May 8, 2008
BIG TEN
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Epstein, Steinberg and Cohen at the Housing Works Bookstore Café |
On Tuesday influential authors Helen Epstein (The Invisible Cure and Jonny Steinberg (Sizwe's Test) spoke to a packed house at the Housing Works Bookstore Café about what is hindering AIDS prevention and treatment efforts in Southern and Western Africa. The discussion, moderated by Jonathan Cohen of the Open Society Foundation, was one of the AIDS advocacy components of the Housing Works Bookstore's 10th anniversary celebration. For a list of upcoming 10th anniversary events click here.
Before the event got underway, Housing Works President and CEO Charles King took a moment to explain the role the bookstore played in Housing Works ability to provide services in Downtown Manhattan. The Housing Works Bookstore Café was founded ten years ago in conjunction with Housing Works' syringe exchange program on Crosby Street. “Crosby Street was the toilet of SoHo," King said, and neighbors complained about the needle exchange. King promised that "far from making Crosby Street worse, we would contribute to its gentrification." And he was prophetic. Today everyone from fashion glamazons to Housing Works’ clients to world-famous literati flock to the Bookstore’s chic Soho location. As Cohen noted, "I think every needle exchange throughout the world should have a bookstore attached."
Seeing clearly in Africa.
Steinberg and Epstein have been widely praised for breaking through the piles of books on AIDS in Africa with fresh ideas about the epidemic. Steinberg is a white South African who in Sizwe's Test followed a man in a South African village where antiretrovirals were newly introduced. Epstein's The Invisible Cure argues that the AIDS epidemic's spread in Africa is largely due to the fact that both men and women are likely to have more than one partner concurrently.
During her remarks Epstein noted that well-meaning Western prevention efforts don't address the issue of long-term multiple partners. She said prevention efforts are too focused on "commercial sex workers and truck drivers," when one study showed that for black South African women in one village the chances of contracting HIV were the same whether they were a commercial sex worker or not.
"South Africa has incredibly low numbers of commercial sex workers. Yet a lot of programs target them. That's important, but it's done at the expense of things that are putting everyone at risk," Epstein said. She also criticized abstinence and condom campaigns for not addressing the fact that most people are getting infected by long-term partners and don't see themselves as being at risk.
"Throughout South Africa, there were billboards promoting condom use that made it seem like AIDS is about raucous, reckless people. Where really it's the pastor with two wives," Epstein said. An American scientist who once worked on an unsuccessful AIDS vaccine, Epstein passed out packets explaining the scientific reasoning why concurrent sex partners are more likely to pass along the virus than in Western countries. In the West, where serial monogamy dominates, HIV is largely spread through sex work, intravenous drug use and men who have sex with men.
Steinberg noted that prospective South African President Jacob Zuma has four wives and cemented his stature as a populist figure after being acquitted for the alleged rape of an HIV-positive woman. Zuma said that as a Zulu it was his duty to pleasure a sexually aroused woman, a claim that many African men agreed with. "He was speaking to men who feel marginalized," Steinberg said. According to Steinberg, both men and women have concurrent relationships, but for women it is more of an open secret. "It's a practice so well-tolerated as long as it's done in silence," Steinberg said. "But AIDS lit up a trail because a woman came home with a disease."
But Steinberg said that white people telling black people why they are getting AIDS is politically touchy, especially in South Africa. He noted that only 30 percent of people in South Africa who choose to get treatment when it's available are men. "And here we are saying African men are the problem," Steinberg said.
Epstein, a believer in the power of information, noted that in Uganda, infection rates fell from 18 percent in 1992 to six or seven percent today. Though there has been a lot of discussion around the abstinence, monogomy and condoms prevention campaign—the so-called "ABC" strategy— "the success is not from abstinence," Epstein said, "but a strong home grown, feminist campaign, talking about sexual behavior and women demanding monogamy from their husbands."