Breaking the silence: Safer sexuality and conception for HIV-positive Africans

A striking failure of AIDS programming is that HIV-positive Africans' desires for sexual intercourse and procreation have been expected to be sublimated, even though young adults account for nearly half of new infections. The dominant prevention paradigm has been to change individual sexual behavior through promoting adherence to the “ABCs” (abstain, be faithful, use condoms). However, the ABCs actually represent a throwback to 19th century Christian moralizing about “good” sexual practices, since being faithful to an HIV-positive partner is not protective. Moreover, faith-based programs in Africa often depict the condom as “not 100% effective” and appropriate only for those unable to control their sexual urges, rather than as the optimal strategy when sero-status is unknown or discordant. In this presentation, we will discuss how donors and African governments—through their funding priorities, programs, and dictums—in essence have abrogated the sexual and reproductive rights of HIV-positive Africans, which may be fueling the epidemic. Our analysis of voluntary testing and counseling guidelines from various African countries reveal that sexual counseling of HIV-positive people is deficient and no mention is made of safer conception. Artificial insemination and sperm washing for sero-discordant couples is not being discussed or offered. Even AIDS support organizations do not legitimate PLWHAs' sexual and reproductive desires. If a new paradigm gains credence, in which HIV-positive Africans' sexual and fertility desires are considered natural and legitimate, then prevention programs to promote safer conception and pleasurable sex for HIV-positive people would be normative—and transmission might be significantly reduced.