Liaisons fueling AIDS in Africa

Teenage girls are at the very center of one of the most heartbreaking scenarios now playing out in many parts of Africa. Young girls have up to 6 times the rate of HIV infection as boys of comparable ages. In parts of eastern and southern Africa, more than one-third of teenage girls carry the virus.

As deeply troubling is the way they are becoming infected — through what AIDS experts call “cross-generational sex.” Older, typically married, men seek young girls for sex in the belief that the younger they are, the less likely they are to carry the HIV virus.

Having a young girlfriend has come to be a sport, a way to gain status among men. Cross-generational sex has become a new cultural norm in parts of sub-Saharan Africa, and not just because of one-time seductions or coercions. Sometimes it is the girls who seek the “sugar daddies,” who reward girls with clothes, school tuition, food or small gifts.

One of many problems with this is that the younger the female, the more biologically vulnerable to HIV infection she may be. This seems to be due in part to the delicacy of the vaginal lining in immature females. Tiny tears and lesions occur during intercourse, especially if male partners are full adults and/or intercourse is coerced or forced.

Young girls are not only more likely to be HIV-infected, they are also more likely to infect others, in part because they are likely to be recently infected, meaning they will have higher “viral loads” and will be shedding viruses. Their partners then pass the virus on to their wives and perhaps future children.

Therefore, any action that protects girls from infection will pay great lifesaving dividends in the broader population.

It’s past time for our government leaders to get involved. The cross-generational sex issue cuts across the politics of morality that color the current highly polarized debate on how best to combat AIDS in Africa. Both faith-based organizations and others who champion abstinence programs, and organizations well-known for condom marketing like Population Services International, are in fact equally outraged by and concerned about these dangerous relationships and their tragic consequences.

President Bush’s global AIDS initiative will finally make antiretroviral drugs available in the countries targeted by this initiative (all but two are in Africa). But there still needs to be major emphasis on AIDS prevention, since many more lives will be saved through effective prevention than through treatment. Yet there cannot be effective prevention if we continue to tiptoe around sexual behavior and simply rely on risk reduction technologies.

We urge the Bush administration to include the prevention of cross-generational sex as a central component of its AIDS efforts, no matter how uncomfortable the idea makes some people.

Defenders of the current, unspoken hands-off policy worry that we must not become “moralizers.” Yet like it or not, rape, coercion and seduction of minors take us into the realm of right and wrong.

Ellen Goodman has wondered whether in the American transition from a more religious to a more secular society, we have somehow given ourselves a “moral lobotomy.” She asks whether our reluctance to being considered judgmental has “disabled [us] from making any judgment at all.” To advocate protection of highly vulnerable young girls is not unwarranted moralizing. It is both ethically right and life-preserving.

Changing sexual behavior is never easy, yet change is occurring in some African countries, notably in Uganda, the country with the greatest decrease in HIV infection rates.

Efforts must take place on at least three levels: individual, social normative, and legislative. This translates into communications campaigns that stress abstinence (for youth) and faithfulness to one partner (for everyone else), and implementation of a new generation of programs aimed at changing social norms that perpetuate cross-generational sex.

Uganda has dealt with the “sugar daddy” phenomenon in part through communications campaigns designed to bring public shame on middle-aged men who try to seduce or entice schoolgirls.

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