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without being run out of town. te KK In the Strange Case of Clarisse and Her Condomless Ex, I was at least Being Faithful with a pre-tested partner, and I didn't live in an HIV-rich population. The risks were lower, and it's true that I've never run those kinds of risks outside a long-term monogamous relationship. But the bottom line remains: my ex and I did it even though we knew better. He and I are both privileged people. Neither of us was dependent on the other for money, for instance. If two highly privileged people who agree that condoms are necessary can fail to use condoms, what about people who don't have that privilege? In many places across the world, including much of southern Africa, sex workers can charge double for sex without a condom. No businesswoman is likely to insist on a measure that will halve her profits -- especially if she already lives on a razor-fine margin, and especially if she's already contracted HIV herself. Likewise, if a girl can't afford expensive school fees and therefore sleeps with her teachers, then she's hardly in a position to demand protection. Many married women quite justifiably fear divorce, violence or murder if they refuse their husbands sex without a condom -- in one recent case, a wife tested negative for HIV while her husband tested positive, but when she tried to refuse condomless sex, he killed her. Some pro-condom campaigns tell the populace that "it's your responsibility: you must respect your body and take the initiative"; but while that works for some people, it's a terribly cruel message for people who lack the standing to negotiate with their partners. Add to this the fact that, if you know enough people living with HIV -- and if your life already seems difficult and directionless -- the disease will start to seem like much less of a big deal. A friend reports that one day, sitting in a salon, she saw a man exit with a sex worker. "Don't forget a condom!" she called bluntly. His reply: "I'm not the first to get it and I won't be the last." (Indeed, there are documented cases of marginal populations deliberately contracting HIV when they perceived benefits. For instance, when HIV- positive illegal immigrants in France were offered citizenship as part of a humanitarian initiative, some sought out the disease.) People who ignore prophylactics will always be with us. Some of them will be like me and my ex, or the sex worker's client: despite knowing the risk, transient pleasure trumps absolute safety. There isn't much to be done about that demographic, save ensuring that they (we) truly grasp the consequences we risk with our silliness. ? Some people, however, will be vulnerable more because they're female, or young, or poor. In those cases, addressing the root causes -- sexism, poverty, abuse -- becomes the only solution. Thus, some of the best HIV programs in southern Africa appear to address completely different issues. These include: * Identifying and supporting income-generating projects for women, so that they have the resources to walk away from abusive partners; * Sponsoring schools, so that they can educate for free and remove one reason a HOUSE_OVERSIGHT_018592