10 Mar 2014

Moral prejudice drives HIV/Aids

Written by  Antonia Porter

No. 293: Moral prejudice drives HIV/Aids / Antonia Porter / Cape Times
10 March 2014

Much of the global coverage of HIV/Aids - particularly in the West - has, predictably, presented a prejudiced view of Africa as an undifferentiated, homogenous mass of poverty. It has not recognised the different socio-political conditions among African countries which affect how HIV/AIDS is made manifest and the responses to it.

The dynamics of HIV/Aids are different in contexts with violent conflict (although the exact nature of the relationship between conflict and HIV/Aids remains an area of fierce contention in the research world).

A meeting held by the Centre for Conflict Resolution (CCR) in Cape Town on "HIV/Aids and Post-Conflict Societies in Africa" found that the dynamics, spread, and impact of the epidemic are also different in post-conflict societies in Africa to areas still in the midst of violent conflict, or to those which are largely conflict-free.

But far less research and resources have been directed towards societies in the aftermath of conflict. This is despite the fact that the little research that does exist suggests that post-conflict settings, including South Africa, have higher transmission rates, but also present unique opportunities to address the epidemic because they are societies in transition.

Although some coverage of World AIDS Day globally calls for greater attention to specific groups, such as black gay men in the United States, or even men in general; when it comes to Africa, there has not been much focus on marginalised groups which are particularly vulnerable to the disease. Focusing on African post-conflict societies, groups must be included which are marginalised by society and by HIV/AIDS prevention and treatment strategies.

This includes groups displaced by conflict such as migrants, refugees, and internally displaced persons (IDPs). National efforts across the continent tend to exclude these vulnerable mobile groups. As Wit's University's Joanna Vearey recently noted, there is very little international donor support for tackling the epidemic among such groups.

But not only mobile groups which are often considered victims of conflict such as refugees and IDPs should be targeted: what about those mobile groups which fall outside the law, such as undocumented migrants, rebel groups, and other militia? Governments and donors must get over the unpalatibility of these groups and stop neglecting them within HIV/AIDS prevention and care efforts.

If the epidemic is to be addressed effectively in countries which have experienced conflict, mobile groups below the legal radar must also be included.

Other groups which are too often excluded by HIV/AIDS prevention efforts across Africa are sex workers and sexual and gender minorities, as has been increasingly noted. Discrimination against these groups drives HIV/AIDS in general, and certainly in settings where people have been displaced by conflict.

For example, Uganda's notorious penal code which proscribes homosexuality (and sex work), defining them as "crimes against morality" - in combination with the accompanying stigma - makes access to healthcare for these groups in the country incredibly difficult.

This is also the case in post-conflict countries like Burundi and Rwanda. Ugandan scholar Stella Nyanzi maintains that a fundamental shift in focus from normative heterosexualities to an approach which embraces non-heteronormative sexual orientations and identities is required. She considers the notion of an "erotic pyramid", developed by feminist anthropologist Gayle Rubin.

The pyramid places "good", socially acceptable sex well within its boundaries - typified as heterosexual, monogamous, married/in a relationship, procreative, non-commercial, and in pairs, among other characteristics.

"Bad sex", on the other hand, characterised as homosexual, unmarried, promiscuous, non-procreative, commercial, casual, and alone or in groups etc., lurks at the pyramid's outer edges. "Good sex" is constantly socially upheld. "Bad sex" is socially penalised. According to Nyanzi, subversive sexual practices and sexual and gender minorities are silenced; made invisible - not catered to by most HIV/AIDS efforts in Africa, including in post-conflict contexts or where people have been displaced. This prioritisation of "good sex" and exclusion of "bad sex" in HIV/AIDS responses in Africa means that those who practise "bad sex" do not receive the healthcare they need. It also drives HIV/AIDS. Approaches which embrace non-heteronormative sexual orientations and identities must therefore be adopted.

Another discomfiting reality which is still not taken seriously by many HIV/AIDS response efforts in post-conflict - and indeed all - societies, is that patriarchy and gender inequalities lie at the heart of sexually-transmitted HIV/AIDS. About three-quarters of all new HIV infections are sexually transmitted heterosexually. Gendered power relations inform the behaviour and sexual practices of women and men globally.

Men still possess overwhelming power in decisions on sexual matters, including whether to use condoms. A heterosexual woman's awareness of what constitutes risky behaviour does not mean that she does not participate in it: not only because of pressure from men, but often because of the myriad unspoken oppressive messages she receives about her role in sex, which are difficult to articulate, let alone overturn.

Power often operates in the subtle undertones of things, sometimes at the borders of the consciousness of both those who exercise it and those upon whom it is exercised.

Power can also be difficult to name. Ensuring that HIV/AIDS efforts address gender inequalities is therefore critical: not only through cognitive approaches which provide information on means of transmission, or even through provision of negotiation skills for women, but through multi-layered, psychosocial approaches for both women and men, which operate at a deeper psychological levels and encourage awareness among both genders of their own gender conditioning, and how this is enacted during sex. These kind of approaches are particularly important for post-conflict societies, because conflict often makes the gender identities of both men and women more rigid.

HIV/AIDS prevention and treatment efforts in conflict and post-conflict societies across Africa must include refugees, IDPs, migrants - as well as those who are undocumented - former combatants, rebels and militia, and other vulnerable mobile groups. They must also fully embrace sexual and gender minorities and sex workers. And equality across all societal faultlines, human rights, and anti-patriarchy must lie at the heart of all of them.

Antonia Porter is a project officer at the Centre for Conflict Resolution in Cape Town. This is part of a special issue of the journal International Peacekeeping on "HIV/Aids and Post-Conflict Societies in Africa" published in December 2013.

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