Or Talbott’s Research Grows Legs …
Halperin, Gray, Bailey and Auvert (have I missed anyone?) may scoff, but Zimbabwe shows the signs of Talbott’s theory [html, pdf] in action albeit imposed by forces outside of Western aid agencies. Zimbabwe has a falling HIV infection rate because female prostitutes are too expensive for men so-inclined due to 4000% inflation. Remove or reduce prostitutes or the politer version, mistresses, and look what happens: infection goes down. Of course, I don’t support suppressing prostitution necessarily, but rather regulation and licensing would seem a reasonable first step.
It’s absurd to think that hardship has come to play a role in curbing an epidemic. But that appears to be the case. A secondary but no less important lesson here is that predicting what will work, even with studies supporting one course or another, can be perilous — in this particular case, due to the longstanding belief that poverty is a marker for high infection rates. In the case of circumcision, separating the many factors may well be impossible.
Further irony? If they can’t afford prostitutes, they won’t be able to afford circumcisions either — unless the West swoops down in do-gooder fashion and provides the now useless service for free. If that happens, they damn well better provide economic development aid to make it worth it.
Story after the jump.
Zimbabwean inflation helps curb HIV rate:
Researchers trace drop in infections to men’s inability to pay for mistresses, prostitutes
CHITUNGWIZA, Zimbabwe–It’s not only the prices of bread and eggs that are out of control in Zimbabwe, land of 4,000 per cent inflation. For the man inclined to cheat on his wife, these are trying times.
Keeping a mistress, visiting a prostitute or even taking a girlfriend out for beers is simply becoming too expensive, men say.
But their strain is Zimbabwe’s gain in its fight against AIDS. Alone among southern African countries, Zimbabwe has shown a significant drop in its HIV rate in recent years. A major reason, researchers say, is the changing sexual habits of men forced to abandon costly multiple relationships.
“Those extramarital relationships, they’re getting tough to sustain,” said Thomas Muza, 37, who is struggling to support his wife and a mistress on the shrinking value of a math teacher’s paycheque. Worth $50 (U.S.) a month at the beginning of June, it’s now worth $17 and falling almost every day.
AIDS activists and some researchers long blamed the continent’s high poverty rates for its unusually widespread HIV epidemics, arguing that poor medical care and hunger made Africans especially vulnerable to the virus, while financial need accelerated its spread by pushing women into prostitution.
Yet Zimbabwe’s experience shows that the connection between AIDS and economics is not nearly so straightforward. The country has made strides against HIV during eight years of steep recession. Wealthier neighbours such as South Africa and Botswana, meanwhile, have struggled to curb new infections despite much higher
levels of development and massive spending on the disease.
Many researchers now suspect that economic vitality – expressed in rising truck traffic, burgeoning bar scenes and widening income disparity – encourages the behaviours that fuel a sexually transmitted epidemic. But as men get poorer, they pare back their relationships, making them less likely to contract or spread HIV.
AIDS remains severe here, with an estimated one in five Zimbabwean adults infected with the virus that causes the disease, but surveys show the number of new infections has fallen. Men report fewer girlfriends, fewer visits to prostitutes and less casual sex – all indicators that in other countries have accompanied a retreating epidemic.
Nightclubs, cinemas and brothels have closed in Harare, the capital, and in some cases evangelical churches have taken over the buildings. Less visibly, men say they are abandoning what Zimbabweans call “small houses,” a legacy of the polygamous marriages once common here.
In these relationships, married men pay rent and other living expenses for a second or even third regular sex partner. As in marriages, condoms rarely are used, creating webs of unprotected sex easily infiltrated by HIV if the man or any of the women become infected.
“Having a lot of girlfriends or having `small houses,’ you’ve got to have a degree of disposable income,” said Godfrey Woelk, an epidemiologist at the University of Zimbabwe. “Being poor and being in love does not really work, no matter what the romantics say.”
Muza once was part of Zimbabwe’s broad middle class that also included the bureaucrats, engineers and factory managers whom the country’s schools, once the best in Africa, turned out by the tens of thousands.
Now these same men find prices rising so much faster than their salaries that many are slipping below the poverty line.
Muza earns 2.5 million Zimbabwean dollars a month teaching, and about half goes to the rent, groceries and other expenses of his “small house.”
“It’s very difficult,” Muza said softly, his voice trailing off.
Among the initial skeptics about the falling HIV rate was Zimbabwean AIDS researcher Exnevia Gomo. He recalled the early speculation: Perhaps it was caused by a surge of death in the absence of effective treatment.
Or maybe the exodus of young, well-educated people to other countries explained the trend.
But several studies show that shifts in sexual behaviour drove the HIV decline in Zimbabwe. This finding echoes the changes experienced in Uganda during the early 1990s, when its rate of new infections fell sharply.
“That behaviour is changing significantly is clear,” Gomo said from Blantyre, Malawi, where he teaches at the University of Malawi’s medical school. “The question is: What has caused that change?”
With unemployment estimated at 80 per cent, trading sex for money remains an appealing choice for some women, said Tsitsi, a sassy 23-year-old who gets about $75 a month from her married businessman boyfriend.
“He’s like an ATM,” Tsitsi said. “You just go and punch money and it comes out.”
But such relationships are getting harder to find and maintain, she said. When a man gets low on cash, “he’ll just take care of his wife.”
Timberg, Craig. Zimbabwean inflation helps curb HIV rate: Researchers trace drop in infections to men’s inability to pay for mistresses, prostitutes . The Toronto Star [Originally published in The Washington Post]. July 16, 2007.
[Dead link] http://www.thestar.com/printArticle/236278