Shane Doyle from the School of History at the University of Leeds presented on Wednesday in a seminar entitled Sexual Behavioural Change and the Origins of the HIV/AIDS Epidemic in East Africa. Doyle critiqued three prominent theories explaining the origins of the HIV/AIDS epidemic in East Africa, and particularly the rapidity at which the disease spread in southern Uganda and north-west Tanzania, in the regions of Buganda, Ankole and Bahaya. The disproportionate rates of infection during the epidemic’s initial stages have drawn a flood of researchers to the region. One of the main theories explaining the disproportionate rates of infection is attributed to the distinct ‘crisis’ of the 1970s. The growth of urban centres, unemployment and the oil crisis of 1973 led to the expansion of the black market, which subsequently expanded sexual networks and the rate of partner exchange. The second theoretical stance is typified by the work of John and Pat Caldwell, who suggest that ancient African sexual traditions and a culture of rapid partner exchange produced a ‘distinct African sexuality’ ideal for the transmission of HIV/AIDS. The third main theory, put forth by Epstein and Thornton, suggests that people in Uganda are not having more sexual partners, but that sexual partnership occurs concurrently which facilitates the spread of HIV/AIDS. Epstein’s concurrency model is highly influential and has been adopted by the Ugandan government through the current public health campaigns encouraging Ugandans to get off the ‘sexual network’.
Yet, Doyle suggests that all three approaches are inherently ahistorical and flawed. Taking a historical approach, relying on newspaper accounts beginning with the colonial period, Doyle tracks a shift in public attitudes surrounding sexual customs in Buganda. Additionally, interviews and surveys were heavily drawn upon, asking the same questions in all three societies. Caldwell’s assumption is monolithic and proves untrue, within the three societies and even within Ankole itself. The notion of a uniform sexual tradition is unsustainable. In Buganda extramarital affairs were viewed as common, but dangerous, in Ankole extramarital affairs and sex before marriage were an uncommon practice, and in Bahaya there was very little criticism of extramarital sex. In all three societies while elders frequently condemned sexual patterns of the young, when they related their own experiences they did not diverge from current youth practices. Lastly, Doyle compared people’s accounts with public records, particularly in Buganda where there is an abundance of medical research and historical accounts documenting patterns in sexual behaviour.
Epstein and Thornton understate the complexity of Ugandan sexual networks of the past, while Epstein downplays the contribution of casual or short-term sex to the transmission of HIV/AIDS. If Epstein’s model is true why would concurrent relationships respond to HIV/AIDS control programmes? Epstein fails to include the occurrence of short-term or individual sexual interactions, which can pose the greatest risk for transmitting HIV/AIDS.
Additionally, for Doyle the suggestion that Ugandans did not have more sexual partners is not supported by historical evidence, this claim is only supported if you rely on the period of the mid-1990s when sexual behavioural changes were already taking place, after the introduction of HIV/AIDS initiatives. Doyle further suggests that the scope of sexual networks are incredibly far-reaching. For HIV/AIDS programmes to be successful they must be based on a full and accurate sense of the complexity of patterns of sexual behaviour.
Edinburgh Medical Anthropology 