NEW YORK — Dr. Anthony Fauci, one of the world’s leading AIDS scientists, warned at an international conference on AIDS in Sydney, Australia, that the world is losing the battle against the virus. He indicated that increased emphasis should be placed on prevention efforts, particularly with regard to social and cultural circumstances that affect the rate at which the pandemic is growing.
One of the cultural factors that has proven to be significant is cross-generational relationships — in which at least a 10-year age difference exists between partners. Unless this problem is properly addressed, it will have significant social and demographic consequences in the regions most affected: Sub-Saharan countries, the Caribbean and the Middle East, among others.
The “sugar daddy” phenomenon, as it is called, accounts for a much greater prevalence of HIV infection among teenage girls than among boys. In several African countries, the HIV-infection rate for young girls is up to six times greater than that for boys of similar ages.
In Uganda, according to a government report, 10.3 percent of women aged 15 to 24 had HIV/AIDS, compared with 2.8 percent of men in the same age bracket.
Women, particularly adolescents, are more vulnerable than men to becoming infected with sexually transmitted diseases. One reason for this is that their reproductive-tract tissues are not yet fully developed and are more susceptible to tearing and becoming infected.
But what explains the high prevalence of wide age gaps between older men and younger women?
Older men believe that younger women can better satisfy their sexual needs than older women, and that it is a sign of status among an older man’s friends to have one or more young girlfriends. In addition, older men believe that younger women are virgins and therefore less likely to be infected.
For young women, taking older men as sexual partners is a sign of prestige among their peers and a way for them to pay for luxuries that they otherwise could not afford, such as cell phones, clothes and fancy jewelry. In other cases, these relationships provide young women with funds for education. Many poor families encourage young girls to enter into these relationships in the belief that they will improve the family’s overall economic situation.
This phenomenon clearly illustrates the powerful link between women’s health and their lack of empowerment, since young women are frequently unable to negotiate a safe sexual relationship with older, more powerful men.
For example, in traditional African societies, because of the respect shown to elders, it is difficult for young women to reject advances by older men. This places young women at a disadvantage in demanding the use of condoms.
The reluctance by men, both young and old, to use condoms is one of the main drivers of the HIV/AIDS epidemic. It has been demonstrated that the older the man is with regard to his female companion and the more money he gives her, the less likely he is to use a condom. Studies have also shown that the greater the age difference between partners, the more frequent is the practice of unsafe sexual behavior.
Many activities now being conducted across Africa are dealing with this phenomenon, some with the collaboration of the clergy — a critical ally in the fight against HIV/AIDS. Mass communication campaigns are aimed at creating a stigma against this kind of relationship. There are also a wide range of education activities aimed at empowering young women by providing them with life skills, micro-credit loans and vocational training.
These initiatives should be reinforced through outreach activities involving nongovernment organizations that work in the field to train local health workers to recognize this issue and address it within their communities.
At the same time, there should be increased cooperation between the ministries of health and education to improve health curricula in schools and to sensitize lawmakers to pass enforceable legislation that addresses the seduction of minors. Although many countries have legislation, it is seldom enforced.
Prevention of cross-generational sex should be an important part of AIDS prevention efforts. The devastating effects have proven that “sugar daddy” relationships to be anything but sweet.
Cesar Chelala, an international public health consultant, is the author of “AIDS: A Modern Epidemic,” a publication of the Pan American Health Organization.