Love is the drug putting couples at risk of Aids in Africa

A fear of disrupting the trust between couples in long-term relationships in Africa is preventing many from seeking the protection they need from HIV

Sex is no longer the main driver of Aids in Africa. It is love, and trust.

This autumn I spent five weeks travelling through the most captivating continent on Earth, examining the epidemic that has laid waste to it. As I journeyed through bars and brothels, schools and hospitals, clinics and research centres, one phrase echoed in my head. I talked to scores of doctors, sex workers, tribal leaders, patients, civil servants, mothers, social workers and campaigners, assisted by a no-strings grant from the European Journalism Centre.

But it was the words of Jane Thiomi, manager with a Kenyan HIV organisation called LVCT in Nairobi, which kept coming back to me.

She was explaining how, among sex workers, it was not their clients who infected them, but their boyfriends. “It is love that makes them vulnerable,” she said.

In its fourth decade, the epidemic, which has claimed over 20 million lives so far, has changed. Unlike other diseases which wreak devastation across the continent such as malaria and tuberculosis, Aids is wholly avoidable. People know better than they did what they need to do to protect themselves. They know the importance of abstinence, faithfulness and condoms. 

What they have not learnt to deal with is love. Long-term relationships between men and women involve commitment and trust and it is fear of undermining that trust that prevents many from seeking the protection – whether condoms, male circumcision, or treatment with antiretroviral drugs – that they need.

Read more:

A journey to the heart of Africa’s Aids epidemic

The condom conundrum: how to persuade Africa's prostitutes to practice safe sex

Hope for the future as Malawi battles the Aids virus's capacity to infect succeeding generations

A cut too far? Zambia is still 75 per cent short of its target of two million male circumcisions by 2015

Is this the silver bullet at last? A new treatment regime could stall Africa's Aids epidemic  

While Western leaders proclaim the end of Aids, bolstered by research showing antiretroviral drugs reduce HIV transmission by 96 per cent, few in Africa share their optimism. Huge advances have been achieved in rolling out the drugs – taken by 10 million people –and new infections have fallen by a third since 2001.

But no one knows how much of that is due to behaviour change, drug treatment or to the natural course of the epidemic – newly emerging viruses always cull the most susceptible first. The fall has slowed in recent years and in Uganda new infections have begun to rise again. The drivers of the epidemic in Africa are strengthening, not weakening. As economies grow and men become better-off they can afford to keep mistresses or use sex workers. Continuing gender inequality keeps women dependent on men, forcing many who lack a male breadwinner into sex work.

The major donors are losing faith in efforts to change sexual behaviour. In Uganda, the US Centres for Disease Control organisation has closed its behaviour change research centre in Entebbe. In Kisumu, Kenya, a well-regarded youth project called Tungaane shut its doors after donors switched to biomedical interventions such as male circumcision.

Biomedical interventions require behaviour change too. As with condoms, men must be persuaded to volunteer for circumcision and HIV-positive pregnant women must be persuaded to accept antenatal testing and drug treatment. In each case what prevents them doing so is love.

Condoms, the single most effective preventive measure against HIV infection, were once uncommon in Africa. Today they are widely used in casual affairs and with sex workers. But their use in long-term relationships is close to zero – it signals mistrust.

“If a man uses a condom, the woman will ask him, ‘Are you sick?’ If a woman uses one, he will ask her ‘Are you having other men?’ Most people have negative attitudes to condoms. There is very little use by couples,” said Molly Businge, chief nurse at the Kawaala Health Centre in Kampala.

With male circumcision, the message about its protective effect has got through. Parents bring their children and teenage boys to queue up for the surgery. But the over 25-year-olds stay away. They have wives and girlfriends – how do they explain why they need circumcision? Fear of undermining their relationships holds them back.

A pregnant woman who discovers she is HIV positive must start drug treatment immediately, and continue for life. She must bring her child back for testing after birth and may have to give it drugs, too. And she must break the news to her husband who may reject her. Many fear this so much they throw the drugs away.

Among the lessons I learnt on my journey are that there is not one HIV epidemic in Africa but hundreds, each with its own drivers. That nothing can be achieved without involving specially trained “peer educators” – members of the community being targeted to help spread the message – a strategy that is now being adopted across the continent. And while starting people on drugs is a huge achievement, keeping them on them is an even tougher challenge.

But one area of research has been neglected – trust. If we understood it better we might understand how to help couples protect themselves more effectively from the holocaust that has swept Africa. In Kenya, almost half (44 per cent) of the 100,000 new infections a year occur in stable relationships while just a third are linked to high-risk groups such as sex workers.

Nduku Kilonzo, head of the Kenyan HIV organisation LVCT, said: “We are not investigating the nature of trust. What leads a couple to abandon condoms for example? It’s a key thing we avoid. We need to start thinking about it.”

Suggested Topics
Life and Style
tech

Sales of the tablet are set to fall again say analysts

News
A Brazilian wandering spider
news

World's most lethal spider found under a bunch of bananas

Life and Style
fashion

British supermodel and hitmaker join forces to launch a 'huge song'

News
news

The Duke and Duchess of Cambridge announce they are set to welcome second child in spring

PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
Life and Style
gaming

I Am Bread could actually a challenging and nuanced title

Sport
Mario Balotelli pictured in the win over QPR
footballInternet reacts to miss shocker for Liverpool striker
Voices
Sol Campbell near his home in Chelsea
voices
News
i100
News
Kimi the fox cub
newsBurberry under fire from animal rights group - and their star, Kimi
Sport
Fans of Palmeiras looks dejected during the match between Palmeiras and Santos
footballPalmeiras fan killed trying to 'ambush' bus full of opposition supporters
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

NQT Job Opportunties in Winsford

£85 - £100 per day: Randstad Education Chester: Are you a Newly Qualified Teac...

Year 3 Teachers needed for supply roles

£110 - £130 per day + Competitive rates of pay: Randstad Education Reading: Ye...

Year 1 Teachers needed for day to day roles

£110 - £130 per day + Competitive rates of pay: Randstad Education Reading: Pr...

Year 2 Teachers needed for day to day roles

£110 - £130 per day + Competitive rates of pay: Randstad Education Reading: Ye...

Day In a Page

Oscar Pistorius sentencing: The athlete's wealth and notoriety have provoked a long overdue debate on South African prisons

'They poured water on, then electrified me...'

If Oscar Pistorius is sent to jail, his experience will not be that of other inmates
James Wharton: The former Guard now fighting discrimination against gay soldiers

The former Guard now fighting discrimination against gay soldiers

Life after the Army has brought new battles for the LGBT activist James Wharton
Ebola in the US: Panic over the virus threatens to infect President Obama's midterms

Panic over Ebola threatens to infect the midterms

Just one person has died, yet November's elections may be affected by what Republicans call 'Obama's Katrina', says Rupert Cornwell
Premier League coaches join the RSC to swap the tricks of their trades

Darling, you were fabulous! But offside...

Premier League coaches are joining the RSC to learn acting skills, and in turn they will teach its actors to play football. Nick Clark finds out why
How to dress with authority: Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear

How to dress with authority

Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear
New book on Joy Division's Ian Curtis sheds new light on the life of the late singer

New book on Ian Curtis sheds fresh light on the life of the late singer

'Joy Division were making art... Ian was for real' says author Jon Savage
Sean Harris: A rare interview with British acting's secret weapon

Sean Harris: A rare interview with British acting's secret weapon

The Bafta-winner talks Hollywood, being branded a psycho, and how Barbra Streisand is his true inspiration
Tim Minchin, interview: The musician, comedian and world's favourite ginger is on scorching form

Tim Minchin interview

For a no-holds-barred comedian who is scathing about woolly thinking and oppressive religiosity, he is surprisingly gentle in person
Boris Johnson's boozing won't win the puritan vote

Boris's boozing won't win the puritan vote

Many of us Brits still disapprove of conspicuous consumption – it's the way we were raised, says DJ Taylor
Ash frontman Tim Wheeler reveals how he came to terms with his father's dementia

Tim Wheeler: Alzheimer's, memories and my dad

Wheeler's dad suffered from Alzheimer's for three years. When he died, there was only one way the Ash frontman knew how to respond: with a heartfelt solo album
Hugh Bonneville & Peter James: 'Peter loves his classic cars; I've always pootled along fine with a Mini Metro. I think I lack his panache'

How We Met: Hugh Bonneville & Peter James

'Peter loves his classic cars; I've always pootled along fine with a Mini Metro. I think I lack his panache'
Bill Granger recipes: Our chef's heavenly crab dishes don't need hours of preparation

Bill Granger's heavenly crab recipes

Scared off by the strain of shelling a crab? Let a fishmonger do the hard work so you can focus on getting the flavours right
Radamel Falcao: How faith and love drive the Colombian to glory

Radamel Falcao: How faith and love drive the Colombian to glory

After a remarkable conversion from reckless defender to prolific striker, Monaco's ace says he wants to make his loan deal at Old Trafford permanent
Terry Venables: Premier League managers must not be allowed to dictate who plays and who does not play for England

Terry Venables column

Premier League managers must not be allowed to dictate who plays and who does not play for England
The Inside Word: Brendan Rodgers looks to the future while Roy Hodgson is ghost of seasons past

Michael Calvin's Inside Word

Brendan Rodgers looks to the future while Roy Hodgson is ghost of seasons past