While many scholars have pointed to a lack of condom use and impulsive promiscuity in examining the prevalence of HIV in southeast Africa, the practice of men and women having multiple long-term, concurrent sexual relationships may be more to blame, author Helen Epstein said in her lecture, "The Invisible Cure: Africa, the West and the Fight against AIDS," on Tuesday afternoon in Filene auditorium.
Epstein is the author of a book by the same name.
According to Epstein's theory, there are high rates of HIV in societies where individuals often have two or more continuous sexual partners. These societies are common in southeast Africa.
"Even when someone's absolute number of sexual partners is low, concurrent relationships are more conducive to the spread of HIV," Epstein said.
In cultures that commonly practice concurrent relationships, it is less likely that males will use condoms, Epstein said. Those with multiple simultaneous relationships are more likely to spread the disease to several people, while those in a monogamous relationship are only at risk of infecting their partner, according to Epstein.
"Everyone gets infected very rapidly," Epstein said. "This network of multiple partners serves as a sort of super-highway for the spread of the virus."
Although Americans are more likely to have had ten or more sexual partners than Ugandans, HIV rates in Uganda were 17 percent higherthan those in the United States in 1994, Epstein said. Condom use, along with cultural norms for the number of acceptable long-term partners, are to blame for this disparity, she explained.
"Much more needs to be studied, but from a very broad, bird's-eye view of the continent, these multiple concurrent partnerships seem to stand out," Epstein said.
AIDS prevention efforts in Africa should be directed away from the promotion of condom use and abstinence and towards disseminating information about the spread of HIV through multiple, long-term sexual partners, according to Epstein.
"I think giving people in Africa frank information might help generate a social movement rather than just trying to get them to use condoms," Epstein said. "When I've talked to officials in African countries, many have never heard of this theory of long-term concurrency."
In Uganda during the 1990s, HIV rates decreased dramatically as citizens spoke candidly about the disease and its spread through normal families, according to Epstein.
Recently, the number of HIV infections in Uganda slowly increased after local and international authorities introduced campaigns promoting abstinence and condom use, Epstein said.
She described a billboard in Botswana that reads, "Even the best ballers take a safe dunk with it," in an attempt to promote condom use and slow the spread of HIV.
"The enemy is not people with AIDS," Epstein said. "People need to realize, as the Ugandans realized in the 1990s, that the real enemy is HIV itself."
Epstein's lecture is part of the Great Issues lecture series, sponsored by the John Sloan Dickey Center for International Understanding, which brings an influential member of society to Dartmouth three times a year to speak on important global topics. Epstein was chosen because of her successful work involving AIDS and the social justice issues that surround the disease, according to Christianne Wohlforth, associate director of program development at the Dickey Center.
"AIDS is a disease that disproportionately affects the less-endowed countries of the world," Wohlforth said. "Her work takes a social justice look at a public health problem."
AIDS and its effects in Africa interest many students at Dartmouth, according to Wohlforth.
"There is a large contingent of students who are interested in and active in the fight against AIDS in Africa and the relations between more-developed and less-developed countries," Wohlforth said. "This is partly because most Dartmouth students are in a relatively privileged condition to do things that will have an impact on the world."
Endowed by Andrew Lewin '81 and his wife Marina, the lecture was held in honor of Rabbi Marshall Meyer '52, who worked for social justice in Latin America. One lecture on social justice in the Great Issues lecture series is held each year in Meyer's memory.
