The poster is seen in Kenya. Below a lurid picture of a worm wriggling through a human heart, the caption reads: "Careless sex is a fruit with a worm in it. AIDS."
At the 10th International AIDS Conference in Yokohama in August, Dr. Yuichi Shiokawa put the sentiment in a different way. The African AIDS epidemic, he said, could be brought under control only if Africans restrained their sexual cravings.
But Professor Nathan Clumeck of the Universite Libre in Brussels is skeptical that Africans will ever do so. In a recent interview with Le Monde, Clumeck claimed that "sex, love and disease do not mean the same thing to Africans as they do to West Europeans because the notion of guilt doesn't exist in the same way as it does in the Judeo-Christian culture of the West."
Such myths about the sexual excesses of Africans are old ones.
Early European travelers returned from Africa bringing tales of black men allegedly performing carnal athletic feats with black women who were themselves sexually insatiable. The affront to Victorian sensibilities was cited alongside tribal conflicts and other "uncivilized" behavior to justify the need for colonial social control.
Today, AIDS researchers have added new, undocumented twists to an old repertoire: stories of Zairians who rub monkey's blood into cuts as an aphrodisiac; claims that ulcerated genitals are becoming widespread; and urban folklore about philandering East African truck drivers who get HIV from prostitutes and then infect their wives.
The World Health Organization claims that 10 million HIV-positive Africans are responsible for 300,000 cases of AIDS reported since 1981. On the face of it this seems to be a catastrophe. Unlike in developed countries, where over 90 percent of AIDS cases are homosexual males, intravenous drug users and blood transfusion recipients, African AIDS is supposedly suffered by men and women in equal numbers who contract it, presumably from heterosexual intercourse. The African figures are often cited by the AIDS establishment and safe sex activists in Europe and the United States to prove that "everyone" is at risk.
BUT INCREASINGLY, discrepancies about the dynamics of HIV transmission, skepticism about what really causes AIDS and mounting evidence of imprecise medical diagnoses are stirring up a backlash among African scientists. They argue that in Africa AIDS is not a contagious epidemic linked to sexual habits but is the new name for old diseases that result from inadequate health care, widespread malnutrition, endemic infections and unsanitary water supplies. Dr. Richard Chirimuuta of Zimbabwe notes sarcastically that in order to have one-third of the sexually active adults in some central and east African countries infected with AIDS, "life in these countries must be one endless orgy."
A growing number of African physicians including Dr. Mark Mattah (Midland Center for Neurology in England), Dr. Sam Okware (former director of AIDS research in Uganda) and Dr. P.A.K. Addy (director of clinical microbiology in Kumasi, Ghana) say they think the panic over the heterosexual transmission of AIDS may be a hoax. Dr. Felix Konotey-Ahulu, a Ghanaian physician at London's Cromwell Hospital, toured Africa countries a few years ago to assess the "epidemic." In a scathing report for Lancet, Dr. Konotey-Ahulu asked, "If tens of thousands are dying from AIDS (and Africans do not cremate their dead), where are the graves?"
Some Western scientists, including Dr. Luc Montagnier, the French virologist who discovered HIV, claim that the practice of female circumcision facilitates the spread of AIDS. How do they explain the fact that Somalia, Ethiopia, Djibouti and Sudan, where female circumcision is the most widespread, are among the countries with the lowest incidence of AIDS?
In fact, there is little evidence to support Western perceptions of African sexual promiscuity. Widespread modesty codes for women, whose sexuality is considered a gift to be used for procreation, make many African societies seem chaste compared to the West. The Somalis, Afars, Oromos and Amharas of northeast Africa think that public displays of sexual feelings demean a woman's "gift," so that sexual contacts are restricted to ceremonial touching or dancing. Initial sexual relationships are geared to the beginnings of making a family. The notion of "boyfriends" and "girlfriends," virtually universal in the West, has no parallel in most traditional African cultures.
No one has ever shown that people in Rwanda, Uganda, Zaire and Kenya-the so-called "AIDS belt"-are more active sexually than people in Nigeria, which has reported only 722 AIDS cases out of a population of 100 million, or Cameroon, which reported 2,870 cases in 20 million. Scientists dismiss the notion that males from any continent or region are more addicted to sex than those from another because testosterone levels, the measure of sexual vigor in men, never vary more than a tiny fraction of a percent anywhere in the world.
IN 1991, researchers from the French group Medicins Sans Frontieres and the Harvard School of Public Health conducted a survey of sexual behavior in the Moyo district of northwest Uganda. Their findings revealed behavior that was not very different from that of the West. On average, women had their first sex at age 17, men at 19. Eighteen percent of women and 50 percent of men reported premarital sex; 1.6 percent of the women and 4.1 percent of the men had casual sex in the month preceding the study, while 2 percent of women and 15 percent of men did so in the preceding year.
No national sex surveys have ever been carried out in Africa, yet AIDS researchers blithely assume that heterosexual HIV transmission in Africa parallels the dynamics for HIV among homosexual men in the West. There is no scientific basis for this. Because female-to-male transmission of HIV is extremely difficult, AIDS has never "exploded" into the heterosexual populations of the U.S. and Europe, even though condom-less sex remains the norm.
From 1985 to 1991, Dr. Nancy Padian and her associates studied 72 HIV-negative male partners of HIV-infected women. As reported in the Journal of the American Medical Association (1991), they found only "one probable instance" of female-to-male transmission. As for sexual transmission in general, a definitive study in the British Medical Journal (1989) by the European Study Group on AIDS concluded that the only sexual practice leading to an increased risk of HIV infection for men or women was receptive anal intercourse.
Even the definition of AIDS differs from one continent to another. In Europe and America, AIDS-defining diseases include 29 unrelated maladies ranging from pneumocystis carinii pneumonia and pulmonary tuberculosis to cervical cancer. In addition, an HIV-positive test and a T-cell count below 200 are necessary for a confirmed diagnosis.
But in Africa, the term "AIDS" is used to describe symptoms associated with a number of previously known diseases. In the mid-1980s, those common diseases were suddenly reclassified as "special opportunistic AIDS-related infections" and Africans were warned to change their sexual practices through abstinence, monogamy and condoms-or they would die.
Hilarie Standing, a British medical anthropologist and AIDS researcher, concedes that African "risk populations are assumed rather than revealed." So why are AIDS cases in Africa nearly evenly divided between men and women? The answer lies in the World Health Organization's definition of "AIDS" in Africa which differs decisively from AIDS in the West. The WHO's clinical-case definition for AIDS in Africa (adopted in 1985) is not based on an HIV test or T-cell counts but on the combined symptoms of chronic diarrhea, prolonged fever, 10 percent body weight loss in two months and a persistent cough, none of which are new or uncommon on the African continent.
HIV TESTS are notoriously unreliable in Africa. A 1994 study in the Journal of Infectious Diseases concluded that HIV tests were useless in central Africa, where the microbes responsible for tuberculosis, malaria and leprosy were so prevalent that they registered over 70 percent false positive results.
Furthermore, everything we know about viruses tells us that they are equal opportunity microbes. They will attack men and women weakened by malnutrition, the most effective cause of immune suppression. Venereal diseases left untreated can also impair one's immunity, rendering any victim susceptible to other infections. Africans are often assumed to die from "AIDS-like" symptoms after their immune systems have been weakened by malaria, tuberculosis, cholera or parasitic diseases.
By calling these deaths "AIDS" and claiming there is a new epidemic in Africa, are health officials from the West, perhaps unwittingly, helping to provide opportunities for development agencies, biomedical researchers and pharmaceutical companies who clamor for more money and markets? Certainly, promulgating the idea that AIDS is an epidemic caused by sexual promiscuity will deepen Africa's dependency on Western aid for diagnostic tests, high-tech sterilization equipment and medical personnel.
Another consequence of having millions of Africans threatened by AIDS may be to make it politically acceptable to use the continent as a laboratory for vaccine trials and the distribution of toxic, anti-HIV drugs like AZT. Vaccine experiments in the United States have been curtailed due to government regulations and fear of lawsuits from research-related injuries. However, according to a 1994 Rockefeller Foundation report, "Accelerating Preventive HIV Vaccines for the World," risky HIV vaccine trials would be tolerated-even welcomed-in African countries.
Because of the extraordinary time lag between HIV infection and onset of "AIDS"-now set at six to 12 years-AIDS activists warn that their awareness campaign will require many years of active government intervention and funding to overcome resistance to behavioral changes.
These new missionaries with their messages of safe sex seem especially preoccupied with changing men's behavior. They want to turn African women into "gatekeepers" who negotiate sexual relations and risk-reduction strategies. At the Yokohama AIDS conference and the recent U.N. Conference on Population and Development in Cairo, feminists insisted that AIDS would be halted only when women were empowered to reduce inequalities by creating "networks" that enhanced gender sensitivity and prevented sexual victimization.
IT IS the political economy of underdevelopment, not sexual intercourse, that is killing Africans. Poor harvests, rural poverty, migratory labor systems, urban crowding, ecological degradation and the sadistic violence of civil wars imperil and destroy far more African lives. When essential services for water, power and transport break down, public sanitation deteriorates and the risks of cholera and dysentery increase. African poverty, not some extraordinary sexual behavior, is the best predictor of AIDS-defining diseases.
AIDS skeptics should scrutinize ethnocentric stereotypes about African sexuality and thoroughly reappraise the entire HIV=AIDS orthodoxy. The purported link between HIV and AIDS was only hypothesized 10 years ago but it has subsequently acquired a life of its own, especially among fund raisers and sex educators who, like the theory, remain immune to criticism.
Of course, people everywhere should be encouraged to behave more thoughtfully in their sexual lives. They should be provided with reliable counseling about condom use, contraception, family planning and venereal diseases. But whether in Cameroon or California, sex education must no longer be distorted by terrifying, dubious misinformation that equates sex with death. *
Dr. Charles L. Geshekter is a professor of African history at the California State University, Chico.