According to Human Rights Watch, “Twenty-five years after AIDS was first identified, programs to fight the disease continue to be undermined by conservative ideologies and moralistic approaches.” Yet, as one who has worked in Africa, I wonder why, in a world that worships “multiculturalism”, why so few criticize the attempt of western activists to impose their own moral and ideological agenda on African societies.

According to this agenda, governments in Africa are supposed to stop reinforcing tribal and religious imperatives toward virginity and limiting sex to marriage (including polygamous marriages). Instead, they are to give out expensive condoms that are prone to deteriorate in the hot climate, are foreign to the culture. I have no objection to funding HIV drugs, but would point out that western donors who lament the lack of expensive retroviral drug availability often forget that more people die from more easily treated diseases such as diarrhea, malaria, and tuberculosis, which do not get the publicity or funding of the more politically correct disease of AIDS.

When powerful, well funded western activists try do deny funding to alternatives such as teaching virginity as HIV prevention, they ignore that virginity and  alternative “safe sex” practices not involving condoms have long been customary in many African tribess for both courting couples and for married couples. (If a breast feeding mother becomes pregnant prematurely, she weans her child. Prolonged breast feeding for three years is necessary in lands where this is the main source of protein for growing babies; it is also a good form of birth control).

“Virginity parades” are not new in Africa, where in some tribes tradition designated a female relative to examine the girls periodically to ensure she is still a virgin. And although ridicule is not a major blockage to behavior in the West, in African tribes, where shame and exclusion from the family are the traditional ways to discipline children, such ridicule is a powerful incentive for and against behavior.

Western activists, who often come from the gay subculture, have as a priority to stop stigmatizing sexual activity. By insisting sexual activity should not be moralized, they shame (!) those who would marginalize openly gay behavior as an excuse to exclude gays from mainstream society.

But in Africa, society is hirarchtical, so the inferior must obey the superior. This means homosexual behavior was not “gay marriage” between equals. It was often associated with sexual exploitation of the young by the powerful (an uncle, an employer, a chief). That is why the taboos against homosexuality are stronger.

Similarly, one reason for the taboos around virginity involve protecting young women from similar exploitation. If a girl loses her virginity to an older man, he will have to either marry her, or support her child and pay a fine to her family, since she now will bring a lower “bride price” when she marries.

Free women in cities are assumed to be prostitutes, since they are not under the protection of family. Educated women are free to chose, but poor women are still enticed to prostitution to support their families, and maids often are expected to sleep with employers or fellow employees as part of their work.

How does one cope with this? The western cry against “moralism” essentially destroys any protection these women have against sexual exploitation. The answer is to increase the status of women, and to do so, it means to stress a moral ethic where women have permission to say no, where women have permission to chose their husbands, and where women have alternative means to support themselves besides prostitution.

Not mentioned in the report: the spread of HIV via dirty syringes in clinics and by semi trained traditional healers who use scarification therapy. Ironically, Western AIDS activists want free syringes for Asian drug addicts, but one could argue free syringes and scalpals for traditional healers would go a long way to stop HIV transmission in some parts of Africa.

Also not mentioned: Circumcision. Male circumcision is now being fought by progressives in the West, but genital sores in the uncircumcised might be one reason for the high “female to male” transmission in Africa, and  might be one major reason for the low incidence of HIV in Muslim Africans. Indeed, I wonder if the custom of female circumcision started and spread because of the association of promiscuity and disease/death and infertility.

A final point in this discussion can be found HERE, where Asian public health workers critique the misapplication of Western HIV agendas to Asian society.

They point out that in Asia, the HIV epidemic is less likely to spread to the mainstream population precisely because the stigmatization of certain behaviors in the Asian “shame culture” limits promiscuity and drug use. That is why most Asian governments are unlikely to try to change their societies’ moralistic approach to the disease by promoting the idea that either promiscuity or drug use is normal. From a public health standpoint, a better way to approach HIV is to have governments fund NGO’s to work with the marginalized groups, so as to keep them marginalized and socially stigmatized so as to discourage such behavior by the majority.

Indeed, Africans, by trying to reach back to tribal customs of virginity, and by using the churches  and mosques to limit promiscuity (and thereby to increase female empowerment to say no), are trying to strengthen forces in society to do just that same thing.

Outside groups that try to impose a non moralistic approach are actually working against the very weapons that will limit the spread of HIV in the long run.

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Nancy Reyes is a retired physician living in the rural Philippines with her husband, six dogs, three cats, and a large extended family. Her main website is Finest Kind Clinic and Fishmarket and she often posts medical essays to HeyDoc Blog

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