A Time for Frankness on AIDS and Africa

The author, a physician, the prime minister of Mozambique and its former minister of health, asserted that during the UN special session on AIDS next week, "there is likely to be too little said about what is the primary means by which AIDS is spread in sub-Saharan Africa: risky heterosexual sex." HIV "proliferates because of women's poverty and inequality," he wrote. In Mozambique, "the overall rate of HIV infection among girls and young women -- 15 percent -- is twice that of boys their age, not because the girls are promiscuous, but because nearly three out of five are married by age 18, 40 percent of them to much older, sexually experienced men who may expose their wives to HIV and sexually transmitted diseases. . . . Those who try to negotiate condom use commonly face violence or rejection."

Although most nations have agreed to develop adolescent- friendly health services, "In Africa and elsewhere . . . most political leaders still view adolescent sex as a politically volatile subject to be avoided. Community and religious leaders wrongly believe that sexuality education promotes promiscuity. Health providers and teachers are ill-trained about sexuality and ill at ease with it. Parents know little about sexuality, contraception or sexually transmitted diseases, and many believe that early marriage will 'protect' their daughters."

"For the long term, we need to develop HIV vaccines and provide treatment to everyone with HIV. We need to develop protection methods like microbicides that women can use with or without a partner's knowledge or cooperation. Above all, we must summon the courage to talk frankly and constructively about sexuality. . . . We must provide [our children] with information, communications skills and, yes, condoms. To change fundamentally how girls and boys learn to relate to each other and how men treat girls and women is slow, painstaking work. But surely our children's lives are worth the effort."

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