Combating HIV: testing the ideas

HIV, the virus that causes AIDS, is a global problem. Sub-Sahara Africa has been particularly hit hard and the prevalence in adults reached 25% at the peak of the epidemic in Zimbabwe.

Behavioural changes by men have helped lower the HIV prevalence rate to around 13%. There is still some way to go.

There has been a recent explosion of ideas in Zimbabwe of how to combat the spread of the deadly virus, HIV. A few of the recent suggestions caught my attention. Are we about to reach that eureka moment?

Every little helps, but doing a bit of research and reflection before airing your idea could be helpful. Lessons need to be learnt from the current president of South Africa, Jacob Zuma, who shocked the world by suggesting that washing after sex can reduce the risk of acquiring HIV. Under cross-examination in a trail for allegedly raping an HIV positive woman, Zuma said that he took a shower afterwards because “it was one of the things that would minimise contact with the disease.”

At first glance the idea sounds plausible. But is there any evidence that taking a shower after sexual intercourse reduces risk of contracting HIV?

If Zuma had read the study from Uganda prior to his sexual adventures, he would not have wasted his precious time by rushing for a quick refreshing shower after sex. Instead of going for a shower, I suggest to him that the next time he gets entangled, afterwards he should kneel down and pray, “Lord I am coming”.

Washing your manhood after unprotected sex increases the risk of acquiring HIV. The sooner you wash, the greater the risk of becoming infected. This information could be too late for Zuma.

Sex education and condom distribution in schools is always hotly debated. Emotions will invariably end at a boiling point, if not an exchange of blows. There will always be people who bury their heads in sand and those who take a pragmatic approach.

In South Africa, research showed that more than 10% of young people between the ages of 10 and 13 are sexually active and about 27% thought that HIV infection can be prevented by bathing after sex. Many young girls believe that the contraceptive pill can also prevent the transition of HIV.

Is there evidence that providing condoms to school children actually reduces the spread of sexually transmitted diseases and HIV? While making condoms available in schools always provokes emotional debates, there is growing evidence of the positive effects of such programmes on students’ sexuality and demeanours.

A study in America showed that condom availability appears not to increase sexual activity among high school students which a lot of parents fear. It led to improved condom use among males, which reduces the risk of sexually transmitted infections and unwanted pregnancies.

With or without a condom, if your child decides to have sex at any age, they will do it. Although hard to swallow, a condom compartment in the book and pencil case may save your child’s life.

A Zimbabwean Senator Sithembile Mlotshwa suggested a prescription of monthly sex and an injection to reduce the lasciviousness of the randy males. I am a bit puzzled by how she came up with once a month timetable instead of weekly or annually or even never? Who will keep, monitor and enforce this monthly diary of private encounters? But this is not the end of her ideas, she also had another bright idea of providing sex toys for prisoners.

Her first idea has its basis in abstinence. Once a month sexual encounters appears to be a worth-while compromise. There is no evidence currently that this will ever work, unless legislated and thousands of “sex compliance” police officers are recruited to make sure people adhere to this timetable. A systematic review of abstinence only programmes showed no evidence of beneficial effects. The promotion of abstinence alone as a routine component of effective safer sex advice is not recommended.

Sex in prison is a reality and a considerable proportion of sexually transmitted diseases among inmates are acquired in prison. In same-sex inmate prisons, this implies homosexual activity. Can sex toys reduce homosexual activity in prisons? Currently there is no evidence that it does. Sex toys have been implicated in transmission of HIV in prisons; therefore providing such sex toys can exacerbate the problem.

Another idea was to make women look ugly and unattractive. Senator Morgan Femai told a conference that he believes this could reduce the risk of spread of HIV because men will be able to resist unattractive and shabbily-dressed women. This sounds male chauvinistic and politically incorrect.

Does making women look ugly really help? It was suggested that governments should come up with a law that compels women to have their heads clean-shaven (maybe covered like in Muslim countries). This is a ludicrous idea to say the least, but hang on, could there be evidence that it works?

There is evidence that HIV risk perception is at least partly based on spontaneous impressions of others, and that ‘safe’ impressions can override the reliance on effective protection strategies such as condom use. Gorgeous women are often considered ‘safe’ by men. If all women looked the same, ugly with clean-shaven heads, there is no evidence that this will work.

A Zimbabwean legislator, Thabitha Khumalo, is campaigning for the legalisation of prostitution and has vowed to assist commercial sex workers form a trade union to fight for their rights. This will always be a controversial topic. However, reasons for not legalising it should not be guided solely by sentiments. Legalising it is not tantamount to condoning it. Prostitution is the oldest trade in the history of mankind and is not going to suddenly disappear any time soon. It appears to be a good idea because there is mounting evidence that this empowers women, promotes safe sex and reduces the risk of spreading of HIV.

There are many things that could be done to combat the spread of HIV. Politicians taking a lead is crucial. A recent public testing of politicians in Bulawayo during a political congress was a good idea. Unfortunately no one had the courage of Magic Johnson of declaring their positive status. I read about a few negative results which makes it a pointless exercise.

There are legal loop-holes in prosecuting people who spread HIV and this needs acting on as a matter of urgency. Education, promotion of safe and de-stigmatisation of HIV/AIDS are pivotal to combating the spread of HIV. Every little helps.