Renewed calls for sexual behaviour change

Growing concern over the sustainability of government-sponsored HIV/AIDS treatment programmes in Southern Africa has prompted renewed calls for a change in sexual behaviour to curb the spread of the disease. Four southern African countries (Botswana, Lesotho, Swaziland, and Zimbabwe) now have national adult HIV prevalence rates exceeding 30 percent. In an interview coinciding with World AIDS Day, Botswana's President Festus Mogae reportedly told the British Broadcasting Corporation that the funding of anti-AIDS drugs would not go on indefinitely, and Botswana on its own could not afford to keep a rising number of patients alive. Some 35,000 people are now on free anti-retroviral therapy (ARVs), and the number is rising. Mogae called on Batswana to abstain from "unsafe sex", or face the consequences. Mogae's spokesman, Jeff Ramsey, said on Wednesday that there was increasing concern that the rate of infection in the country on the increase. "The president's message is not particularly new - the government has always urged those who are negative to remain that way by having safe sex. What is worrying, though, is that the infection rates are still high, despite increased awareness campaigns and services," Ramsey said. Botswana spends up to US $260 yearly per patient on ARVs. While AIDS activists acknowledge the impact of expensive treatment programmes on already resource-strapped regional economies, they argue that calls for change in sexual behaviour fail to take into account the social conditions giving rise to the spread of the virus. "It is important that individuals accept responsibility for their own behaviour, whether it be sexual or not, but it is too simplistic say that a change in sexual behaviour is the panacea to stopping the spread of the virus. For millions of poor women and girls in Southern Africa safe sex is not an option," Winston Zulu, the manager of KARA, a Zambian AIDS NGO, told IRIN. He explained that chronic poverty and the lack of education had made girls increasingly vulnerable to infection. "But, essentially, male sexual behaviour needs to be addressed, given the inequality between the sexes. The sexual behaviour of women in general is largely dependent on male cooperation to protect them from infection," said Zulu. According to the United Nations, girls and young women in sub-Saharan Africa were twice as likely to be HIV-infected as young men, with up to six times the infection rate of their male peers in parts of the sub-region. In parts of southern Africa more than one-third of teenage girls are infected with HIV. Chrisine Stegling of the Botswana Network on Ethics, Law and HIV/AIDS said Mogae's remarks echoed the "frustration" felt by AIDS activists struggling to arrest the spread of the virus. She noted that one of the shortcomings of current anti-AIDS efforts was the lack of "analytic tools" to "give a clearer picture of where AIDS campaigns did contribute to changes in sexual behaviour". Although Botswana had embarked on several interventions to support those living with the virus, there was a lack of legislation to combat discrimination, especially in the workplace. "So, while the government may be dealing adequately with those who are positive," said Stegling, "it has made very few inroads in helping to reduce stigma and discrimination."