Infections are down, but our sexual behaviour is a worry

Last week, SA participated in the biennial International Aids Conference in Washington. Given our recent gains in the fight against HIV, we received acclamation from the international community. Mother-to-child transmission of HIV is down from 8 percent in 2008 to 2.7 percent in 2011.

At least 1.7 million people are now receiving treatment, up from 900 000 two years ago. HIV prevalence among pregnant women attending public health facilities is stable at about 30 percent.

Twenty million tests have been conducted since the voluntary HIV counselling and testing campaign started in April 2010.

Before this, an annual average of 2 million tests was recorded. Fewer babies are getting infected post- birth as breastfeeding mothers are put on treatment.

In 2008, HIV prevalence in women aged 30 to 39 was estimated to be between 22 and 25 percent compared to 15 to 22 percent for males of the same ages (using prevalence levels adjusted for antiretroviral therapy).

For females aged between 20 and 24, prevalence levels stood at 19 percent compared to 5 percent for males in the same age group.

What this means is that my eccentric girlfriend, who is 24, might be HIV negative and may remain so if she continues to demand test results and condoms.

In the Know Your Epidemic Report from which these figures are derived, we learn that the vulnerability of people older than 30 increases due to extended period of sexual activity with different partners.

Like me, my banker partner is not as worried about HIV infection as she is about another child out of wedlock. This may explain our liberal disposition towards condom use. While aware of the possibility of infection, we were ready to have unprotected sex. After all, my lady is on birth control pills.

This is contrary to the stigma that younger free-spirits are the ones most likely to be infected. For the Model C generation, different social and economic considerations may be influencing their sexual health considerations.

Hence the reported stabilisation of prevalence rates among people in their late teens to mid-twenties, such as the one who banged my bedroom door and exclaimed: “Hell no! No condom, no sex. No HIV certificate, no sex, thank you!”

SA launched a revised Aids plan in December last year. The new plan recognises the need to consolidate the gains made in curbing mother-to-child transmission and providing treatment to people with viral loads of 350.

The plan moves us to new frontiers where we must confront rising infection rates among the most productive members of our population – those in their late twenties and mid-thirties.

It reminds us that Aids is not just a pandemic affecting the poor and the marginalised.

Necessarily, the plan emphasises prevention as the most potent weapon in the fight against Aids.

Consequently, safe sex messages must change given the multi-class nature of the audience as well as complex social determinants driving the pandemic.

The message from the International Aids Conference is clear: we must intensify our efforts to turn the tide against HIV, Aids and TB. We must move beyond biomedical science and investigate social science – real-life experiences that increase vulnerability to HIV.

We must ask, and seek answers to, why infection rates increase even among the most educated and upwardly mobile people.

What social pressures affect the middle class to the extent that they readily exhibit risky sexual tendencies, much like the least educated and marginalised population groups that are exposed due to sexual violence, poverty and inter-generational sex?

A false sense of invincibility exists that “this won’t happen to me”, or “surely this banker can’t be HIV positive”, or “let us just enjoy sex unencumbered by intermediaries like condoms”.

Social and behavioural scientists must study this phenomenon to realign strategies in response to what statistics tell us about the incidence and prevalence trends.

Zero infections remain our goal. An Aids-free generation is possible. But we need bold steps by individuals, organisations, communities and stakeholders to spread the message, and to live by it, that safe sex is the way to go and knowing your status is a prerequisite for unprotected sex, in addition to faithfulness.

This is a choice individuals make, including my drunkard friend who “scored” at a birthday party. After a one-night encounter of unprotected sex, he spent an entire Sunday in pharmacies looking for the morning-after pill and post-exposure prophylaxis.

I know him. The morning-after pill is his contraception; post-exposure prophylaxis his condom.

As for my misfortunes, I have no one to blame but myself. I should have known better. I should have been prepared.

I do not know the status of my banker lady. She does not know mine.

That we did not have sex is sheer chance, not occasioned by the absence of condoms. Accounts of history got us emotionally drained to the point of being content with cuddling.

I did not have sex with the engineer because we agreed on its irrationality in the absence of knowing each other’s status and without her preferred brand of condoms. Next time!

n Ngcaweni is a public servant writing in his personal capacity.