By Melanie Kirsh
HIV is often thought of as a global health issue that disproportionately affects people of color, regardless of income. This may be a result of inaccessibility to HIV education and effective interventions, or of the negative social factors that contribute to higher likelihood of unsafe sexual practices within the population. ABC programs (abstinence, being faithful, and condom use) were rolled out in sub-Saharan Africa in the 1990s; in Uganda, these programs resulted in significant declines in HIV prevalence. Despite this success, other sub-Saharan African countries’ HIV continues to affect women at disproportionate rates. In her book, Love, Money, & HIV: Becoming a Modern African Women in the Age of AIDS (2014) Sanyu A. Mojola illuminates the socioeconomic and environmental factors that may explain why her home province of Nyanza, Kenya demonstrates rates of HIV/AIDS that are much greater among young, wealthier women in comparison to men of the same age group and poorer women. She argues that the engagement in modern consumption and their perceived need to consume items like makeup, clothing, and feminine hygiene products contribute to their increased vulnerability to contracting the virus. In order to purchase these items, they need money, but since they are much less likely to be employed or receive substantial financial support from their families, they rely on relationships with men (Mojola 2014). Intimate heterosexual relations become complicated with social norms in regards to condom use: even though youth are taught about condom use, their behaviors do not reflect this education. Mojola’s male subjects believe that condoms may be uncomfortable or may (falsely) indicate that the woman is sleeping with other people (2014). This stigma, in combination with concurrency that men practice around the Lake Victoria region, results in the women’s increased risk of contracting HIV. Due to the quotidian nature of female hygiene product consumption, and the implicit need to aspire to European beauty standards with makeup and clothing that impresses their peers, women engage in transactional relationships that expose them to HIV/AIDS. In short, modernity is killing them.
I had the pleasure of meeting Mojola recently, as her book was assigned for a seminar of mine called Contemporary Debates on Sexualities Research. The professor pooled questions from the class prior to Mojola’s arrival, and one of my questions regarded my intrigue with her book’s lack of discussion on Pre-Exposure Prophylaxis (PrEP) as an alternative preventative measure for the young women. Mojola expressed skepticism about the effectiveness of such an initiative, because PrEP requires the person at-risk to follow a diligent schedule, with 100% compliancy, and this is extremely difficult to achieve –especially in a setting like sub-Saharan Africa where resources are already limited and sexual education programs are insufficient. A PrEP study conducted in Kenya, South Africa, and Tanzania from 2009-2011 confirms this, as the study was halted due to female participants’ weak adherence and the poor efficacy that resulted (Damme et al. 2012). Mojola explains that in order for women to be compliant, they need to perceive themselves as ‘at-risk’ in the first place. However, these women do not think they are at risk of contracting HIV because of the perception that sex without a condom signifies the man is not having sex with other women. So, the cycle begins again and preventative measures are tainted with the conflation of trust = love = sex without a condom.
Evidently, the typical ABC programming that advocates for seemingly practical behavior changes has failed the young women of Mojola’s native country. Not all young people abstain from sexual activity, faithfulness is challenged by the concurrency and polygamy in which men and women engage, and condoms increases false suspicion that one’s partner is not faithful or trusting. Given Mojola’s findings and skepticism of alternative preventative initiatives, it is clear that eliminating the HIV epidemic among young women (particularly those in Nyanza, Kenya) would involve a complicated untangling of modern Westernized feminine beauty ideals, deconstruction of gendered economies that disadvantage young women and girls, and increasing access to menstrual products (this would keep girls in school and encourage economic autonomy). It is time to introduce and implement a redefined ABC programming that goes beyond education. It looks like this:
Of course, this involves a major overhaul of the socioeconomic structures in Kenya and other sub-Saharan African countries. But, Mojola’s work provides us with the understanding that women’s current economic position in conjunction with the initial results of ABC campaigns is killing them. Such an economic overhaul is long overdue.