The HIV Superhighway

Unfortunately, a great many people still do not know this. In September, a Ugandan colleague of mine explained this hypothesis -- known inelegantly as the long-term concurrency theory -- at a meeting attended by 15 African health ministers. None of them had heard of it.

"We knew AIDS was there," an HIV-positive woman from Swaziland told me recently. "But we thought it was for truck drivers and prostitutes."

What difference would it have made if people had been informed about the concurrency superhighway 10 years ago, when the evidence of its importance first came to light? Would sexual behavior have changed more rapidly?

Changing sexual behavior is difficult. But the founders of the World Health Organization recognized long ago that accurate health information is empowering -- and that access to it is a human right. Information about the perils of concurrent partners won't solve the AIDS crisis on its own, but it could at least help people spot where risks are coming from.

I have often wondered whether such knowledge may even help spur a more compassionate, forward-looking political response to Africa's epidemic. For years, most African governments all but ignored the AIDS crisis. Their indifference recalled that of the Reagan administration, which turned its back on the crisis and scorned its mainly gay and drug-injecting victims. How could African leaders, faced with a far more widespread catastrophe, do the same?

Whenever I visit Africa, I have discussions about AIDS with all sorts of people. When I explain the difference between the "prostitute theory" and the "long-term overlapping partnerships theory" of how HIV spreads across the region, I am always amazed to see how people's expressions change. Young people, especially those who aren't yet sexually active, are eager to know more. Even poor, illiterate adolescents have told me that the explanation makes sense. They understand how overlapping partnerships can transmit HIV because they see such relationships all around them.

But older people often go silent when I explain the theory. Some of them work for governments whose responses to AIDS have been desultory. Perhaps these bureaucrats went silent because they were thinking about their own behavior -- and wondering whether they or the people they cared about may have been infected. Perhaps it was dawning on them that this wasn't just a disease for faraway "promiscuous" people. Perhaps, for the first time, they were seeing the AIDS crisis for the tragedy that it is.

helenepstein@yahoo.com

Helen Epstein is the author of

"The Invisible Cure: Africa, the West,

and the Fight Against AIDS."