Let’s get real: female sexual pleasure and HIV prevention

The dominant HIV intervention response assumes that HIV transmission only occurs in contexts of danger and violation. It is time to take into account young women’s actual sexual experiences and recognise that sex is also a positive and joyous experience, however unsettling this may be for the HIV prevention community, says Tsitsi Masvawure.

During fieldwork for my doctoral thesis in anthropology in 2007 I recall a female student at a university in Zimbabwe’s capital Harare saying to me, ‘Girls should stop acting as if they don’t like sex…from what I have seen from girls here on campus, they look forward to that [sic] more than guys do’. This statement caught me off-guard, not only because of the contempt with which it was uttered, but also because it was made by a young, unmarried African woman, in the presence of her best friend (another young unmarried woman) and was addressed to me, a virtual stranger. This was my second meeting with the two female students and already, both had stunned me with their frankness around sexual issues and especially around their own sexual experiences. In earlier discussions the two students had been quite vocal on the issue of sex and, in response to a question I had asked, one of them had declared that she never had reason to turn down her boyfriend’s sexual advances: ‘If he asks for sex, I give him. Why not? It’s not like girls don’t enjoy sex. They do!’ 

I was conducting ethnographic research on the relationship between ‘campus sexual cultures’ and female and male students’ HIV risk-taking behaviour and I found this openness by young Zimbabwean women both intriguing and refreshing. It is rare to read about young, heterosexual African women’s positive and pleasurable pre-marital sexual experiences. Often, the policy and academic literature portrays African women in one of two ways: as sexually passive and unwilling participants in the sexual act, or as sexually ‘immoral’ and ‘loose’ if they show any interest in sex at all. Neither of these portrayals fully capture the totality of young, unmarried African women’s lived realities. The views and experiences of the young women I encountered during fieldwork challenge these stereotypical portrayals, and suggest that in reality sex is not always something that is ‘done’ to young women. Neither are young women always passive and reluctant participants in sexual encounters. Feminist scholar Carole Vance, who championed a mini-revolution around women’s sexual pleasure in the US in the late eighties, poignantly observed that ‘danger and pleasure are ever-present realities in many women’s lives’. She further argued that focusing wholly on pleasure or danger oversimplifies women’s actual sexual experiences, which, in reality, are more complicated and unsettling. Dichotomies, as we very well know, are problematic in that one can only ever be one or the other— never both, and certainly never something else entirely.

According to a recent report by the United Nations Entity for Gender Equality and the Empowerment of Women (UNWomen), women and girls accounted for 60% of all people living with HIV in Africa in 2009. The report found that young African women aged 15 -24, in particular, are at least eight times more likely to be HIV positive than young men of the same age. Zimbabwe’s adult HIV prevalence is estimated at between 14% and 16%, and although the country has experienced a significant decline in its HIV prevalence, it remains among the worst affected countries in the continent . As elsewhere in the continent, young women in the country account for the bulk of new HIV infections and their disproportionate vulnerability to HIV infection has been linked to biological factors and to a myriad of socio-cultural and economic factors. HIV responses have, and rightly so, called for the ‘empowerment’ of young women as a key strategy in reducing their vulnerability to HIV infection. An unfortunate consequence of this, however, is that most HIV interventions emphasise the adverse effects of sex - such as disease and unintended pregnancies - and rarely acknowledge the many pleasurable aspects of sexual acts that could just as easily expose young women to HIV/STI infection.  In other words, the dominant HIV response assumes that HIV transmission only occurs in contexts of danger and violation. And yet, some studies show that women’s quest for sexual pleasure affects their willingness to use reproductive and sexual health technologies such as contraceptives and condoms.  A comprehensive and realistic response to the HIV epidemic has to take women’s heterogeneity and their multifaceted sexual experiences seriously into account.  

So, what did sexual pleasure look like for the young women I encountered and how did they experience it?  Female students placed a premium on the pursuit of pleasurable sex in and of itself. This was especially evident in the manner that they spoke about their sexual experiences. One student made it clear that she, and not her boyfriend, had initiated many of their sexual encounters, while another student matter-of-factly explained that condoms interfered with her full enjoyment of the sexual act: ‘Condoms are too clinical! I know that there isn’t much of a difference between sex with a condom and without, but I like to know that it’s just me to him, not me to him through some plastic!’ 

Another female student engaged in what I will refer to as ‘lust sex’ with multiple partners. I had known this particular student for at least a year when she decided to talk about her romantic relationships, mainly because she knew I was conducting research on HIV. Seven of the ten boyfriends she had dated were on average more than fifteen years older than she was and included politicians, business men and company directors.  At the time of the interview, she was in concurrent relationships with four men. She was twenty-three years old. Lust was the dominant theme in the incidents that this student chose to share with me and it is her own lust, in particular, that she focused on. Furthermore, she did not downplay the fact that she was sexually adventurous and sexually uninhibited; if anything, she played it up and appeared to thrive on it.

My point in highlighting these particular experiences is clearly not to advocate for forms of sexual practice that may increase the risk of HIV transmission, but rather to encourage a broader and realistic conversation amongst researchers, policy makers and service providers around the varied ways in which young women define their sexuality and what they find sexually pleasurable. If our responses do not resonate with young women’s lived realities, they will fail. It is especially worrying that mistrust of African women’s sexual pleasure has become the default position in the HIV prevention world. There are hardly any interventions that are designed specifically to address young women’s sexuality in a positive and non-judgmental way and which acknowledge that some young women have sex because they find it pleasurable. Indeed, those of us in the HIV prevention world would do well to remember that sex is not always about danger and risk but is also  ‘a positive and joyous experience’ for many people, including young, unmarried African women. In the mid-nineties, US anthropologist Ralph Bolton wrote a piece in which he lamented the fact that most HIV research had completely ignored ‘the joys of sex’. He identified twenty-six ways in which sex is a positive—rather than a negative—experience and these included: sex is play, adventure, transcendence, fun, fantasy, interaction, pleasure, liminality, ecstasy, experience, an expression of emotions and a source of meaning. Play, adventure and experience were particularly strong themes in the narratives of the female students I encountered and yet, as Kenyan feminist scholar Mumbi Machera so poignantly asserted in Re-thinking sexualities in Africa, very rarely is ‘women’s sexual desire depicted as an autonomous gesture and as an independent longing for sexual expression, satisfaction and fulfilment’ in most of this literature. Surely, our reluctance and failure to acknowledge that young women are autonomous sexual beings must, at some level, impede our ability to effectively intervene with this population. The continued high rates of HIV infection among young women point to major inadequacies in current responses and these, in turn, can partly be attributed to the fact that many of these responses have been premised on the notion of women’s victimhood and lack of sexual agency.  Examples include generic messages that are based on the ABC approach—abstain, be faithful and use condoms—which encourage young women to ‘say no’ to pre-marital sex or which focus on teaching women condom negotiation skills. These do not leave much room for individual choice and preference, and they do not resonate with the lived realities of those young women who prefer to ‘say yes’ to sex, or who may have successfully negotiated the non-use of condoms with their sexual partners. In fact, US scholars Jennifer Higgins and Jennifer Hirsch note that a few studies have shown that women - rather than men -  are sometimes responsible for the non-use of condoms in relationships as they complain that condoms adversely affect their sexual enjoyment.

The absence of recent research on ‘the joys of sex’ - with the exception of Sylvia Tamale's African Sexualities Reader  - reflects societies’ general discomfiture with young women’s sexual desire and sexual freedom more than it does the actual absence of the phenomena. Indeed the observation by sexologists Gagnon and Simon that ‘the idea of female sexual freedom is intolerable in most societies’  holds true today in many parts of the world, including Africa, as it did of nineteenth century America that they were writing about. Therefore, as we work towards making this years World AIDS Day theme of ‘Getting to Zero’ a reality, HIV interventions will need to be bolder and seriously take into account young African women’s actual sexual experiences and their lived sexual realities, however unsettling these may be for us in the HIV prevention community.


 


About the author

Tsitsi B Masvawure is a medical anthropologist and post doctoral research fellow at the HIV Center for Clinical and Behavioral Studies at Columbia University, New York. She is also affiliated with the Center for the Study of AIDS at the University of Pretoria. She is trained as a medical anthropologist and is interested in how gender, youth sexual cultures and HIV intersect.