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Time for Frankness on AIDS and Africa
By Pascoal Mocumbi, Prime Minister of Mozambique
special United Nations session on AIDS next week, there will be
much discussion about international aid, about drugs and vaccines.
But there is likely to be too little said about what is the primary
means by which AIDS is spread in sub-Saharan Africa: risky heterosexual
AIDS is not like smallpox or polio. We may not be able to eliminate
it simply with a one-time vaccination or course of shots for children,
since new strains of H.I.V. are constantly evolving. And unlike
the communicable killer diseases we have encountered most often
in the past, H.I.V. is transmitted through the most intimate and
private human relationships, through sexual violence and commercial
sex; it proliferates because of women's poverty and inequality.
In Mozambique, the overall rate of H.I.V. infection among girls
and young women is 15 percent, twice that of boys their age, not
because the girls are promiscuous, but because nearly three out
of five are married by age 18, 40 percent of them to much older,
sexually experienced men who may expose their wives to H.I.V. and
sexually transmitted diseases. Similar patterns are common in other
nations where H.I.V. is rapidly spreading. Abstinence is not an
option for these child brides. Those who try to negotiate condom
use commonly face violence or rejection. And in heterosexual sex,
girls and women are biologically more vulnerable to infection than
are boys or men.
As a father, I fear for the lives of my own children and their teenage
friends. Though they have secure families, education, and the information
and support they need to avoid risky sex, too few of their peers
As prime minister, I am horrified that we stand to lose most of
a generation, maybe two. The United Nations estimates that 37 percent
of the 16-year-olds in my country will die of AIDS before they are
As a man, I know men's behavior must change, that we must raise
boys differently, to have any hope of eradicating H.I.V. and preventing
the emergence of another such scourge.
In 1994, at the International Conference on Population and Development,
and again in 1995, 1999 and 2000, most nations agreed that adolescents
have a right to information about their sexuality. We agreed that
programs should help build adolescent girls' self-confidence and
boys' respect for girls' rights. We agreed to develop both adolescent-
friendly health services and the education and training that will
give young people hope.
Today, in Africa and elsewhere, we are far from achieving these
goals. Most political leaders still view adolescent sex as a politically
volatile subject to be avoided. Community and religious leaders
wrongly believe that sexuality education promotes promiscuity. Health
providers and teachers are ill-trained about sexuality and ill at
ease with it. Parents know little about sexuality, contraception
or sexually transmitted diseases, and many believe that early marriage
will "protect" their daughters. They may themselves condone or perpetrate
sexual violence as a legitimate expression of masculinity.
For the long term, we need to develop H.I.V. vaccines and provide
treatment to everyone with H.I.V. We need to develop protection
methods like microbicides that women can use with or without a partner's
knowledge or cooperation. Above all, we must summon the courage
to talk frankly and constructively about sexuality. We must recognize
the pressures on our children to have sex that is neither safe nor
loving. We must provide them with information, communications skills
and, yes, condoms.
To change fundamentally how girls and boys learn to relate to each
other and how men treat girls and women is slow, painstaking work.
But surely our children's lives are worth the effort.
Pascoal Mocumbi, prime minister of Mozambique and its former minister
of health, is a physician and a board member of the International
Women's Health Coalition.
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