I first visited Uganda in 1993. Driving into Kampala I passed dozens of open-air carpenter’s shops whose primary product was coffins, stacked high. A number of pre-arranged meetings failed to materialise, as individuals absented themselves to attend funerals. Several years later, researching in northwest Tanzania, villages were populated predominantly by children and the elderly. Informants often showed me around their gardens so that I could witness their loss, made material by the crosses in the family graveyard, where adult child after adult child had been buried with depressing regularity. Over these years I never met anyone in East Africa who I knew to have AIDS. Yet AIDS mortality was terrifyingly ubiquitous. This was the starting point for my book, Before HIV: Sexuality, Fertility and Mortality in East Africa, 1900–1980, (2013).
In 1982, large numbers of individuals in villages on the Tanzania-Uganda borderland were diagnosed as suffering from AIDS, locally categorised as Slim. Within a few years around 30% of women attending maternity clinics around the city of Kampala were diagnosed HIV+. By this time HIV in Africa was categorized as inherently different from epidemics in the West, as most infections seemingly resulted from heterosexual sex. At its peak, HIV would affect 13% of the Ugandan adult population, before a range of behavioural changes reduced adult prevalence rates to 5% by 2002. Meanwhile, however, the virus had spread rapidly through southern African societies, infecting 37% of adults in Botswana at the height of the epidemic in that country. In 2014, around 25.5 million people in Africa were living with HIV, and approximately 790,000 had died of HIV-related causes. A series of preventive campaigns and increasingly comprehensive antiretroviral provision had reduced infection rates, enabling politicians to start imagining a post-AIDS future. Whether such discourse is appropriate, with close to 1.4 million new cases in 2015, it certainly indicates that Africa’s epidemic is now a subject which demands historical examination.
Two questions seem particularly relevant at this juncture. Is it helpful to conceive of one African epidemic, with one set of universal causes? And how is the history of HIV understood within African communities? To answer these questions, I conducted a wide range of interviews and focus groups with community and faith leaders, commercial sex workers, elders, and healers. Among none of my interviewees did a concept of an African, continent-wide sexual culture resonate. Out of hundreds of interviewees, only two refused to answer questions of such intimacy that asking them in my home village would be unimaginable. A keen sense of ethnic identity tended to obscure sub-ethnic local variation, and fostered an understanding of HIV as something associated with outsiders, and with the exceptional circumstances of war or economic collapse. A sense of the quotidian, localized nature of most sexual encounters tended to emerge towards the end of interviews, or in the marginal detail of legal transcripts, newspaper stories and other documentary records.
My initial reading of the scholarship around the emergence of HIV in East Africa indicated that there were two dominant narratives, profoundly different in detail, but both largely ahistorical in nature. One focused on the 1970s and early 1980s, as a period of rapid urbanisation and growing poverty, exploitative sex, violence, and instability. Many East African towns and cities doubled in size between 1970 and 1985, in an era of economic decline following the 1973 oil crisis and the fall in global prices for the continent’s major exports. For many within these newly urbanising communities, the commodification of sex seemed a crucial survival mechanism. To most social and medical scientists, this immediate context was sufficient. An alternative view was that HIV developed out of an ancient African sexual tradition, which prioritised the maximization of reproduction over fidelity and monogamy. These opposing conceptualizations seemed to me to be at odds with what we knew of HIV by the end of the century: that it was more helpful to think less about one pandemic and more about a series of interconnected but locally distinct epidemics; that HIV seemed to follow pathways which were as frequently “modern” as “traditional”; that regions where fertility had declined seemed to be especially badly affected by the disease; and that HIV prevention campaigns needed to be adapted rather than transplanted, because they rarely reduced infection rates to anything like the global norm.
The implication that the sexual patterns which shaped HIV were locally distinct, not recently established, and related to reproductive change structured my research. I decided to focus on the borderland between Tanzania and Uganda partly because this was where Africa’s first mass AIDS epidemic had emerged and subsequently where dramatic falls in infection rates first occurred. This region is also home to three neighbouring societies, Ankole, Buganda and, Buhaya, which are culturally very alike. Their languages are to varying degrees mutually intelligible; their social relationships have all been shaped by a history of monarchical government; their indigenous religions were based on similar core beliefs and structures; and all three societies have been heavily Christianized over the past century. The hope was that these similarities would permit a comparative history that was credible on its own terms, and that would have broader impact given the continental influence of the interventions first modelled in northwest Tanzania and Uganda.
What was immediately striking when I began working through the ethnographic literature was how much diversity there was in the realms of sexuality, marriage, and reproduction. Across the three ethnic groups, practices varied sharply around pre-marital pregnancy, rules around familial sexual access, widow inheritance, and genitor and pater rights. That Ankole’s cultivators were the most pro-natalist of all groups examined, while Ankole pastoralists imposed the strictest controls on reproduction, reinforced the sense that assumptions of African homogeneity are profoundly misplaced. By the early 1980s, attitudes and practices across the region had grown more similar, but the route that each society took to this end point over the preceding eight decades varied radically, shaped by local patterns of economic development, gender relations, sex-working, and socializing. Buhaya’s story is dominated by commercial sex work. Haya women provided the majority of sex workers in all of East Africa’s cities from the 1920s, but from the 1940s returnees from Kampala, Nairobi and other urban centres began to provide paid sex throughout Buhaya’s rural communities, tying villages directly into urban sexual networks. New forms of socializing in market-oriented trading centres across both Buganda and Buhaya, meanwhile, supported the development of sexual networks that were more geographically extensive and likely to cross class, ethnic and generational lines than in the past. Buganda’s sexual culture was further reshaped by female agency and the complex array of relationships which derived from its unique semi-freehold system of land tenure and lack of colonial control over urbanisation. Autonomous women were favoured as tenants in trading centres and the countryside as their exemption from tax meant they could be charged higher rents, while Kampala was tropical Africa’s most gender-balanced city. Sexual subjugation and repression were not absent from Buganda, but laws penalising women’s sexual autonomy were largely ignored. Similarly, reproduction outside marriage was broadly accepted, while local court records reveal that only a tiny number of men were prosecuted for sodomy, suggesting that both local communities and the state chose to ignore male same-sex relationships.
Buganda and Buhaya were both characterized during the colonial period as societies experiencing moral collapse and uncontrolled modernization. Ankole, by contrast, was regarded as conservative, marginalized by the commercial economy, and dominated by cultivator-pastoralist tensions which fostered claims of moral superiority on behalf of the agriculturalist majority. Sub-ethnic tensions provoked introverted politics that worked against the kind of networking that characterized the more open societies around Lake Victoria. But by the 1950s Ankole’s path began to merge with that pioneered by Buganda and Buhaya. The social distance between the tens of thousands of Ankole labour migrants who travelled to Buganda each year and the local families which hosted them gradually reduced, according to informants from both communities. Ethnic otherness lessened as Ankole immigrants adopted Ganda speech and cultural practices and became associated with sexual exoticism rather than danger. Within Ankole, mass education and democratization undermined pastoralist domination and made redundant the contrasting of agriculturalist probity with herders’ sexual dissolution. Approaching independence created a new logic of national economic integration which fostered a cash crop revolution in Ankole. This in turn engendered the rapid development of commercial sex and extended sexual networks.
This process of regional sexual integration accelerated in the 1970s which, according to informants, was not uniformly a decade of desperation, decline, and intensifying sexual exploitation. Socialist villagization in Tanzania undoubtedly undermined export-oriented farming production, while Idi Amin’s economic mismanagement and dictatorial governance would ultimately lead Uganda into a disastrous, destabilising military invasion of Buhaya in 1978. But real economic crisis only came towards the end of the decade and for many the 1970s were a time of opportunity. A number of elderly oral informants remembered the 70s as a time of entertainment, aspiration, and cash wealth, with sexual networks realigning around the borders, and mushrooming trading centres, reshaped by the pull of the black market and aversion to garrison towns. Sexual culture shifted most obviously in its material expression, as newspaper horoscopes advised readers on who best to have affairs with, cinemas were dominated by sex educational films, the national theatre fixated on tales of adultery, and local magazines marketed pornography and sex information.
Several conclusions can be drawn from this narrative. First, the assumption that one HIV prevention campaign could be developed for the whole of Tanzania or Uganda, given their ethnic, geographical, and economic diversity seems ill-founded. Even where broad similarities exist, in some cases these are of recent origin and conceal local complexities shaped by evolving histories. Secondly, the moralistic approach to HIV, commonly condemning the sexual culture of the young, which is commonly adopted by policymakers and power-holders in this region, is problematic when viewed from a historical perspective. Many elderly interviewees fondly remembered the 1970s as ‘a time when sex was fun,’ but then insisted that sex and fun should be divorced today. Forgetting that they typically grew up in an era of unprecedented sexual tolerance and experimentation seems unlikely to encourage honesty and openness about sexual realities in the present.
These concerns are of significance because Uganda’s HIV prevalence rate increased from 6.4% in 2005 to 7.1% in 2015. While Uganda is still associated in the West with remarkable success in curbing HIV, and its ABC (Abstinence, Be Faithful, Condomize) approach was replicated across the continent, internally the recent rise in prevalence levels is a cause of grave concern among epidemiologists. Ugandan national discourse has abandoned the frequently earthy transparency of the 1980s and 1990s, as political discourse has become increasingly influenced by an evangelical conservatism. Men who have sex with men have been victimized, condom use has been subject to growing criticism, and local elites claim that a moral reawakening requires a return to notional African traditions of familial and sexual values. These developments which reflect a deliberate rejection of local histories, have been implicated in rising rates of infection through same-sex encounters, high levels of unprotected intercourse between clients and sex workers, and declining knowledge of HIV causation among adolescent girls. The history of HIV in this region is important not only because of its relevance to current epidemiological concerns, but also because the trauma of AIDS was limited in the past by a culture of tolerance and compassion, which should not be forgotten. Neglecting the past as a source of inspiration for the future could literally be a matter of life and death.
Shane Doyle teaches history at the University of Leeds. His most recent book Before HIV: Sexuality, Fertility and Mortality in East Africa, 1900-1980 (British Academy and OUP, 2013) won the African Studies Association’s Ogot prize. His current research examine the history of family and fertility in East Africa.
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