In the fight against Aids in Africa, the focus of attention is shifting from prevention to treatment. Having lost the battle to contain the virus, governments are turning to anti-retroviral therapy (ART) to limit the damage it causes.
ART drugs are a remarkable medical success. If taken properly, they add at least 10 years to the life of someone who would otherwise die within two. Distributing them, however, requires effective health systems and well-trained medical personnel. Africa has neither of these and treatment programmes have only reached a fraction of those who need them.
Prevention, then, still matters, but prevention programmes in Africa have so far largely failed. “Safe sex” messages promoting abstinence or condom use have been largely ignored. Most Africans, like most Europeans, have sex young, often and with a variety of partners. Few regularly use condoms. Even the most knowledgeable take risks — a study by the University of KwaZulu-Natal has found that HIV counsellors are no more likely to use condoms than those they advise.
The problem with condoms is that they make sex worse. Many couples are willing to trade safety for better sex, and policy-makers have yet to find a way of reducing HIV transmission without reducing pleasure.
Oral sex may provide a solution. As well as adding variety to sex lives, oral sex is much less infective than vaginal or anal sex. A 2002 Spanish study, published in the journal Aids, of heterosexual couples where one partner was HIV-positive and the other negative found that in more than 19 000 acts of unprotected oral sex, not one resulted in a new HIV infection. More oral sex, in short, means less HIV.
Oral sex is currently taboo in Africa. Few admit to practising it and the little research available suggests vaginal and anal sex are much more common. Breaking taboos is tough, but persuading people to surrender their pleasures is tougher. Oral sex makes sex both more fun and less risky. As a means of reducing HIV infections in Africa, it shouldn’t be such a hard idea for policy-makers to swallow.
Mark Weston is co-author of the World Economic Forum’s annual HIV/Aids and Business Survey Report