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“...young South Africans face a much higher probability of contracting HIV...”

Rethinking Risk

With the commendable strides in biomedical intervention garnering the bulk of our already scant HIV media coverage, the Sunday Times’ focus on young South Africans’ behaviour this week presented a welcome change of pace.

But those looking forward to a meaningful engagement with issues around sexual behaviour would have been somewhat disappointed.

The article recounts the findings of a recent collaborative study by the University of the Witwatersrand and the University of North Carolina, which attempted to gauge the sexual risk-taking behaviours of young adults (18 to 24).

The study concluded that in spite of youth in the US being more likely to engage in risky sex, young South Africans face a much higher probability of contracting HIV. The researchers argue that even though South African youth are not having as many partners and tend to use condoms more often than their American counterparts, the severity of our epidemic renders their sexual encounters considerably more risky. 

On this basis, one of the recommendations of the study is that a concerted effort be made to convey the risks involved in routine sexual behaviour more clearly.

Yet headlines like “High HIV rate not result of risky sex” suggest that there may be multiple understandings of “risk” at play, ultimately diluting the message the research is conveying.

Risk is typically defined as the potential for an undesirable outcome. In risk, the environment is a critical factor. For example, going for a swim in itself does not necessarily indicate risky behaviour. But going for that same swim in spite of numerous shark warnings significantly increases the potential of an undesirable outcome, thus making it a risky swim.

In the case of South Africa, the water is shark-infested and even splashing around in the shore break can have a nasty outcome. It is indeed up to communicators to effectively convey the severity of the epidemic and routinely issue “shark warnings”.

But the Sunday Times article stops short of addressing the risk-communication aspect of the issue and instead features a number of somewhat dubious-sounding quotes without much further exploration of the issue.

Dr. Heather Jaspan of the University of Cape Town is quoted as saying: “It is clearly not what you do but with whom you do it”. It is a comment that sits uneasily with HIV’s stereotyped and stigmatised history.

Jaspan’s comment is loosely linked to the study’s findings that South African girls tend to sleep with slightly older men, which indicates there might be sexual mixing a older demographic where prevalence is higher.

In the article, study-leader Pettifor also argues that as the behaviours themselves (multiple partners, unprotected sex) are not the key variable, “biological forces” must be at play. This is backed-up by a comment from Prof. Francois Venter of the WITS Reproductive Health and HIV Institute, who reckons that there might be “something in our genes” that makes sex so much more dangerous.

Whilst the biological argument may well be true and valid, the picture the article paints is one completely removed from the social and political context of the South African epidemic. And critically, it removes a sense of agency from South Africans, as if to ask: “if biology or genetics are ultimately accountable, then what can we really do?”

The truth is that our HIV prevalence is high partially because the country’s response has until recently been dismal and for the most part tragically ineffective. While the US began responding to its emerging epidemic in the late 80s by sensitising people to the epidemic and addressing risky behaviour, our tricky political situation meant that South African authorities were preoccupied. As a result, the virus spread unchecked for most of the 80s and 90s - ultimately resulting in our nearly 18% adult HIV prevalence.

Technically, this makes South African sex the riskiest in the world – even the trusting, loving kind you may have with your long-term partner. (Consider as evidence, the news this week of a doctor’s bid to take his fiance to court for infecting him with HIV).

It is about time those risks are communicated clearly to us in a way that speaks more to our behaviour than our biology.