Intergenerational Sex and Marriage: Just Another HIV Myth?

9 Mar

[Cross posted from Don’t Get Stuck With HIV site.]

In 2007 the Population Council published an article on early marriage and HIV in Kenya. There’s nothing surprising about a eugenicist or ‘population’ NGO taking a close interest in such matters, of course, and the Population Reference Bureau published an article about cross-generational sex in various Africa countries in the same year. Both articles express concern about these phenomena potentially posing a risk for HIV transmission.

What is surprising is the figures used by the Population Council, listed below. The province where early marriage is most common, Northeastern, is the province where HIV prevalence is lowest, by a long shot. Early marriage is also less common in Nairobi, where HIV prevalence is second highest in the country. Where HIV prevalence is highest, Nyanza, early marriage is not particularly common. At least, there is no noticeable correlation between the phenomenon and HIV prevalence.

% married by 18 years HIV prev 08-09*
Northeastern 56 0.9
Eastern 16 3.5
Coast 34 4.2
Central 15 4.6
Rift Valley 35 4.7
Western 32 6.6
Nairobi 12 7
Nyanza 34 13.9

The relevant table is 14.5, page 217

In fact, these NGOs should have been very suspicious. HIV prevalence often tends to be higher among wealthier, better educated, urban dwelling, employed people, whereas intergenerational sex and marriage may be more closely associated with poorer, less well educated, rural dwelling, unemployed people.

So it is significant that AidsMap reported a presentation at the 21st Conference on Retroviruses and Opportunistic Infections (CROI). This presentation suggests that “Sex with older men is not placing women under 30 at higher risk of HIV infection in rural South Africa, and relationships with older men may even be protecting women over 30 from infection“.

The author of the study suggests that programs addressing relationships between older men and younger women may even stigmatize men and women in such relationships. But stigmatizing people with, or thought to be at risk of, HIV is something NGOs and international health institutions have never shied away from.

The media will be disappointed because they have enjoyed years of talking about sugar daddies and sugar mummies, which fits into the ‘all men are bastards, all women are victims’ paradigm of HIV transmission, and their concomitant assumptions that African men will do anything for sex and African women will do anything for money.

Many population (and eugenicist) NGOs generally also claim an interest in ‘reproductive health’, but their agenda often seems to veer towards matters that have little to do with health, and activities that have little to do with human rights. But for those that really are interested in health, there is another set of figures they may be interested in.

HIV prev 08-09 Medical supplies for common delivery complications
Northeastern 0.9 52
Eastern 3.5 61
Coast 4.2 59
Central 4.6 77
Rift Valley 4.7 49
Western 6.6 38
Nairobi 7 81
Nyanza 13.9 25

The Service Provision Assessment for Kenya for 2010 (Table 6.7, page 136) finds that only 25% of health facilities in Nyanza Province have essential supplies for common complications relating to child delivery, which means 75% of facilities lack “Needle and syringes, intravenous solution with infusion set, injectable oxytocic, and suture material and needle holder all located in delivery room area; oral antibiotic (cotrimoxazole or amoxicillin) located in pharmacy or delivery room area”.

With the highest HIV prevalence in Kenya, the fact that 46% of hospitals in Nyanza do not have all essential supplies for delivery, which refers to “Scissors or blade, cord clamp, suction apparatus, antibiotic eye ointment for newborn, skin disinfectant”, the Population Council and Population Reference Bureau may like to take a look at unsafe healthcare, now that intergenerational sex and marriage seem so much less of a priority now.

Again, these NGOs should also have noticed something important about HIV prevalence often being more closely associated with wealthier, better educated, employed, urban dwelling people: access to health facilities is also generally far higher among these groups. When poorer people with less education, those without formal employment and those who live in isolated rural areas do have access to health facilities, those facilities may turn out to be pretty unsafe. But that’s a matter for research that these NGOs haven’t yet carried out (or perhaps they just haven’t published it).

Ever-eager to snatch defeat from the jaws of victory, those who subscribe to the (eugenicist) population control theory of development in Africa, whether covertly or overtly, continue to receive generous funding. They don’t wish to lose any ground when it comes to pandering to the prejudices of those who still believe that Africans have loads of unsafe sex, and that this is why HIV prevalence is so much higher there. Yet, funding for unsafe healthcare always seems to put donors off their morning read, which is evidently when they set their funding priorities.

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