AIDS, Culture, and Africa

11. Tugende Uganda: Issues in Defining “Sex” and “Sexual Partners” in Africa

11 Tugende Uganda Issues in Defining“Sex”and“Sexual Partners”in Africa Susan McCombie and Ariela Eshel Preface by Susan McCombie This chapter draws on data from AIDS-related research that I was involved with in several countries between 1989 and 1998. Most of the examples are from Uganda, hence the title “Tugende Uganda” (Let’s go to Uganda). Uganda was the first country in Africa that I visited, and I will always think of it as a second home. On the first day of my first visit in April 1989, I had the good fortune to be taken to the National Theatre, where Philly Lutaya was addressing a full house. He was the first Ugandan celebrity to publicly announce that he had AIDS and to attempt to turn his misfortune into an opportunity to educate others. His actions had a tremendous impact on attitudes , and many believe it was a turning point for AIDS prevention efforts in Uganda. This chapter is dedicated to Philly Lutaya, Francis Rwakagiri, Kenneth Dunnigan, and all of the people in Uganda who devoted themselves to AIDS prevention while living with HIV. Introduction AIDS was first recognized in Uganda in 1982. By the time HIV was identified and prevention efforts initiated, prevalence rates were already very high, with a median prevalence of 24 percent among pregnant women in urban areas (UNAIDS 2003). Uganda was one of the first countries in Africa to recognize and respond to the AIDS epidemic. The median rates among pregnant women in urban areas peaked at 30 percent in 1992 and fell to 11 percent by 2000 (UNAIDS 2003). Unfortunately, many countries in Africa have experienced an opposite trend, with low infection rates in the late 202 Susan McCombie and Ariela Eshel 1980s and early 1990s that have mushroomed into explosive epidemics in the twenty-first century. This tragedy, which could have been prevented, is due at least in part to a failure of people to realize that their sexual behavior was putting them at risk. AIDS prevention messages that focused on “risk groups” or “risky partners” may have contributed to losing the opportunity to prevent AIDS in many parts of Africa. One result of the AIDS epidemic was an increased interest in research surrounding sexual behavior. Many international agencies have conducted large sample surveys in order to determine if changes in reported behavior have occurred as a result of prevention programs. The use of standardized questionnaires to conduct research on sexual behavior has been the topic of considerable discussion centering on concerns about validity. The major focus of concern is that people will refuse to answer, give inaccurate answers , or both. There has been little attention to issues of translating terms for sexual activities and sexual partners. Sexuality is defined and given meaning in a variety of ways in different sociocultural settings. There are substantial differences in definitions of sex and types of partners both intraculturally and cross-culturally. It is not possible to say “sex” or “wife” and assume a universal understanding of the terms. This chapter problematizes the use of language in sexual behavior surveys and explores its relationship to categorization of sexual partners, lay perceptions of risk for HIV infection, and patterns of condom use with different types of partners. Language, Sex, and AIDS Alfred Kinsey’s (1948, 1953) studies of sexual behavior, although extensive and revolutionary, began a tradition of surveys based on the mistaken assumption that “sex,” “spouse,” and “sexual partner” are unambiguous constructs . Hunt and Davies (1991: 43) point out that the notion of a “sexual encounter” is central to studies of sexual behavior in general, and to the epidemiology of sexually transmitted diseases (STDs) in particular, but is rarely defined: “The question ‘How many sexual partners have you had?’ is asked explicitly or implicitly in all studies of sexual behavior. A moment’s thought should, however, suffice to convince that the question, ‘who is a partner?’ begs the question, ‘what counts as sex?’” For many people, what counts as “sex” includes more than “sexual intercourse ” (Bolton 1992; Michaels and Giami 1999; Smith 1999). Crossculturally , people tend to categorize sex as either physical or affective. But within these two general categories, “sexual acts” may range from kissing to 203 Tugende Uganda: Issues in Defining“Sex”and“Sexual Partners”in Africa “full sex,” where the latter implies vaginal or anal intercourse culminating in orgasm. What counts as sex may be defined not only...