distributing condoms and facile 'messages' or by lecturing people, children and adults, about right and wrong. This is not a new discovery. But as soon as HIV was found to be sexually transmitted, the whole issue was hijacked by political and religious (and later commercial) crusaders. And it's only occasionally that people have been able to wrestle back some control over HIV as a human rights, health or development issue.

If the conditions under which HIV spreads are to be changed, people need health, education and social services that are accessible to all, female as well as male, rural as well as urban, poor as well as rich. People need to be enabled to ensure their own health and the health of their children and dependents. People need their rights to be recognised and upheld by the law. The right to food is particularly important.

Seeing the connection between food insufficiency and risky sexual behaviour shouldn't take much genius. Surely those who think HIV is just a matter of sexual behaviour don't think that being hungry or having hungry children makes people feel a stronger sexual urge or enjoy risky sex more? So if the limit of their HIV prevention programmes consists of things like behaviour change communication, mass male circumcision and, eventually, HIV vaccines and microbicides, they will find HIV continuing to spread.



Claire said...

An excellent summary of one of your core arguments.

Simon said...

Thanks Claire! S

marry said...

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Simon said...

Thanks for the encouragement, Marry, I'll keep it up!