In Sizwe’s Test (originally entitled Three Letters Plague), author Jonny Steinberg recalled his deep feeling of shame associated with his first HIV test. Discussing his experience with a psychotherapist friend, she found an analogy with how pregnant women were prohibited to appear in public three or four generations ago as they would have been a huge source of shame.

“What was the root of that shame? What was it that had to be concealed? It is not the fact that she has sex. Everyone knows she has. It is the external manifestation of the sex she has had that must be hidden. The bulge in her stomach shouts out: what you have done is manifest now, what you have done is known; your guilt is now on public records.”

Nowadays in some countries like Thailand though there is not policies preventing pregnant teenagers or university students to attend school there is still a strong social pressure for young women to leave school once they become pregnant.

But what is it that a pregnant women or someone who goes for an HIV test is guilty of? “Of being gluttonous, of being disgustingly greedy. Of being shameless”. But being gluttonous and greedy of what wonders Steinberg. His answer is quite simple: “sex”.

Hence this is all it boils down to: having sex is being greedy, having sex is being shameless, having sex is being selfish; it is stealing pleasure that one is not entitled to because carnal pleasure is a danger for society and therefore must be strictly morally controlled.

For a breathtaking interpretation of fornication see Embassy of Heaven

The Bible makes fornication a sin. It is a sin against God (as is drunkenness), a sin against one’s fellow man, a sin against one self, a sin against the soul, a sin against one’s family, a sin against society. The Qur’an describes fornication (zina) as one of the biggest sins and greatest transgressions and condemns the fornicators to lashing and stoning. The Bhagavad Gita considers that fornication leads to a confusion of castes, degradation of family values and social disorder and condemns the fornicators to a future life as a creeping insect. The Buddhist scriptures, with the qualified exception of Tantric Buddhism, defines sex as an unwholesome activity.

Hence those who go against these religious precepts that have been translated and integrated into many common laws until recently and are still part of the law in some countries, are condemned to public shame and opprobrium if not public stoning. No surprise that with such a deeply rooted social condemnation and atavistic repressive attitude towards sexual pleasure it is so difficult to get people to test for HIV.

Botswana has the second highest adult HIV prevalence in the world after Swaziland with an estimated prevalence of 23.9% in 2006 (UNAIDS). Since 2000, the Government of Botswana has supported a network of Voluntary Counselling and Testing centres (VCT), and since the beginning of 2004, HIV tests have been offered as a routine part of check-ups in public and private clinics in Botswana. Despite being an African example to follow, only a small percentage of the population is prepared to be tested for HIV, stigma being the main obstacle to testing.

In a study examining the impact of treatment access on HIV stigma in Botswana 3 years after the introduction of a national program of universal access to antiretroviral therapy, Wolfe and colleagues observed that of 1268 adults surveyed in Botswana in 2004, “38% had at least 1 stigmatizing attitude: 23% would not buy food from a shopkeeper with HIV; 5% would not care for a relative with HIV. Seventy percent reported at least 1 measure of anticipated stigma: 54% anticipated ostracism after testing positive for HIV, and 31% anticipated mistreatment at work.”

Sex and shame. Like pregnancy, HIV has the potential to expose our shame and guilt and it does not even need to be visible. Being seen attending a VCT centre, spending too much time in one such centre, being seen coming out of a centre with a provision of ART even if they are given in an unmarked bag will raise suspicion particularly in small community where people have much opportunities to watch others (this is particularly well described in Steinberg book). Our shame and guilt is indeed on public record.

If some think this is an attitude limited to Africa or developing countries think twice. As a volunteer for an organisation catering and delivering food for people living with HIV and AIDS I have been delivering food in white unmarked carrier bags and when calling on an inter-phone I used not to mention for whom the delivery was or even what it was.

The fight against HIV does not start with fighting the disease, 25 years of research have led to the development of efficient treatment that can so far control the progression of the disease. Fighting HIV starts in our mind, fighting centuries of criminalisation of sex, fighting external forces trying to control one’s body, fighting public perception of a social construction of a crime that is not.

The fight against HIV starts by fighting our own shame, so that we don’t impose it on others.

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