HIV/AIDS is one of the world’s biggest problems, and it garners a huge amount of attention. We’ve known for decades that heterosexual sex is the main mode of transmission worldwide. We’re also well-aware that the HIV epidemic is worst in the southern cone of Africa, where all nine of the countries with infection rates above 10% lie in a single contiguous block. And so huge amounts of money have been poured into the prevention of sexual transmission of the virus in that region. Safer sex isn’t just promoted in Southern Africa, it’s practically an industry in its own right.
With that in mind, it would make sense that we’d pay attention to how people have sex in this place, right? And that we’d consider how it affects the spread of HIV, and the effectiveness of ? But as best I can tell we don’t even acknowledge the basics. Anecdotally, a huge share of people in Southern Africa appear to engage in some form of vaginal drying as part of the sex act. This has serious implications not only for the riskiness of unprotected sex, but also for the way people would interact with condoms (Lubricated for my pleasure? No thanks). A conversation I had recently highlights the problem. The person I was talking to is an expert on HIV/AIDS in Africa. When I brought up dry sex, the only knowledge they had was having heard crazy stories about women packing their vagina with dirt. My informal sense (which will become formal research shortly) is that if that exists anywhere, it doesn’t here in Malawi. But drying does exist, in various forms, and the prevalence is exceedingly high among people I talk to informally.
There’s no reason to pick on one person – there’s shockingly little research on the topic considering how important it is. I’ve had serious trouble even determining exactly how it works: how dry? Totally? Wouldn’t that hurt, badly – or prevent penetration entirely? I’m aware of only a handful of studies that ask questions about this, mainly working with small, non-random samples (Halperin 1999 has a good review of the literature). The most recent wave of the Cape Area Panel Study does have a pretty good question on the topic, but it’s not public yet. To my knowledge that will be the survey to ask a representative sample of the population about this practice. And it’s a hard thing to ask about: would Americans say they had “wet” sex? The implication is that when it comes to sex we are literally speaking a different language than many of the people we want to target, assuming that condoms will work the way they do when we use them, because we don’t realize there’s even another alternative.
I keep thinking that I must be missing something obvious, and that we can’t possibly be so ignorant on such a fundamental issue. I’d love to see a better-informed reader provide more evidence on the topic, but I have the sinking feeling that none exists – and that that goes a long way toward explaining the failure of HIV prevention policy in Southern Africa.