AIDS and Masculinity in the African City: Privilege, Inequality, and Modern Manhood

By Robert Wyrod

AIDS has been a devastating plague in much of sub-Saharan Africa, yet the long-term implications for gender and sexuality are just emerging. AIDS and Masculinity in the African City tackles this issue head on and examines how AIDS has altered the ways masculinity is lived in Uganda—a country known as Africa’s great AIDS success story. Based on a decade of ethnographic research in an urban slum community in the capital Kampala, this book reveals the persistence of masculine privilege in the age of AIDS and the implications such privilege has for combating AIDS across the African continent.

• Language: English
• Publisher: University of California Press
• Release date: Jul 5, 2016
• ISBN: 9780520961784

Robert Wyrod

Robert Wyrod is Assistant Professor in the Department of Women and Gender Studies and the International Affairs Program at the University of Colorado Boulder.

Book preview

AIDS and Masculinity in the African City

AIDS and Masculinity in the African City

PRIVILEGE, INEQUALITY, AND MODERN MANHOOD

Robert Wyrod

UC Logo

UNIVERSITY OF CALIFORNIA PRESS

University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit www.ucpress.edu.

University of California Press

Oakland, California

© 2016 by The Regents of the University of California

All photographs are by the author.

Library of Congress Cataloging-in-Publication Data

Names: Wyrod, Robert, author.

    Title: AIDS and masculinity in the African city : privilege, inequality, and modern manhood/Robert Wyrod.

    Description: Oakland, California : University of California Press, [2016] | Includes bibliographical references and index.

    Identifiers: LCCN 2015047468 (print) | LCCN 2015047889 (ebook) | ISBN 9780520286689 (cloth : alk. paper) | ISBN 9780520286696 (pbk. : alk. paper) | ISBN 9780520961784 (ebook)

    Subjects: LCSH: AIDS (Disease)—Social aspects—Uganda. | Masculinity—Uganda.

    Classification: LCC RA643.86.U33 .W97 2016 (print) | LCC RA643.86.U33 (ebook) | DDC 362.19697/920096761—dc23

    LC record available at http://lccn.loc.gov/2015047468

Manufactured in the United States of America

25  24  23  22  21  20  19  18  17  16

10  9  8  7  6  5  4  3  2  1

In keeping with a commitment to support environmentally responsible and sustainable printing practices, UC Press has printed this book on Natures Natural, a fiber that contains 30% post-consumer waste and meets the minimum requirements of ANSI/NISO Z39.48–1992 (R 1997) (Permanence of Paper).

Contents

List of Figures and Tables

1. Remaking Masculinity in Bwaise

2. The Making of Masculinity in Urban Uganda

3. Providing in Poverty

4. Women’s Rights in the Remaking of Masculinity

5. The Intersection of Masculinity, Sexuality, and AIDS

6. Beyond Bwaise

Epilogue

Acknowledgments

Appendix

Notes

References

Index

Figures and Tables

FIGURES

1.1. Kampala’s central business district.

1.2. Bwaise’s main commercial strip.

1.3. HIV prevalence in Uganda by year, gender, age, and region of country.

1.4. Masculinity as a social process.

1.5. Kampala, Kawempe Division, and Bwaise.

1.6. Housing in Bwaise.

1.7. Business in Bwaise.

2.1. Main ethnic groups in Uganda.

3.1. Kimombasa section of Bwaise during the day.

3.2. Exterior of a lodge in Bwaise.

3.3. A typical carpentry workshop in Bwaise.

3.4. Author during carpentry apprenticeship.

4.1. A young couple in Bwaise.

4.2. A family outside their home in Bwaise.

5.1. Bwaise’s main intersection.

5.2. Bwaise during the rainy season.

5.3. A group of women in Bwaise.

E.1. Bwaise’s main intersection in 2015.

TABLES

A.1. Demographic Characteristics of Interviewees, 2004

A.2. Demographic Characteristics of Participants in Couples Research, 2009

1

Remaking Masculinity in Bwaise

Crammed into the back of a stuffy matatu, one of Kampala’s ubiquitous white minivan buses, I strained to see my stop. I was making my first visit to Bwaise, a densely populated slum community that became the focus of my fieldwork in Uganda. Our matatu had begun its journey in Kampala’s city center, near the office towers, government buildings, and large hotels that were the pulsing core of this vibrant capital city. In twenty minutes, after many jarring stops to disgorge and ingest passengers, we had passed the main university campus, a nearby slum with mushrooming student hostels, a long stretch of carpentry workshops displaying overstuffed couches, and a Pentecostal megachurch that resembled an airplane hangar. I knew I was now close to my destination, and when I spotted Bwaise’s main landmark, a three-story furniture showroom, I shouted, "Siteegi!" (Bus stop!), and clambered out of the matatu.

I had come to Bwaise to visit the home of Christine, a forty-four-year-old widow who had lived in Bwaise for over two decades. Christine and I met a week earlier at a nearby health clinic when I attended a support group for HIV-positive people. Christine was the treasurer of the Post-Test Club, and she had passionately channeled her own experience living with HIV into educating and counseling residents of Bwaise about AIDS. When she learned I was interested in how AIDS had affected life in Kampala, she extended an invitation to visit her neighborhood.

As the matatu sped away, I felt conspicuous—a white American man standing alone in a neighborhood few Western foreigners ever visited. Even without the many stares, I found the congested strip of storefronts overwhelming as a thick stream of pedestrians, cars, trucks, and motorcycles clogged the sidewalk and road. To my relief, a young man approached me and politely introduced himself as Christine’s youngest son, Paul. Stocky and with something of an urban swagger, Paul seemed an ideal escort in a place like Bwaise. He led me through a narrow alley beside the furniture showroom, and in moments we were in the crowded residential interior of Bwaise. The traffic noise and exhaust fumes of the main road were replaced by sounds of children playing and the stench from the shallow streams of raw sewage snaking between the homes.

Although I had visited other Kampala slums, I was surprised by the dirt and trash, and the density of dilapidated housing. Yet on this first visit I also caught glimpses of Bwaise’s energy and vitality. Women sat outside their homes laughing with each other, watching their children while preparing snack food to sell. A group of men bantered loudly as they grilled the chapatti bread sold in the night market, teasingly calling out, "muzungu," white person, as I passed. Ugandan hip-hop blared from a tiny yellow stand selling cassette tapes as a man with a wheelbarrow full of bright green matooke (plantains) maneuvered past us on the narrow dirt path. It was this contrast between the undeniable squalor of Bwaise and the vigor, resourcefulness, and resilience of so many of its residents that became a leitmotif of my time in the community.

Paul and I wound through the mazelike housing, passing one- and two-room homes packed cheek by jowl. Some were constructed of only mud and wattle and topped with rusting metal roofs; others were older, more substantial homes long past their prime. Eventually we reached a cluster of three small homes that shared a tiny courtyard. On the right side was Christine’s house, a two-hundred-square-foot, two-room rectangle made from brown bricks and covered with an aging corrugated metal roof. It sat on a two-foot concrete foundation that provided some protection from the makeshift sewage canal that encircled the compound.

Christine, a slightly stout woman with a broad nose, almond eyes, and high cheekbones, greeted me warmly and invited me into her home. She was in the middle of her morning ritual, preparing maandazi (sweet fried bread). Rising around six, she spent several hours over a small pot of boiling oil, frying balls of batter to sell. This was her main source of income, and her goal was a dozen batches, each with ten pieces of maandazi. Around ten, she would deliver her product to women at the market and collect the money from the previous day’s sales—an effort that yielded about one dollar in profit.

As Christine plopped the batter into the oil, she began telling me about her life, including how she was infected with HIV. At twenty, she married a man with a good job as a medical assistant. They were able to afford both an official Catholic wedding and a traditional ceremony in keeping with their heritage as Baganda, the largest ethnic group in Uganda. Over the next decade they had five children together. But then her husband fell sick and died from AIDS. From that point forward, Christine said she knew she too was infected, and because she was monogamous while her husband had two other long-term relationships during their marriage she felt he was to blame. But Christine was not embittered, saying, At that time people were not fearing AIDS so much. They were not well informed. She referred to the other women as her cowives, and she was grateful for the financial support they provided after her husband’s death. Over the course of the next decade, both of these women also died from AIDS.

As I listened to Christine’s story, I came to appreciate the devastating toll AIDS had taken on her family. In addition to her husband and cowives, she had lost a brother to the disease, and she was now sharing her house with her younger sister, Mary, who was in the advanced stages of AIDS. Like Christine, Mary believed her husband had infected her with HIV. Over the next six months I watched as Mary slowly succumbed to the disease, even after gaining access to antiretroviral drugs. Christine was devastated by her death. The disturbing images of Mary’s frail body on their couch remain with me still, tempered only by memories of her courage and dry wit in the face of her suffering.

While other women might have remarried, Christine was not interested in a new relationship and had remained alone since her husband’s death. I had a little money, but I had to work for my children, she told me, so I had no time for those men. Concerned a new relationship would bring more problems than benefits, Christine was resigned to survive on her own. Her income, however, was much too low to cover her family’s needs, and she was now burdened by thousands of dollars of debt from microfinance loans. Caring for her sister Mary and Mary’s children added to her responsibilities, which were becoming overwhelming. Christine faced the bleak prospect of never getting out of debt. If her health ever started to fail, she said, she would not even be able to continue her modest income-generating activity. She was determined that her children receive an education, hoping that they would eventually find decent employment and, in turn, support her.

Having finished her maandazi, Christine said it was time to make her weekly rounds as an AIDS counselor. Her responsibility was to check on members of her Post-Test Club who lived in Bwaise, to monitor their condition and provide encouragement. She had been doing this volunteer work for three years, compensated by only a trifling stipend from an international nongovernmental organization (NGO). As we headed deeper into residential Bwaise, crossing increasingly large sewage canals, we eventually reached a narrow alley where a woman was scaling fish. She enthusiastically greeted us, and Christine asked her about her health, taking careful notes. In the next two hours, we would make four more similar visits, all with HIV-positive widows like Christine. If there had been more time, Christine told me, there were many more HIV-positive people we could have visited in Bwaise, something I would see firsthand in my many months of fieldwork that followed.

Given her experience with her husband, I was not surprised to learn that Christine was preoccupied with how her two sons were negotiating AIDS and sexual intimacy. She was less concerned about her older son, Peter, who at twenty-two was extremely leery of relationships because of his family’s experience with AIDS. In contrast to most of his male peers, Peter decided to forgo girlfriends altogether, never having had sex, and was instead focused on his studies, a strategy that eventually resulted in a government university scholarship. Christine was very worried about her youngest son, Paul, however, who she felt was heading down a risky path. At eighteen, and ostensibly still in secondary school, Paul spent most of his days hanging out with friends and many of his evenings at the local clubs. Paul’s style of dress took cues from the American hip-hop culture so influential among Kampala youth: baggy jeans, unlaced Timberland-style boots, white tank tops, and loose short-sleeved shirts. He was fond of thick silver jewelry, and his most cherished accessories were his tattoos—gothic Old English designs in black ink that covered his muscular upper arms and back.

Christine viewed Paul’s tattoos, jewelry, and attitude as part of a dangerous teenage rebellion that revolved around Bwaise’s rather notorious club scene. As I would see myself, Paul was a frequent club patron, and he had befriended the staff, as well as most of the edgy young men in Bwaise. In contrast to Peter, Paul boasted to me about his girlfriends but also insisted, I can’t have sex with a girl when I don’t have a condom. That only happened once, the first time I had sex. And ever since I’ve never done it without one. Nonetheless, Paul’s club crowd worried Christine, and she often complained he was spending too much time with Bwaise’s abayaye (thugs). As a mother raising her sons alone, Christine said it was difficult to counteract the influence of his peers. These surroundings, Christine complained, when you are a woman only, you get problems with children, because they mostly fear men. They fear their fathers. Without such a man in Paul’s life, Christine remained concerned that she could not stop him from getting pulled deeper into the world of Bwaise’s abayaye.

•    •    •    •    •

This glimpse into Christine’s life encapsulates what motivates me to write about how AIDS has shaped gender and sexuality in Uganda. Christine’s story reveals the ubiquity of AIDS in a place like Bwaise and shows how the disease has become a pervasive aspect of everyday life. From my visits with Christine, it was obvious that AIDS had not only ravaged her family but her community as well. Christine’s story is also emblematic of the many Ugandans who take action to address the disease, whether by being part of an AIDS support group, or helping those afflicted with the disease, or simply by discussing AIDS in a frank and open manner.

Most centrally for this book, Christine’s life also illustrates the role that gender relations have played in the epidemic. Both she and Mary claimed to be monogamous wives and believed they were infected with HIV by their husbands. While not resentful of her deceased husband, Christine’s experiences made her concerned about her sons and how they would negotiate their intimate relationships now that the dangers of AIDS were well known. Paul and Peter were exploring very different strategies for navigating masculinity, sexuality, and AIDS, each with consequences not only for their sexual health but for their transitions into male adulthood as well.

Finally, Christine’s life underscores how the challenges of AIDS were further complicated by Bwaise’s grinding poverty. For Christine and her son Peter, poverty made intimate relationships too fraught with conflict and suspicion, something to be avoided altogether. This same poverty, in Christine’s eyes, provided her son Paul with easy access to perilous forms of escapism and exposure to far too many male peers who reveled in the more decadent side of life. Most obviously and sadly, poverty also impeded Christine’s sister, Mary, from receiving the health care she needed, hastening her death from AIDS.

The ways that Christine and her family grappled with AIDS are not unique to life in Bwaise. Their struggles are repeated in similar communities across Kampala and illustrate how AIDS shapes everyday life in many urban African settings (figure 1.1). I chose to locate this study in Uganda because the country holds a special place in the history of the global AIDS pandemic. During the late 1980s and early 1990s, HIV infection rates dropped rapidly in Uganda, in sharp contrast to skyrocketing rates in much of southern Africa. Uganda was, in fact, the first country on the continent to document a drop in HIV prevalence.¹ Given that the country had just emerged from over a decade of civil war, this was a remarkable achievement—one that earned Uganda the label of Africa’s great AIDS success story.

Figure 1.1.Kampala’s central business district.

This success has been attributed in part to political leadership but also to the attitudes and perceptions of Ugandans from all walks of life. There was an openness in talking about AIDS in the country and a flowering of grassroots responses to the crisis. A forthrightness about how sexual behavior was tied to AIDS also emerged, including emphasis on men reducing the number of their sexual partners to mitigate the spread of HIV. This in turn helped disrupt dense networks of sexual relationships, a factor now seen as important to Uganda’s success (Thornton 2008). By the early 1990s, Uganda was also emerging as an African leader in women’s rights, propelled by both the government’s promotion of a rights agenda and the more far-reaching work of a vibrant women’s movement. It has been suggested that this institutionalization of women’s rights also played a role in how Ugandans, especially Ugandan women, were able to respond to the epidemic (Epstein 2007; Epstein and Kim 2007).

It was this success story that drew me to Uganda. I wanted to understand how the AIDS epidemic—a tragic event of historic proportions—had shaped gender and sexuality in Africa, especially conceptions of masculinity. Modifying sexual behavior—including promoting abstinence, condom use, and limiting sexual partnerships—has figured prominently in the public health response to AIDS in Africa. There is, therefore, good reason to suspect that the AIDS crisis may have altered normative discourses of sexuality, especially in those countries where the epidemic has been intense. In addition, because sexuality and gender are deeply intertwined, it is reasonable to presume that pressure on normative notions of sexuality would have reverberations for gender relations, especially in contexts where other forces are destabilizing the gender status quo.

If AIDS had shaped these social relations anywhere in Africa, Uganda seemed the best place to find evidence for it. Prior research on AIDS in Uganda, and sub-Saharan Africa more generally, however, has largely focused on the factors that fueled the spread of HIV on the continent, including economic and gender inequalities (Kalipeni et al. 2004; Kim et al. 2007; Pronyk et al. 2006). Far less attention has been paid to how the prolonged AIDS epidemic may have altered gender relations and intimate relationships—an issue at the heart of this book. While I could have explored these issues by examining the impact of a particular government AIDS program or a specific public health AIDS intervention, I instead focused on everyday life in Bwaise (figure 1.2). As one poor community among very many in Kampala, Bwaise gave me a view into the lives of typical Kampalans and a way of tracing the deeper cultural implications of the AIDS epidemic in urban Uganda.

Figure 1.2.Bwaise’s main commercial strip.

My fieldwork in Bwaise paid particular, but not exclusive, attention to men and masculinity. Over the past two decades, a great deal of research has shown how normative notions of masculinity have contributed to the spread of HIV across Africa (Barker and Ricardo 2005; Bujra 2000; Dworkin 2015; Foreman 1999; Gibson and Hardon 2005; Hunter 2010; Lindegger and Quayle 2009; Parikh 2009; Rivers and Aggleton 1999; Setel 1999; Smith 2009a, 2014). In this book I examine the reciprocal nature of this dynamic—how AIDS has shaped masculinity, especially male sexuality. Throughout I develop a core theme that emerged from my fieldwork: the central role of what I refer to as masculine sexual privilege, both in everyday responses to AIDS and in the reproduction of gender inequality. In the urban Ugandan context, I use masculine sexual privilege to refer to both men’s authority to dictate the terms of sex and a man’s right to multiple sexual partners if he so chooses, whether they are wives, girlfriends, or shorter-term partners.

Importantly, my phrase masculine sexual privilege should not be read to suggest that male sexual behavior and power in urban Uganda is monolithic, with all men striving, and always able, to maximize their control of sex and the number of their sexual partners. As I discuss in historical depth in the next chapter, there is a wide spectrum of normative male sexual behavior in urban Uganda, including not only polygamous and other forms of overlapping relationships but also monogamy. What is common across this spectrum, however, is the sexual control and agency all men can claim as members of the privileged gender group. This sexual privilege remains available to all men, even monogamous and celibate men, but not to women. And as my fieldwork reveals, it can be a potent resource for all men as they navigate the complexities of intimate relationships in the context of AIDS.

Uganda’s reputed success in addressing AIDS suggested that masculine sexual privilege may have been significantly undermined. My fieldwork with men and women in Bwaise, therefore, focused on how AIDS has prompted challenges to masculine sexual privilege and whether these challenges have significantly reworked such privilege. To what extent can Ugandan men still draw on masculine sexual privilege in their strategies for managing intimate relationships? What new paradoxes has AIDS presented for men as they grapple with embodying normative notions of masculinity and male sexuality? And how have interactions between men and women, especially in intimate relationships, rein--forced, contested, and remade masculine sexual privilege in the context of AIDS?

The story of Uganda’s AIDS success was what initially inspired me to explore these questions. Yet a troubling emerging trend in Uganda has made these questions particularly timely: the steady increase in new HIV infections in recent years.² This trend has provoked much concern that Uganda’s success has unraveled, and in this book I strive to provide a complex sociological account of masculinity in Bwaise that contextualizes this unsettling development. While many conventional approaches to HIV prevention in Uganda continue to focus on promoting monogamy and being faithful, in my view the number of sexual partners a man or woman has is not the key issue. I make the case, instead, that a serious engagement with the persistence of men’s privileges to dictate the terms of sex and the freedom to choose, on their own, to establish multiple sexual partnerships is crucial to efforts to address AIDS in Uganda, as well as the many other African countries affected by HIV.

While the long-standing AIDS crisis motivated this ethnography, my fieldwork made clear that AIDS was only one aspect of the story of changing masculinities in a place like Bwaise. As I discuss in detail in the next chapter, Uganda has been experiencing heightened tensions over gender relations for nearly two decades. The first decade of current president Yoweri Museveni’s rule brought improvements in women’s status in the late 1980s and early 1990s. More recently, there have also been important advances, in particular the 2010 passage of the Domestic Violence Act that significantly expands penalties for gender-based violence, including the sexual abuse of women. However, there has also been an increasing backlash against some of these gains (Kyomuhendo and McIntosh 2006). A long-sought, ambitious set of legal reforms focused on improving women’s marriage and property rights, known as the Marriage and Divorce Bill, was resoundingly rejected, yet again, by parliament and the president in 2013. The Anti-Pornography Act, passed in 2014, not only contains new restrictions on sexualized media but also has prompted harassment of women wearing miniskirts or any revealing clothing. In 2014 the HIV Prevention and Control Act was also unanimously adopted by parliament and signed into law by Museveni. This new law makes it easier for a woman’s HIV status to be revealed to her partner against her will.³

The most notorious aspect of this backlash, however, is the Anti-Homosexuality Act, which was passed by parliament and signed into law by the president in early 2014. The bill broadened the criminalization of same-sex relations and mandated some of the harshest punishments for homosexuality in Africa. Much has been made of the role that evangelicals from the United States have played in spurring this bill (Sharlet 2010). The bill has also been seen as the result of rivalries within the ruling political party, with younger party members introducing the bill to create controversy for President Museveni in the lead-up to the 2016 presidential elections. Museveni’s willingness to sign the bill has, in turn, been viewed as an attempt to regain his populist support by appearing as a leader able to stand up to a Western gay rights agenda. Although the Anti-Homosexuality Act was struck down by Uganda’s Constitutional Court on a technicality in 2014, it is far from dead and is expected to be reintroduced in modified form.

While American evangelicals and domestic political machinations are indeed important factors in the rise of the Anti-Homosexuality Act, such explanations tend to view the anti-gay legislation in isolation. They neglect the fact that the act is part and parcel of a spate of recent legislation that attempts to capitalize on a broader unease and uncertainty in gender and sexual relations in Uganda. The anti-homosexuality legislation is, therefore, best understood as one facet of a backlash against shifts in the gender status quo, especially those shifts that are perceived as threatening men’s power and privilege on several fronts. As the Ugandan feminist Sylvia Tamale (2003b) has argued about an earlier wave of homophobia in Uganda in 2003, public debate surrounding homosexuality has made homophobia a gendered concern. By maintaining a regime of compulsory heterosexuality, Tamale (2003b, 6) argues, the state seeks to enforce conventional gender relationships and identities and keep a stranglehold on public discourse on these topics.

While the Anti-Homosexuality Act has drawn global attention to Uganda’s sexual politics, the tensions in gender and sexual relations that underlie the bill are hardly unique to Uganda. Across the continent, similar social processes are at work challenging male privilege: precarious and uncertain work, growing economic inequality, women’s expanding access to education and employment, women in politics, and the institutionalization of women’s rights (Aboim 2009; Cornwall 2002, 2003; Goetz and Hassim 2003; Morrell 2001a; Smith 2014). As in Uganda, these dynamics are intertwined with the omnipresence of AIDS, which has created new problems and paradoxes for men, and women, as they try to navigate a shifting social and moral terrain (Decoteau 2013a; Hunter 2010; Setel 1999; Simpson 2009). As Daniel Jordan Smith (2014, 5) aptly notes based on his research in Nigeria, AIDS has produced a gamut of moralizing discourses that have been so powerful because they express and stand for people’s experience of and ambivalence about certain consequences of ongoing social changes and in particular, their discontent about rising levels of social inequality.

I share Smith’s interest in understanding AIDS not in narrow public health terms but as a powerful lens on broader anxieties about social change and inequality. Throughout this book, I focus on three different aspects of the entanglement of masculinity, AIDS, and social change: the ways societal problems, including gender inequalities, have contributed to the spread of AIDS; how AIDS often symbolizes tensions about such wider social problems; and, importantly and distinctively, the ways AIDS itself is the engine for social change, especially through a remaking of masculinity.

AIDS AND MASCULINITY IN AFRICA

Throughout my fieldwork in Bwaise, I encountered residents committed to raising AIDS awareness in the community, and among their ranks I occasionally encountered young men. One of these men was twenty-two-year-old Patrick, born and raised in Bwaise. He lived with his wife and newborn daughter in a quiet corner of the neighborhood, in a rented, one-room home set on a high concrete foundation that kept the nearby sewage canal at bay. Like many of his male peers, Patrick had been unable to find steady work, and he had channeled his frustration into volunteering for a Ugandan NGO focused on HIV prevention. He was particularly interested in talking with his underemployed male peers, and I often came across Patrick chatting animatedly with other young men during his rounds as a peer educator in Bwaise.

When I asked Patrick why he spent his days this way, he admitted he hoped the volunteering might lead to paid employment with the NGO. But he also stressed that his family’s experience with AIDS had motivated him: We’ve lost one sister to AIDS so far. And I’ve lost several uncles and aunties because of HIV/AIDS. People who I thought would assist me have died. Very good friends, supportive ones have died. So HIV/AIDS has really affected me. . . . All the people who were supposed to help me have died.

The plague of AIDS has not only devastated Uganda. The same is true for much of sub-Saharan Africa, which has borne the brunt of the global burden of AIDS since the beginning of the pandemic. In 2011, 24 million people were living with HIV in sub-Saharan Africa, representing nearly 70 percent of all infections globally (UNAIDS 2012). Over a million sub-Saharan Africans died from AIDS in 2011 alone, and almost 2 million people were newly infected with HIV. East and southern Africa have been, and continue to be, the regions of the world most severely affected by AIDS, with one quarter of all adults in countries such as Botswana, Lesotho, and Swaziland living with HIV in 2011.

Sub-Saharan Africa is also the only global region where women are more likely than men to be infected with HIV. This is a long-standing trend; in 2011, for example, 58 percent of people living with HIV in sub-Saharan Africa were women. This trend holds true for Uganda as well. During my fieldwork HIV prevalence was higher among women than men, especially younger and urban women (see figure 1.3).⁴

Figure 1.3.HIV prevalence in Uganda by year, gender, age, and region of country.

SOURCE: Uganda AIDS Indicator Survey 2011.

These bleak statistics are tempered by some encouraging recent trends in the region. Between 2001 and 2011, the number of new HIV infections in sub-Saharan Africa dropped by 25 percent, leading to some speculation that the African AIDS crisis has crested (UNAIDS 2012). Nonetheless, the magnitude of the AIDS pandemic remains immense, and there are now more people living with HIV in Africa than at any time in the history of the epidemic—a trend that will continue if the number of new infections remains high and increasing numbers of people receive life-prolonging AIDS drugs.

As the severity of the African AIDS crisis became evident in the 1990s, it produced an unprecedented global response. While some African countries (most notably Uganda) pioneered their own solutions to this new threat in the late 1980s, by the 1990s the response was largely being funded and overseen by the developed world, especially the United States and Western Europe. The turn of the millennium marked a massive scaling up of resources to address AIDS in Africa, including the establishment in the United States of the President’s Emergency Plan for AIDS Relief (PEPFAR). At the same time, the Global Fund to Fight AIDS, Tuberculosis, and Malaria was created as an independent, international funding agency, and together PEPFAR and the Global Fund provide the vast majority of global AIDS funding.

Such institutions have provided crucial resources and have played essential roles in many successful efforts to prevent HIV infections and treat AIDS in Africa. However, this global response to AIDS has also rekindled an intense interest in African sexuality, a subject that has long fascinated Westerners. In response to AIDS, there has been an unparalleled effort to survey, quantify, and modify the sexual behavior of African men and women, such that it can now be difficult to discuss sexuality in Africa beyond the frame of HIV/AIDS. The AIDS epidemic has intensified a persistent tendency to reduce African intimate relationships to sex, which, as Lynn Thomas and Jennifer Cole (2009, 4) argue, is especially problematic given the long history of Westerners deploying arguments of hypersexuality to dehumanize Africans and justify degrading policies.

Thomas and Cole are alluding to the nexus of AIDS and African sexuality that is part of a much longer history linking health, medicine, and sexuality to colonialism. This was especially evident in colonial South Africa, where allegedly unhealthy and unruly black bodies were disciplined by a new British public health regime (Comaroff 1993). This colonial regime emerged from nineteenth-century racial science, which gave new scientific authority to racist claims about Africans’ inferiority—a legacy that remains as Westerners are often all too ready to seek the origins of virulent disease in the uncontained nature of ‘others’—in the undisciplined sexuality of Africa (Comaroff 1993, 324).⁵

Ellen Stillwaggon (2003, 2006) has dramatically charted this legacy, arguing that metaphors rooted in nineteenth-century racial science still suffuse much AIDS analysis in Africa (see also Bibeau and Pedersen 2002; Patton 1990; Treichler 1999). Social scientists and policy makers constructed a hypersexualized pan-African culture as the main reason for the high prevalence of HIV in sub-Saharan Africa. Africans were portrayed as the social ‘Other’ in works marked by sweeping generalizations and innuendo (Stillwaggon 2003, 809).⁶ For Stillwaggon, this myopic attention to a purported African sexual exceptionalism has led to a fixation on strategies for modifying Africans’ sexual behavior and diverted attention from key co-factors in the spread of AIDS of Africa, including malnutrition, other diseases, and inadequate healthcare. Unlike extraordinary sexual behavior, these factors are rooted in poverty, and it is this poverty that actually distinguishes life in