Speeding HIV's Deadly Spread

Faruk Maunge, 36, a high school counselor in Francistown, Botswana, points out one of several friends who died of complications from AIDS. (By Craig Timberg -- The Washington Post)

West Africa has been partially protected by its high rates of circumcision, but in southern and eastern Africa -- which have both low rates of circumcision and high rates of multiple sex partners -- the AIDS epidemic became the most deadly in the world.

"That's the lethal cocktail," said Harvard University epidemiologist Daniel Halperin, a former AIDS prevention adviser in Africa for the U.S. government, speaking from suburban Boston. "There's no place in the world where you have very high HIV and you don't have those two factors."

No Word for 'Fidelity'

---

From under the broad thatched roof of Francistown's Customary Court, which handles minor crimes and misconduct, Chief Judge Ludo Margaret Mosojane had long suspected that the city's torrent of AIDS deaths flowed from its sexual culture. Each year brought more cases resulting from elaborate, overlapping relationships, she said.

"It explains why Africa is hardest hit" by AIDS, Mosojane said. "The way we contract for sex is different from how others do it."

Polygamy once was common in the region, and in some parts still is; Swaziland's king has 13 wives. In generations past, even Batswana with just one spouse rarely expected monogamy. Husbands spent months herding cattle while their wives, staying elsewhere, tended crops, Mosojane said. On his return, a husband was not to be quizzed about his activities while he was away. He also was supposed to spend his first night back in an uncle's house, giving his wife time to send off boyfriends.

In Setswana, the national language, "the word 'fidelity' does not even exist," Mosojane said.

The few checks that traditional villages had on sexual behavior dwindled during the development frenzy after 1967, when diamonds were discovered. Batswana increasingly moved to cities for school or work. Plentiful television sets delivered a flood of Western images, including racy soap operas and music videos featuring lightly clad women vying for the attention of wealthy, bejeweled men.

Francistown, with nearby mines, military camps and border posts overflowing with desperate refugees, changed faster than most cities. Amid the bustling malls, there was soon an unsettling concentration of young adults because so many people ages 35 to 50 had already died of AIDS complications, residents say.

Faruk Maunge, 36, a high school counselor whose dreadlocks, goatee and rectangular glasses give him a cosmopolitan air, noticed the changes when he returned from stays abroad. "They are just a lost bunch," he said. "They are very, very reckless."

Maunge said that rent, clothing, even cellphone airtime became part of implicit sexual exchanges. Men and women maintained two, three, even four regular partners. The toll was clear from the snapshots he kept in a green plastic first-aid box.

"This one is gone," Maunge said, pointing to a faded picture of a woman in a red top who was nibbling her fingernails. Moving deeper into the pile, he continued: "This one is gone, Mooketsi. And this one is gone, Themba. This one is gone, too, this one on the far left. This one is positive."

With a hint of frustration, Maunge said of one man, "He's sleeping around again." Maunge also grew irritated at a picture showing a friend with AIDS who seemed to father a child -- he was awaiting his fourth -- with every girlfriend.