General
Source: Health-E
Nonhlanhla Matsunyane was in Grade 11 when a man 20 years older than her followed her to school one day.
Within months, the man was providing her struggling family with groceries and money – and she was providing him with sex even though he refused to use condoms.
"I was afraid of getting pregnant but, because he was doing everything, I felt like I owe him. I need to pay him with something," Nonhlanhla told Health-e.
And pay she did. Not only did the married man impregnate her, but he also infected her with HIV.
Nonhlanhla's is a common story, and health researchers have long identified "sugar daddies" as one of the main culprits spreading HIV in the country.
Who else could be infecting young women, but older men? Women aged 15 to 24 are four times more likely to have HIV than men the same age, while HIV peaks in men aged 35 to 39.
Based on these kinds of statistics, the KwaZulu-Natal health department launched a 2012 campaign aimed at stigmatising "sugar daddies" and preventing "cross-generational sex." Over 800 billboards were put up in the province exposing sugar daddies giving girls things in exchange for sex.
Watch Nonhlanhla's story in the Health-e documentary, "Innocence for Sale"
New research challenges old notions
But conventional wisdom on the dangers of dating older men was challenged recently by research done by the Africa Centre in Hlabisa in northern KwaZulu-Natal.
The centre has been testing people in the surrounding areas for HIV since 2005, and asking them a range of questions including the age of their most recent partners.
Dr Guy Harling caused a stir at a recent HIV conference in Boston, when he reported that the Africa Centre had found that local women had no additional risk of HIV from partners who were five or more years than themselves.
HIV infection is very high in Hlabisa. About six out of ten women are HIV positive by the age of 30, while half the local men are HIV positive by 40.
Of the 2 444 women aged 15 to 29 that the centre tested between 2005 and 2012, 458 became HIV positive. This is around 7% every year. Of the 1 734 women aged 30 to 57 who were tested, 116 became infected (2,6% a year).
Yet there were no differences in infection rates between those women with older partners and those involved with men the same age, said Harling.
In fact, the older women involved with older men were safer from HIV than if they were involved with men of a similar age, said Harling. In addition, many women said they preferred older men as they were more respectful and less abusive.
Unpacking the science
"We need to understand the context in which they happen. Are they based on money or not? If the people are both poor, then the man is not a sugar daddy. It is just about two people."
Health Minister Aaron Motsoaledi took a dim view of the Africa Centre study, describing it this week as "wrong."
"We don't take that study seriously. It is not even in keeping with anecdotal evidence. I have spoken to a lot of scientists about it... I understand it was done by a student, someone who is still learning," said Motsoaledi.
Certainly, there are holes in the study. The biggest one is that the women were simply asked what the age of their last sexual partner was. There was no attempt to understand their sexual patterns – for example, whether they used condoms or had other partners.
"The most recent partner may not have been the source of their HIV infection if the woman had multiple partners between the annual HIV testing campaigns," said Professor Thomas Rehle from the Human Sciences Research Council (HSRC).
In addition, by Harling's own admission, the men in question were dirt-poor, so they could offer no "sugar."
HSRC head Professor Olive Shisana said the Africa Centre research was not supported by any other studies. But she said the HSRC aimed to "do a thorough analysis of age-disparate relationships."
"We need to understand the context in which they happen. Are they based on money or not? If the people are both poor, then the man is not a sugar daddy. It is just about two people. Sugar daddies involve transactional sex," said Shisana.
Moths to a flame? Move the light.
But relationships based on material exchange have been going on for centuries. Ugly, old rich men are always stepping out with beautiful young women. Hugh Heffner wouldn't have all those "playgirls" if he didn't have money.
"Empower girls and young women to produce their own 'sugar' rather than thinking that they need a man..."
HIV clinician Professor Francois Venter says that, instead of stigmatising relationships between people of disparate ages, a better approach is to empower girls and young women to produce their own "sugar" rather than thinking that they need a man to provide this.
"I think we should stop stigma-laden campaigns, and focus on meaningfully empowering young women," said Venter, who is Deputy Executive Director of the Wits Reproductive Health and HIV Institute.
A number of studies have shown that girls who remain in school are far less likely to fall pregnant or become HIV-positive than girls who drop out. Yet, on matriculating, the work prospects for millions of young women are bad.
A big part of empowerment is the need for government strategies to address the poverty many girls are living in so that, unlike Nonhlahla, they do not need to exchange their bodies for bread.
A study published last November in the Lancet found teenage girls in poor families that received a single childcare grant were far less likely to have sex with sugar daddies.
"Child support grants do not make teenagers more sensible when it comes to safer sex," Wits Professor and study co-author Mark Orkin told Health-e. "What they can do is promote enough financial security for girls that they do not have to choose their sexual partners through economic necessity."
The study's lead author, Oxford University's Dr Lucie Cluver, said: "If we give child support grants or other cash transfers to families then we can reduce HIV risk among girls in those families."
Not a uniquely South African problem
"Bottom line: make girls powerful so that they won't need sugar daddies – although they might well still choose to enjoy relationships with older men"
Meanwhile social scientists Pierre Brouard and Mary Crewe from the Centre for the Study of AIDS have described the health department's anti-sugar daddy campaign as "ill-conceived."
Writing in journal Agenda last April, they said that inter-generational sex was widespread and culturally acceptable throughout Africa with many parents encouraging their daughters to seek out older men who could give them a better standard of living.
"The idea of an older person with power embarking on a (usually) sexual relationship with a younger person has become accepted as a universal phenomenon across all cultures," they argue.
"Because patriarchy allows men to be better educated, more employable and socially and culturally empowered to take charge of money and property, and because women are expected to be dependent, reproductive and reliant on men for status and power, conditions are created for sugar daddies to emerge," they argue
"In other words, if there was greater equality between men and women, and patriarchal entitlements were denied men, young girls would not need to seek out older men for affirmation and financial security, whether this was, albeit obliquely, culturally endorsed or not."
Bottom line: make girls powerful so that they won't need sugar daddies – although they might well still choose to enjoy relationships with older men. – Health-e News Service.