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Strings AttachedAIDS and the Rise of Transnational Connections in Africa$

Nadine Beckmann, Alessandro Gusman, and Catrine Shroff

Print publication date: 2014

Print ISBN-13: 9780197265680

Published to British Academy Scholarship Online: January 2015

DOI: 10.5871/bacad/9780197265680.001.0001

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Sponsored Sexuality, Aids and Tough Choices

Sponsored Sexuality, Aids and Tough Choices

(p.31) 2 Sponsored Sexuality, Aids and Tough Choices
Strings Attached

Christine Obbo

British Academy

Abstract and Keywords

ABC (Abstinence, Faithfulness and (perhaps) Condom) is the brand paradigm and practice on HIV risk avoidance being macro-managed by foreign funding agencies. The solution to the African AIDS epidemic is the ‘fidelity fix’ imperatives promoting pre-marriage sexual abstinence and marital monogamy. The anti-sex-condom crusade ignores gender inequality, poverty and power – the structural drives of the epidemic – and discusses abstinence, fidelity and sexual networks without historical and cultural context. Condom marginalisation downplays the public health responsibility of protecting self and others from infection. The social, political and economic hardships exacerbated by the intractable problems of ignorance, poverty and disease make people vulnerable to the dictates of the rescuers promoting solutions. Negotiating ways around foreign-imposed sexual virtue has happened since colonial contact. Ugandans demanding the reinstating of pre-2003 safer sex education and the condom option are silenced, while the support of local Christian fundamentalist advocates is buttressed with economic incentives.

Keywords:   Sexual virtue, anti-sex-condom, economic incentives, Christian fundamentalism

Sponsored Sexuality, Aids and Tough Choices

Uganda poster, 1995

THE DOMINANT ZEITGEIST IN AFRICA during the past four decades of the AIDS epidemic has been cultural-religious fundamentalism. A UNAIDS (2005) extensive consultative survey presenting three possible 2025 scenarios on AIDS in Africa identified these tendencies together with poverty, underdevelopment and marginalisation in a globalising world as AIDS deepened entrapments that would demand tough policy choices. AIDS control agendas in countries with varying economic, educational and social potential are dictated by conservative tendencies nurtured by foreign funding and advice.

Every generation of Africans has faced tough choices negotiating around foreign-imposed religious values on sexuality. This is an account of the unbroken (p.32) saga of top-down paradigms promoting monogamy and fidelity since colonial contact; and how social, political and economic hardships make people vulnerable to the dictates of rescuers. AIDS is now a matter of life and death fuelled by the intractable problems of ignorance, poverty and disease. This has set a perfect stage for the foreign macro-managing of response choices by promoting paradigms and practice that silence Ugandans long involved in designing diverse HIV prevention approaches which acknowledge that the sexually active who fall short of the ideals of chastity before and fidelity after marriage should be encouraged to seek the public health option of condom use. This promotes HIV self-protection and responsibility for the safety of others from infection. The current neo-colonial Christian antisex-condom crusade ignores gender inequality, poverty and power as the structural drives of the epidemic (Schoepf 2001) and discusses abstinence, fidelity and sexual networks without historical or cultural context.1

Fidelity (Epstein 2004) emerged as the coalescence model for expounding the ABC (Abstinence, Be faithful and perhaps Condoms) brand theory and practice on HIV risk avoidance.2 The real solution to the African AIDS epidemic is to enforce ABC with the ‘fidelity fix’ through curbing the widespread practice of longterm concurrent sexual partnerships which create a regional ‘virtual superhighway’ for HIV in Africa (Morris and Kretzchmar 1997; Halperin and Epstein 2004; Mah and Halperin 2010).

The primacy of foreign theoretical constructions dismissive of local voices is important to understanding the anti-condom debates that inform current funding policies. ABC sponsors and scholar advocates laud it as core to Uganda’s success story and insist it is what Africa needs and ‘African leaders want’ (Human Rights Watch 2005; Fogelberg 2005). However, there is a deafening silence about the economic incentives that buttress the support of key local advocate actors (Rawls 2012).

Sex and marriage choices during colonialism

‘Too much’ African sex emerged as a policy issue at the turn of the twentieth century with the advent of British colonialism. Accordingly, legislation and church sermons discouraged practices such as beer drinking, celebratory and ritual dances, and polygamous marriages. The same practices were identified as engendering the spread of HIV in the 1990s WHO surveys on cultural and behavioural practices.

(p.33) Colonial missionaries promoted nuclear families. Polygamous men demonstrated their true conversion to Christianity by choosing one wife for a monogamous ‘ring’ marriage licensed by church ceremonies, in response to the offered incentives of education, chieftainship and landownership. But the mentality that men are forced to have one wife by poverty persisted. Thus while monogamy was the legally enforced practice for modern families, men maintained women in long-term relationships outside marriage. Thus in a parallel universe monogamy and modernised polygamy flourished under the radar of foreigners’ gaze. This practice continues in a climate undermining condom use but promoting abstinence and fidelity (Parikh 2007; Carpenter et al. 1999).

Under both customary and statutory laws, men could divorce women for infidelity, but women were not accorded the same rights. A woman demanding statutory divorce on grounds of cruelty or infidelity was required to demonstrate that the husband was mad. Needless to say divorces initiated by women were rare. The common recourse for women was desertion.

Ugandan men as the dominant cultural authorities had always had vested interests in promoting chastity for young people and fidelity for women in marriage (Southall 1960). Bride wealth transferred control over the sexual, productive and reproductive rights of a woman from her father and brothers to her husband. The value of the bride wealth depended upon the virginity of a woman on the eve of the wedding. A father’s sister (actual or appointed female relative), the chief adviser to the bride, was responsible for ascertaining this. In many groups, the last bride wealth ‘gift’, coded with names querying whether the woman was still a virgin, was brought at dawn on the wedding day. While in some societies the rights the husband acquired were earmarked by specific payments, in others the rights were revealed by the fines demanded to redress transgressions. For example, fornication and impregnating a girl were fined as transgressions against virginity and childbearing value respectively. If a woman deserted her husband or was divorced for laziness, barrenness or adultery, the husband had a right to demand the return of the bride wealth as compensation for his loss of the woman’s wealth-generating services of economic labour and producing heirs. In gender-cultural prescriptions women are central to food production; to nurturing the physical, psychological and social needs of the family; and to providing a man with sexual gratification and offspring. Many proverbs underscore this by emphasising that unmarried men cannot be homeowners even when they own their residential houses.

In some societies, if a woman died, a sister replaced her as compensation for the husband’s loss. Likewise, if a man died, his male relatives inherited his widow who continued to perform the services that were exchanged for bride wealth. In societies where bride wealth was low, women deserted their husbands and worked to repay the bride wealth if their male relatives were unable or refused to do so. Deserting women and widows who did not remarry set themselves up as independent homeowners. With time they formed a socially accepted named category.

(p.34) Modernisation and religion

The rapid extensive social, political and economic changes that occurred in the 1960s were characterised as consequences of modernisation: another name for prosperity. But as poverty persisted, religious organisations offered relief while entrenching their power.

Economic prosperity from the export of coffee and cotton cash crops enabled parents to educate their children; unmarried women bought land and supported themselves growing food and cash crops, or migrated to urban areas to exploit new income-generating activities catering to the surging urban population. The production of alcoholic drinks and the associated sexual liaisons characterised the low-income areas while modern hotels and nightclubs catered for the leisure activities of the new elites and aspirant poorly educated young people.

In the late 1960s, the Family Planning campaign to space out children in marriage was launched, promoting both birth control pills and condoms. Doctors concerned about rates of abortions and STD infections among university students encouraged condom use as central to the health promotion strategy for males. Unfaithful elite Christian men used condoms to avoid the marital awkwardness of possible ‘outside’ children. Condoms unintentionally captured the local men’s imagination as something to use with women of questionable morals and presumed sexual disease vectors.

Since the early 1960s the dates of political independence from the metropolitan colonisers have been annual celebrations in most African countries. The reins of power were taken up by the first Western-schooled generation of leaders who assumed control over foreign development aid grants and loans that were enthusiastically promoted by accompanying advisers and managers (Timberlake 1986). Despite the different possible development trajectories suggested by existing education and national wealth, leaders in each country mismanaged the money, using it for their personal aggrandisement and expanding their personal power through nepotism and cronyism. This led to the erosion of political institutions and civil society rights. The combination of economic mismanagement, political disenfranchisement and the top-down economic policies resulted in the ‘underdevelopment’ phenomenon characterised by economic and moral impoverishment at personal, community and national levels. Rural poverty drove people to cities with no jobs and infrastructure to support them. The wealth disparity between rich and poor, rural and urban, gave rise to programmes funded by NGOs with the declared mission of redressing poverty by integrating all into the development enterprise.

By the 1980s, the World Bank and the International Monetary Fund advisers and managers had imposed debt collection policies called Structural Adjustment Programmes (SAP) as conditions for further funding (Jauch 1999). Fiscal reforms to increase efficiency required balancing national budgets, in particular by reducing (p.35) expenditure through trimming public sector jobs. The centrepiece of SAP was the opening up of the local market to foreign competition through the privatisation of public enterprises and land reforms.

The Uganda narrative begins with the power struggles over controlling development wealth, which culminated in the lost decade of the 1970s. The 1971 military coup d’état led not only to the disintegration of the economy and social services, but to a reign of terror which destroyed the judiciary, political parties and the press; and anarchy which threatened lives and property with destruction. There was a revival of many traditional practices that had been partly eclipsed by the modernisation impulses of the 1960s. These included neighbourliness in times of need, divination cures and social control notions of ‘good women’.

SAP in Uganda (Jauch 1999; Naiman and Watkins 1999) led to a 40 per cent growth in GDP, which temporarily made it a heavily indebted poor country (HIPC) success story. The main beneficiaries of fast privatisation, and trade liberalisation involving the progressive reduction of export taxation on cash crops, were the enterprises of elites and foreigners. SAP policies were macro in scope and far removed from the reality of who gets access to the means of production, who controls surplus produce and profits, and who is able to respond to the added incentives to produce. Women were dominant among the majority of small-scale farmers receiving poor remuneration because they had limited property rights. The small private sector was unable to cope with the unemployment rates resulting from the retrenchment of about 350,000 public service employees. Women bore the brunt of SAP policies because of their gender responsibilities for the welfare of families. Commoditising education and health services under the ‘cost sharing’ schemes increased hardship for the poor, who struggled to find hospital and school fees.

In the early 1990s, the Jubilee 2000 coalition campaign, demanding debt relief for the poorest countries by the millennium, was the culmination of many NGOs’ campaigns against extensive SAP-induced poverty. In 1997, Uganda was the first country to get the debt relief nod, but a delay of one year left it still servicing the SAP debt. Despite receiving $650 million multilateral debt relief, Uganda was forced back to the status of HIPC with an unsustainable debt-servicing burden by 1999 because the projected earnings from trade export revenues had failed to materialise.

The breakdown of social services in the 1970s and the general impoverishment drove people to seek refuge in religion. Traditional healers and independent churches that had been suppressed during colonial times had surreptitiously expanded during the 1960s. After political independence in 1962, Anglicanism had continued its colonial status as part and parcel of the dominant political framework, and Catholicism continued its successful rural penetration. But since the Anglican and Catholic churches were plagued by the same social disintegration symptoms of corruption, personal rivalry and ethnic conflict, independent churches blossomed as they embarked on the task of mending the social and moral fibre. By the 1980s, (p.36) the gravity of the moral decay was widely acknowledged. Foreign religious NGOs whose overt agenda was to combat poverty and win souls for God became increasingly focused on moral rehabilitation. I attended many brainstorming sessions on strategies for moral rehabilitation but the most memorable one involved an outlandish proposal to install a television in every village for providing all-day religious broadcasts. Lack of rural electrification put a stop to the idea. The focus of evangelical and Pentecostal missionaries was economic assistance to schools, where ambitious young men were encouraged to preach the gospel, with the possibility of overseas training and, when successful, being rewarded with church ownership.

The days of AIDS

At this critical juncture Uganda was hit by an epidemic of a unique wasting illness, ‘slimu ’ (AIDS). In the mid-1980s, the earliest deaths were reported in the fishing village of Kasensero, a Lake Victoria landing point in Rakai District, which was the highway of a flourishing but dangerous smuggling trade between Uganda, Kenya and Tanzania. Survival depended on protective sexual and business networks. AIDS was initially blamed on witchcraft and cultural transgressions. Suspected culprits included rejected women and cheated business partners. However, AIDS proved incurable, responding neither to traditional nor biomedical remedies. As AIDS was spread predominantly through sexual activity, cultural explanations turned their attention to women’s non-observance of reproductive taboos on abortion. Abortion was polluting and required ritual cleansing. Unsuspecting men allegedly acquired HIV through sexual congress with uncleansed women, especially in urban areas lacking cultural controls. The message emanating from the Christian pulpit was that it was punishment from God for sexual indulgences.

By 1986 Uganda and African sex were rocketed into the international glare through medical reports and mass media, following the identification of AIDS as a fatal sexually transmitted disease. Uganda was overrun by WHO AIDS Global Initiative public health experts and in 1987 WHO sponsored the first AIDS Control Programme. People became well informed about the disease and how to prevent it, but translating this into knowledge for survival revived the debate on sexuality. Condoms were promoted as the appropriate public health technology to curb the epidemic. The condom distribution campaign initially targeted prostitutes and their obvious clients, long-distance truck-drivers. Free condoms were made available in the city health clinics. Educated mothers who suspected their adolescent sons of being sexually active encouraged them to get condoms, and sneaked condoms into their travelling husbands’ luggage. These women were roundly condemned from the pulpits and by the press.

(p.37) Urban condom legends about increased sexual activity became widespread. Condoms were condemned as offensive and a threat to communal moral sensibilities, by corrupting the youth, and endangering lives. The litter of carelessly disposed condoms around churches and mosques was offensive, and was dangerous to playing children, who suffocated, mistaking them for balloons, and to small livestock which choked on them when grazing. The most ubiquitous urban legend staple in pulpits went as follows:

In one boarding school the headmaster distributed several condoms to each teenage boy after morning school assembly. Towards the end of the day there was a stream of boys knocking on his door, each saying: ‘They are finished, I need more!’

The moral of the story was that condom distribution in schools was corrupting the youth and distracting them from schooling. The Ministry of Education was forced to dump thousands of much needed books for primary schools. The beautifully illustrated books, a donation by the French Danielle Mitterrand Foundation, featured a mango addressing the subject of sexual development and how to avoid the ubiquitous AIDS disease.

The AIDS Control Programme (ACP) in collaboration with the African Medical Research Foundation mounted a socially playful but conceptually aggressive campaign message ‘zero grazing’ to target the youth and married men. People understood the need to tether animals to restrict their feeding radius space in order to stop them from damaging crops and endangering communal goodwill. For humans, ‘zero grazing’ restrictions translated into assuming responsibility to spouses through faithfulness or preparedness to use condoms with partners. The AIDS prevention picture at the turn of the century was a mosaic.

The infection rates among women were double those of men because they depended upon the goodwill of men for condom protection. Their relatively weak economic and social position eroded their power to refuse sex which was seen as a requirement for procreation and a marital obligation. Older men continued resisting condom use, philandering, and preferring younger women for partners. Such men were openly vocal in their resistance to condoms as not natural sex.

But the men and women willing to use condoms faced the difficult hurdle of ‘exceptionalism’ posed by beauty or emotional closeness. Sex workers did not insist on condom use with special boyfriends. Several elite men independently confessed to routinely ‘not leaving home without a condom’ but frequently failing to use them when overwhelmed with beauty. A telling case is that of a senior ACP official who, after conducting a community workshop on the necessity of proper and consistent condom use in avoiding contagion, propositioned and grappled one of the female volunteers. When she challenged him on why he seemed not to need condom protection, he asserted that he knew she was HIV-free because she was young and beautiful. Her cackle as she walked away attracted our attention to his hypocrisy.

Young people were responding to information as knowledge for empowerment. They were learning new skills for negotiating sexual autonomy with their peers on (p.38) a wide range of issues, including condom use when necessary. Nurses in clinics distributing free condoms reported a trend in youth consultations about sexually transmitted diseases and HIV testing when picking up condoms.

Foreign funding had peaked in the early 1990s, with over 600 AIDS-related programmes, including community-based drama groups, sexually transmitted disease control clinics, and orphan care. Most community-based projects largely focused on knowledge for survival by promoting condom acceptability through orientations courting the approval of religious and other conservative leaders. Traditional Muslim and Christian women were very active in condom promotion because they knew that most of them were being infected by husbands on whose goodwill to use condoms they depended. They wanted to save their children from certain death.

Prompted by the need to evaluate the success of projects for continued funding, WHO, as the leader in the war on AIDS and sponsor of the ACP campaigns, schematised the general picture of what was happening in Uganda as Abstinence, Be faithful and Condom use (ABC).

The United States through its aid agency USAID was from the beginning of the epidemic the largest funder of AIDS prevention programmes. An official boasted to me in 1991, ‘We are doing it all.’ In 1992 Uganda benefited further when Zaire was relegated to the status of international pariah by funding agencies as punishment for its President’s corruption. Following a model that had been successfully developed in Zaire, USAID sponsored private companies to promote condom social marketing, which encouraged people to pay a small fee for condoms. But mostly USAID donated condoms for free distribution in government clinics. The local joke was that the embassy leaned over like the tower of Pisa in Italy from the weight of condoms. The urban youth who had witnessed the horrors of AIDS illness and deaths were scared into embracing condoms as the common-sense preventive measure. But the driving catalyst for their positive response was the availability of free condoms, and the opening of clinics for free confidential HIV testing and counselling.

A paper at the 1995 International Conference on AIDS and STDs in Africa, held in Kampala, reported a drop in HIV prevalence rates from the 18 per cent peak in 1992 among urban youths and mothers attending antenatal clinics. UNAIDS, newly formed to coordinate the AIDS prevention efforts of several UN organisations, joined in the self-congratulatory collective sigh of relief by researchers. With UNAIDS’ acknowledgement of Uganda’s success story status (1999), many organisations vied to share the credit. Religious groups aggressively claimed that their abstinence and fidelity formula had effectively stemmed the epidemic. Their position was strengthened in 2003.

By 1999 evangelical Christians had made extensive inroads in Africa. During the 1990s in America, chastity-until-marriage pledges, violent anti-abortion campaigns and the condemnation of condoms as promoting promiscuity and homosexuality (p.39) had crystallised into benchmarks of cultural wars between religious-social conservatives and civil libertarians. These proxy wars were stealthily imported through their sponsored satellite churches in Africa. In Uganda, ambitious locals were encouraged to preach, and they were awarded scholarships to theological colleges. Trained pastors went on carefully guided tours of America that exposed them to the opulent lives of ‘prosperity gospel’ televangelists who promised material, financial, physical and spiritual success to believers. On their return pastors were encouraged by their American advisers, preachers and fundraisers to groom the power elite in the same way they had been groomed, with prayer and prospects of monetary rewards (see Rawls 2012).

In 2003, conservative religious sponsors of a new American AIDS funding proposal, the President’s Emergency Plan For AIDS Relief (PEPFAR), invited targeted Ugandans to give testimonials. Prominent witnesses were Pastor Martin Ssempa, then a protégé of Rick Warren, pastor of the American Saddleback Church; and Janet Museveni, wife of the President and Ssempa’s millennium eve born-again convert. Their verbal narratives, supported by handwritten notes distributed to congressmen, attributed the ‘Uganda success story’ entirely to abstinence (Bryton 2009). There was no mention of the aggressive condom educational campaign of the 1980s and the 1990s which had reduced the rate of HIV infection from 30 per cent in the 1980s to 6.4 per cent in the mid-1990s. In reward, Uganda was among the first countries to receive funding from PEPFAR. Foreign academic advisers (Hogel 2002), evangelical church leaders and political elites revised the AIDS control narrative and endorsed caveats against funding family planning, abortion and condoms. Sex education in and out of school and condom use became marginalised to the point of obscurity. In 2004, the existing successful American-funded condom-promoting AIDS prevention was dismantled when the government stopped the distribution of free condoms in clinics, and later imposed a tax on them. The new policy emphasis was on antiretroviral treatment. Sex education in schools was discouraged. Virginity-until-marriage pledges borrowed by advocates from the United States reinvented the wedding-morning virginity expectations. Young people are awarded cards and buttons, which they exchange for a ceremonial lantern on their wedding morning. Billboards promoting ‘condomising’ for survival were replaced by abstinence-pledging young people, and irresponsible women straying from the path of fidelity were ridiculed.

In this changed climate, those seeking PEPFAR funding capitulated. Project designers became skilled in self-censoring their experiential grassroots knowledge in favour of condom marginalisation. Concerns over rising infection rates because abstinence was not being practised were drowned by the din of revisionist scholars promoting ABC and blaming condom funders for creating a false sense of security for Africans (Green 2003).

(p.40) Concluding remarks

Uganda has received $1.7 billion from PEPFAR to fight AIDS, and drugs spent on the prevention of mother-to-child transmission are saving babies. However, the anti-condom education and the anti-abortion policies are moral punishment strings that collectively deprive sexually active people of protection against STDs and deny women access to reproductive health services.

The general preference for the behavioural-change sexual paradigm in ‘scientific’ and social-cultural discourses buttresses the PEPFAR sponsorship of sexual morality in Africa. In true ‘hidden persuaders’ (Packard 1957) style, the co-opted locals echo the din emanating from foreigners about the appropriateness and authenticity of ABC as the endogenous cultural formulation. However, AIDS is high politics and when ideology drives the dissemination of information, survival knowledge is compromised.

Current HIV/AIDS prevalence is reported at 7.3 per cent, an increase from 6.4 per cent in 2005. HIV is spreading most not among sex workers or youth, but among married people. Infection rates are higher in women (8.3 per cent) than in men (6.4 per cent), with one in ten women in their thirties infected, compared to one in ten men in their forties (New Vision 2012; New York Times 2012). Health experts want a return to the strong government leadership and effective public education campaigns that contributed to the reduction in infection rates during the 1990s and earned Uganda acclaim and vast amounts of money. Furthermore, they urge that reports of emerging resistant HIV strains locally are the result of increased risky behaviour. Fear of HIV has been eroded by perceptions that antiretroviral drugs are managing and even curing AIDS (Tenywa 2008); and increasing claims of religious miracle cures. Health experts demand a new aggressive campaign reinstating the public health message of safer sex with condoms on equal footing with chastity and fidelity depicted in the 1995 poster.

The discourse pushing solely the ‘partner reduction’ solution presents Africans with false dilemmas. The ‘abstain or die’ anti-condom policy is a tough Hobson’s choice relegating the 1990s Uganda success story to the ‘back to the future’ narrative.


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(p.41) Epstein, H. 2004. ‘The fidelity fix’, New York Times, 13 June.

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Green, E.C. 2003. Rethinking AIDS Prevention: Learning from Successes in Developing Countries. New York: Praeger.

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(1) I have been involved in anthropological AIDS research since 1989. My involvement is particularly focused on Action Research to empower youth and women with skills to negotiate safer sex and to challenge men into harnessing their social and cultural privileges to take responsibility for curbing the epidemic.

(2) The global impact of the American Ivy League universities-generated brand marketing theorising (Applbaum 2004