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In Zimbabwe, fewer affairs and less HIV
Craig Timberg, Washington Post
July 13, 2007

http://www.washingtonpost.com/wp-dyn/content/article/2007/07/12/AR2007071202369.html

CHITUNGWIZA, Zimbabwe -- It's not only the prices of bread and eggs that are out of control in Zimbabwe, land of 4,000 percent inflation. For the man inclined to cheat on his wife, these are trying times. Keeping a mistress, visiting a prostitute or even taking a girlfriend out for beers is simply becoming too expensive, men say.

But their strain is Zimbabwe's gain in its fight against AIDS. Alone among southern African countries, Zimbabwe has shown a significant drop in its HIV rate in recent years. A major reason, researchers say, is the changing sexual habits of men forced to abandon costly multiple relationships.

"Those extramarital relationships, they're getting tough to sustain," said Thomas Muza, 37, who is struggling to support his wife and a mistress on the shrinking value of a math teacher's paycheck. Worth $50 a month at the beginning of June, it's now worth $17 and falling almost every day.

AIDS activists and some researchers long blamed the continent's high poverty rates for its unusually widespread HIV epidemics, arguing that poor medical care and hunger made Africans especially vulnerable to the virus, while financial need accelerated its spread by pushing women into prostitution.

Yet Zimbabwe's experience shows that the connection between AIDS and economics is not nearly so straightforward. The country has made strides against HIV during eight years of steep recession. Wealthier neighbors such as South Africa and Botswana, meanwhile, have struggled to curb new infections despite much higher levels of development and massive spending on the disease.

Many researchers now suspect that economic vitality -- expressed in rising truck traffic, burgeoning bar scenes and widening income disparity -- encourage the behaviors that fuel a sexually transmitted epidemic. But as men get poorer, they pare back their relationships, making them less likely to contract or spread HIV.

AIDS remains severe here, with an estimated one in five Zimbabwean adults infected with the virus that causes the disease, but surveys show that the number of new infections has fallen. Men report fewer girlfriends, fewer visits to prostitutes and less casual sex -- all indicators that in other countries have accompanied a retreating epidemic.

Nightclubs, cinemas and brothels have closed in Harare, the capital, and in some cases evangelical churches have taken over the buildings. Less visibly, men say they are abandoning what Zimbabweans call "small houses," a legacy of the polygamous marriages once common here.

In these relationships, married men pay rent and other living expenses for a second or even third regular sex partner. As in marriages, condoms rarely are used, creating webs of unprotected sex easily infiltrated by HIV if the man or any of the women become infected.

"Having a lot of girlfriends or having 'small houses,' you've got to have a degree of disposable income," said Godfrey Woelk, an epidemiologist at the University of Zimbabwe. "Being poor and being in love does not really work, no matter what the romantics say."

Muza, who has a long face and a thin beard, was not poor when he started teaching. He was part of Zimbabwe's broad middle class that also included the bureaucrats, engineers and factory managers whom the country's schools, once the best in Africa, turned out by the tens of thousands.

Now these same men find their paychecks tripling or quadrupling some months. But prices are rising so much faster that many are slipping below the poverty line. Some joke bitterly that with a roll of toilet paper costing about 30,000 Zimbabwean dollars, it would be cheaper to stack 100-dollar bills in their bathrooms.

Muza earns 2.5 million Zimbabwean dollars a month teaching, and about half goes to the rent, groceries and other expenses of his "small house."

"It's very difficult," Muza said softly, his voice trailing off.

Changing Behavior

With rich reddish soil, steady sunshine and seemingly enlightened governance, Zimbabwe for two decades was regarded as the economic miracle of southern Africa.

President Robert Mugabe, who took over in 1980 from a white-supremacist government, invested heavily in education. Plentiful commercial farms made Zimbabwe an exporter of food. A steady flow of foreign tourists visited the country's unspoiled game parks and Victoria Falls, a mile-wide torrent of water considered one of the world's natural wonders.

But faced with rising political opposition, Mugabe in 2000 endorsed invasions of white-owned commercial farms by landless black peasants. The move won him some support but led to economic ruin and growing political repression. Zimbabwe became one of the world's biggest recipients of international food aid. Its currency tumbled so fast that the money used to buy a new car in 2000 would be worth less than a U.S. penny now.

Many AIDS experts feared this turmoil would worsen an epidemic that already was among the most severe in the world.

Yet in 2005, the U.N. AIDS agency reported that the country had experienced southern Africa's first major decline in HIV. The drop was clearest among pregnant women who attended prenatal clinics, but studies of other groups showed similar trends.

The most recent nationwide survey, conducted in 2005 and 2006, put Zimbabwe's HIV rate for adults at 18.1 percent, still higher than in all but five other countries in the world. Researchers believe it peaked a few years earlier at about 25 percent.

This shift came despite Zimbabwe's pariah status at a time when growing international funding has allowed other African countries to dramatically expand their efforts to combat the epidemic. When President Bush created his $15 billion anti-AIDS program, all of Zimbabwe's neighbors -- South Africa, Botswana, Mozambique and Zambia -- were cited as "focus countries" worthy of extra support.

Zimbabwe, which Secretary of State Condoleezza Rice labeled an "outpost of tyranny," was not, making it one of Africa's least popular recipients of foreign aid. Botswana and Uganda have received 10 times more annual financial support for each person living with HIV than has Zimbabwe, a U.N. analysis showed.

Among the initial skeptics about the falling HIV rate was Zimbabwean AIDS researcher Exnevia Gomo. He recalled the early speculation: Perhaps it was caused by a surge of death in the absence of effective treatment. Or maybe the exodus of young, well-educated people to other countries explained the trend.

But several studies show that shifts in sexual behavior drove the HIV decline in Zimbabwe. This finding echoes the changes experienced in Uganda during the early 1990s, when its rate of new infections fell sharply.

"That behavior is changing significantly is clear," Gomo said from Blantyre, Malawi, where he recently joined the medical school faculty at the University of Malawi. "The question is: What has caused that change?"
Inflation and Fear

With unemployment estimated at 80 percent, trading sex for money remains an appealing choice for some women, said Tsitsi, a sassy 23-year-old wearing designer jeans and a red, scooped-neck top. She spoke about personal matters on the condition that her last name not be used.

A 40-year-old businessman pays Tsitsi about $75 a month to be his girlfriend. She said the man also takes her out to dinner and buys groceries for her parents.

Tsitsi said that, though she is not in love, she regards the relationship as better than many marriages. The man agrees to use condoms, and there is no possibility of betrayal if she does not expect sexual fidelity, she said.

"He's like an ATM," Tsitsi said. "You just go and punch money and it comes out."

Several of her friends have similar relationships, she said, but they are becoming harder to find and maintain. When a man gets low on cash, Tsitsi said, "he'll just take care of his wife."

Pastor Elliot Mandaza of New Life Covenant Church in Harare has noticed a similar trend. As the capital's night spots have closed -- the church uses a former cinema for Bible classes -- pews have filled with financially troubled newcomers seeking divine solace. Few of these men can afford several sex partners.

"That's by and large now the preserve of the wealthy. You have a 'small house' if you have the money," Mandaza said. "It's hard enough to look after number one."

Business is down as well in bars and liquor stores in the dense bedroom community of Chitungwiza, 15 miles south of Harare. Weeknights are especially slow as customers hoard money for the weekend. Every time prices jump, the crowds dwindle again. A brewery truck that once arrived twice a week has stopped coming; bottles now arrive by wheelbarrow because bar owners keep stocks low to hedge against inflation.

The changes are not only economic. Most Zimbabweans have watched a family member or a close friend wither away before their eyes. And unlike Zimbabwe's neighbors, which have used international funding to create increasingly extensive treatment programs, AIDS means almost certain death here.

Brighton Ndlovu, 35, a trader in computer hardware who wore a dapper black suit on a recent visit to a popular Chitungwiza pub, has lost three brothers to AIDS. Each one got thin, lost his hair and sweated his way through terrible fevers, he recalled.

Ndlovu said he uses condoms faithfully, and he made several changes likely to reduce his risk of infection: He avoids prostitutes, cut back on girlfriends and broke up with a "small house" woman whose living expenses he paid.

Driving those decisions was a combination of financial stress and fear of AIDS.

"I know the consequences," he said.

This potent combination has changed business calculations as well. Frank Muhamba, 64, who owns the building that houses Ghetto Blues nightclub in Chitungwiza, said the club no longer employs a night shift of cleaning women who double as prostitutes. Muhamba said that contributing to the death of customers was wrong, and bad for the bottom line, too.

"Before, we could go to a bar," he recalled, "and we'd find 10 women wanting us."

Now, Muhamba said, "We will go home without talking to any of those girls. . . . They will kill us."

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