In The Invisible Cure: Africa, The West and the Fight against AIDS, Helen Epstein suggests that “What may have helped spare the West a heterosexual AIDS epidemic on the scale of Africa’s is the romantic belief that there is a”perfect partner” , a “soul mate”, to be cherished “for richer or poorer” – if not for life, then for a long time.”

This is a rather convincing argument. Epstein built here on some serious research made in collaboration with Population Service International (PSI) and previously published in Health and Policy development. What is important to understand is that HIV infectious power is at its highest in the following weeks after a person is being infected. As time passes, the viral load (amount of virus in the blood and semen) decreases for some time until AIDS kicks out.

The original research supported “the idea that a tradition of polygamy, along with widespread poverty-especially among women-has give rise to a system of sexual networking in which a significant number of men and women have a small number -perhaps two or three-ongoing sexual partnerships at a time, and this links people up in a giant web of relationships that is extremely conducive to the spread of HIV.”

“Such widespread “concurrent” partnering -in which a relatively large proportion of people are having regular sexual contact with more than one person-creates ideal conditions for the spread of HIV. If only one member of such a network becomes infected, everyone else in the network will become infected very rapidly, as if they were all on a “superhighway” for the virus.”

And this is how western romanticism may have protected us from an epidemic on the scale of that in Africa. By limiting the number of concurrent relationships we have we reduce the chance of infecting or being infected by HIV+ partners. It is not about promiscuity, it is all about timing. This is sometimes difficult to understand as demonstrated by a comment left by a reader on the Guardian Website:

“The chance I contact HIV from sensible, unprotected sex is in the neighbourhood of one in a quarter of a billion. Nobody has yet disputed that. So the conclusion seems to be: If you are just an ordinary guy, don’t ever let fear of HIV make you put on a condom” writes ErikD, who did not understand that:

1. It may well be one chance in a quarter of a billion (which it is definitively not!), but this chance maybe the next time ErikD has unprotected sex. Probability are concerned with risk, not with time.
2. ErikD may behave sensibly but what does he know about his sexual partners and the sexual partners of his partners.

When we fail to grasp these two fundamental concepts, faithful wives who never leaved the safety and isolation of far and remote villages in the African country side, end up having the same risk and rate of HIV infection than sex workers in busy townships.

Other comments left by lazy-readers (those who did not bother doing a bit of research) suggest that Epstein would be a proponent of abstinence-only programme. This is not the case, as she wrote in the New York Review of Books:

“Cheerful, sexy condom ads that fail to address the real dangers of AIDS may promote a fatal carelessness; but an exclusive emphasis on abstinence until marriage may well lead to an even more dangerous hysterical

recidivism. The genius of the Zero Grazing campaign [in Uganda] was that it recognized both the universal power of sexuality and the specific sexual culture of this part of Africa, and it gave people advice they could realistically follow.”

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