In societies where HIV infection is rife and few people know whether they have the virus, unprotected sex is a careless act. Whatever the reasons (and there are often good reasons), unprotected sex in an environment where one can infect a partner during a single sexual encounter entails a disregard for others’ health.
Governments should recognise that behaviour is influenced by its social context. In a disordered society where anything goes, individuals are more likely to make reckless decisions. But where there is order, and respect for others, fateful choices such as whether to use a condom are liable to swing in favour of protecting one’s partner, and HIV transmission can be reduced.
Creating a culture that is conducive to responsible behaviour requires many small steps. In The Tipping Point, psychologist Malcolm Gladwell describes the “broken windows” theory of crime prevention, which is based on the idea that small signals of disorder will encourage lawlessness.
For example, if passers-by see windows in a building are broken, they assume no one cares about the building and are therefore more likely to break other windows. If the building remains unattended to, the vandalism is likely to spread to the surrounding streets and more serious criminals will be attracted to the area. Eventually the community develops a reputation for delinquency.
In order to halt this vicious cycle, disorder must be nipped in the bud — the windows must be replaced before a culture of criminality can develop.
In the last two decades of the 20th century, New York police showed how effective this strategy can be. In the mid-1980s, New York was racked by crime. More than 600 000 serious crimes were committed each year, and much of the city’s subway system was a no-go zone. Instead of focusing efforts on the big criminals, however, the police went after those committing petty offences.
On the subway, this meant targeting fare dodgers and graffiti artists. Fare dodgers were handcuffed and lined up on platforms before being arrested, and graffitied trains were cleaned up, and then cleaned up again if the vandals returned.
Gradually, these small steps, along with others aimed at curbing drunkenness and improper behaviour, helped change the culture of the subway system to one of order. Between 1990 and 2000, the number of serious crimes on the subway fell by 75%.
Similar advances are possible in the field of HIV transmission. Much attention has focused on big initiatives for fighting the epidemic, such as vaccine development and antiretroviral therapy. But to spark the behaviour change required to reduce transmission of the virus, small steps towards creating a culture of responsibility may have an equally important effect.
The range of actions is wide. Studies have shown how people are less likely to use condoms after consuming alcohol. Cracking down on drunk driving, public drunkenness and illegal alcohol sales is likely to curtail excessive drinking and leave people more in control of their sexual choices.
Targeting speeding, clamping down on those who litter, and many other small signals that show disorder will not be tolerated can also nurture a greater sense of responsibility. In South Africa these measures are likely to help in the efforts to reduce crime and HIV transmission.
As Gladwell explains, an epidemic — be it of crime or disease — can be reversed “by tinkering with the smallest details of the immediate environment”.
To reverse Africa’s epidemic of unprotected sex, cultural change is needed. Repairing the broken windows may be a good way to trigger that change.
Mark Weston, an independent policy consultant, is co-author of the World Economic Forum’s annual Business and HIV/Aids report