Marriage When Kills
By Nicholas D. Kristof
New York Times
March 30, 2005
http://www.globalpolicy.org/socecon/develop/aids/2005/0330marriagekills.htm
Sex kills all the time, particularly here in Africa. But prudishness can be just as lethal. President
Bush is focusing his program against AIDS in Africa on sexual abstinence and marital fidelity,
relegating condoms to a distant third. It's the kind of well-meaning policy that bubbles up out of a
White House prayer meeting but that will mean a lot of unnecessary deaths on the ground in Africa.
The stark reality is that what kills young women here is often not promiscuity, but marriage. Indeed,
just about the deadliest thing a woman in southern Africa can do is get married.
Take Kero Sibanda, a woman I met in a village in Zimbabwe. Mrs. Sibanda is an educated woman and
lovely English-speaker who married a man who could find a job only in another city. She suspected
that he had a girlfriend there, but he would return to the village every couple of months to visit her. "I
asked him to use a condom," she said, "but he refused. There was nothing I could do." He died two
years ago, apparently of AIDS. Now Mrs. Sibanda worries that she and her beautiful 2-year-old
daughter, Amanda, have H.I.V. as well.
Encouraging more use of male and female condoms might reduce such tragedies, for there's a
disdain for condoms in many countries that social marketing might change (there's an African
saying: "Who wants a sweet with the wrapper still on?"). The fact is that condoms have played a
crucial role in the campaigns against AIDS that have been relatively successful, from Thailand's
"100 percent condom program" to the efforts in Uganda, Cambodia and Senegal. And condoms
don't cause sex any more than umbrellas cause rain.
In theory, everybody agrees on how to prevent AIDS: the ABC method, which stands for abstinence,
being faithful and condoms. But the Bush administration interprets this as ABc. New administration
guidelines stipulate that U.S.-financed AIDS programs for young people must focus on abstinence or
, for those who are already sexually active, "returning to abstinence."
Here in Livingstone, Zambia, I visited Corridors Hope, of a U.S.-financed center for young people that
has proved cheap and effective in reducing H.I.V. among prostitutes and long-distance truck drivers.
One prostitute in the program is Mavis Sitwala, an orphan (probably because of AIDS) who is supporting
her five siblings and one child. She says that truck drivers pay $1 for sex with a condom or $4 for sex
without. "At times, you need food or money to pay the rent," she said, "and so even if he won't use a
condom, you agree."
Encouraging Ms. Sitwala to "return to abstinence" isn't likely to get far, but encouraging more use of
condoms might save her life, the lives of her clients and the lives of her clients' wives. Indeed, the Bush
administration recognizes that, allowing condoms to be handed out to prostitutes in programs like
Corridors of Hope - but not to society as a whole. There's a bit of wiggle room in the administration
guidelines. But the U.S. Center for Health and Gender Equity reports that in several countries, the U.S
. is already backing away from effective programs that involve condoms.
The irony is that President Bush's plan to tackle AIDS in Africa - spending far more than any previous
administration - could be one of his best and most important legacies. It tackles one of the most i
mportant humanitarian challenges in ...