Sexuality - You Must Start With Yourself

	Dr. Nahid Toubia making a presentation at the launch of ARSRC.

I apologise if this paper is not academic enough for some of the readers. That is by choice, as I believe that sexuality should not be dealt with from the convenient distance of intellectual discourse. 

Close Your Eyes and Look Inward
Sexuality: a very loaded word. Seemingly, a very personal matter, yet, in many ways it defines and dictates much of what goes on in society. Thinking about sexuality inevitably starts from the subjective before it moves to the objective, so to understand how and why we all deal with sexuality we must start with ourselves.

Let us pause and contemplate our own personal experiences and our thinking and understanding of our own and other people's sexuality. Yes, close your eyes, contemplate the following questions and record your answers with pen and paper.

I hope that through this short journey of self-scrutiny, I have managed to bring closer home, a few insights:

• We are all sexual beings regardless of whether we physically display our sexuality or we stay celibate.

• Sexuality, while a hushed and taboo subject, in fact permeates many aspects of our lives.

• Sexuality is a social, political and economic concern around which much of our traditional and modern societies are structured.

State of the Field of Sexuality in Africa
I made an attempt to research the literature on sexuality in Africa. I admit that my research was very limited and some readers are likely to be more familiar with what is in the published literature. Still, I confidently report to you that not much has been published in this area. Also the little that is published is not readily available or accessible. I used the Internet as my main tool for research and what was listed is often in specialized libraries and collections. I will attempt to categorise the types of literature dealing with sexuality in Africa in the following non-exhaustive list:

1. Reflections and observations by anthropologists (mostly Western and mostly men) on 'their' perceived version of African sexuality. (Caldwell and Caldwell are a good example).

2. 'Problematic' adolescent sexuality as the cause of unwanted pregnancy with a focus on young women.

3. Sexuality as a "vector" which transmits diseases, and in particular HIV/AIDS, with an emphasis on commercial sex workers and polygamous men. 

4. Sexuality as the contested space for claiming cultural authenticity in the debates around polygamy, female genital mutilation, ritual sexual slavery, virginity taboos, etc.)

5. Challenges of male sexuality (in peace and in war) in the field of violence against women.

6. Feminist writing demanding recognition of the need to acknowledge and protect changing norms of sexuality.

7. Emerging writing by sexual minorities (gays, lesbians and transgendered individuals) emboldened by liberalizing legislation.

8. Very early and tentative writing on sexuality as a human rights issue.

What is Required
What is lacking in this list is a body of considered studies that attempt to understand sexuality within the context of a variety of social and economic orders that regulate our many African realities. Some of these include:

1. The vastly different ways that girls and women experience sexuality different from boys and men (the gender dimension) and the extent that these experience affect their lives (This is recognized only by feminist writers).

2. Investigations into the attitudes towards sexuality of key professionals who shape and regulate our social environments (teachers/health care professionals), law enforcement agents ( police, lawyers and judges) as well as legislators is completely lacking.

3. Understanding of the interaction between our past heritage shaped by longstanding values and traditions; the impact of various colonial cultures, adoption of major religions (Islam and different versions of Christianity) and the impact of globalization that reaches us mostly through the mass media and the internet. 

We have not begun to understand the effect of all these factors on our perception of sexuality across generations.

HIV/AIDS: A Reality Check
While sexuality is very poorly addressed in academic and intellectual circles in Africa, reality has forced us to take action on problems that arise partly from neglecting to address sexuality as a matter of public concern and an issue of responsible governance. The HIV/AIDS epidemic has put sexuality - or more appropriately the need for low risk sexual behaviour - at the centre of policy concern. 

Let me first affirm that "sexuality" cannot and should not be equated to sexual behaviour; be it risky or safe. The latter is a serious consequence of, yet only partial component of, the former. It is sad and ironic that as Africans we had to face the central role of sexuality in our lives as a result of the spread of a deadly disease that is threatening to wipe away whole generations and further disable our ailing economies. The problem is that the need to fend off HIV/AIDS has now, almost exclusively, dominated our thinking at the expense of seeing the need to address issues of sexuality in a broader context.

The Wrong Focus
This 'disease' or 'problem' focused attention to sexuality, be it as a result of HIV/AIDS, unwanted pregnancies, death from clandestine abortions, female genital mutilation, etc., completely misses the point. I believe that this leads to wasted investment on misguided programs and interventions in the search for solutions to these 'problems'. 

The search for root causes and programmatic solutions is often carried out by individuals and institutions that are unfamiliar with the local realities and are uncomfortable dealing with issues of sexuality. Sexually-shy non-African research and technical agents will partner with African individuals and institutions that promote their goals and views on sexuality and gender issues in their selection of program interventions and strategies. This marginalizes those who are able to deal with sexuality in a more open and realistic manner. Women groups and sexual minorities have historically been more able to deal openly with sexuality, and its close connection to gender definitions and power relations, as they already suffer from being sexually defined.

The Gender Dimension
Many still fail to acknowledge that 'gender' is a crucial component in the HIV/AIDS epidemic. While we may not concur with the view that HIV/AIDS is a disease of poverty, the fact is that women's economic vulnerability, their reliance on exchanging their sexuality for survival (within marriage, with sugar daddies and as commercial sex workers), is at the heart of the heterosexual nature of the epidemic in Africa. Distributing condoms and asking women and girls to say no to sex will not stop the epidemic as long as women's economic dependency and their lack of power to negotiate safe sex remains unaddressed. 

Can a woman demand that her husband who just came back from a business trip wear a condom or get tested for HIV before he has sex with her? Can a single mother of small children reveal her HIV status to her current boyfriend (or sugar daddy) at the risk of becoming destitute and starving her children? Can a high school girl insist that her affluent suitor wear a condom if she is desperate to get him to pay her school fees?

Issue of Teen Pregnancy
Another example is the issue of teen pregnancy. The few in-depth inquiries into teenage pregnancy reveal an array of causes including incest, intimate rape (by boyfriend, family friend or relative), complete ignorance of the physiology of reproduction, lack of contraceptives (including the very safe and practical morning after pill), expensive and unsafe abortion services, and the sale of young girls to older men within or outside marriage.

A third example is Female Genital Mutilation. For years, programs repeatedly attempted to 'educate' communities against the health risks of this primitive and "no longer necessary" but harmful traditional practice. What they failed to address is the continuing importance of FGM to the gendered power relations within sexual unions and how they service the social order. 

The reigning social order of patriarchy in certain African societies demands the removal of a woman's sexuality as a component of her reproductive function. Women in return accepted that social order and continue to exchange their genitals as a negotiated settlement for a limited amount of power and control over their lives. 

Addressing Power Balance 
This is the underlying reason why FGM is so deeply protected by women even more than men. Such a strong social pact will not be undone through preaching an abstract link to health risks. Experience has proven that women will not voluntarily abandon FGM unless the existing power balance within the social order is set right and women provided alternative means of negotiating a similar or higher level of power and control. On its own, even the threat of legislative sanctions cannot stop the practice; it only forces it underground.

Modeling of Male 'Sexualities'
Another issue almost completely avoided by program designers, policy makers and even legislators is that of the social and psychological modeling of male sexualities. I deliberately use the term 'sexualities' even though we popularly talk only of male and female sexuality. I believe that thinking of male sexuality as a stereotype and a singular entity re-enforces dominant and problematic norms

Let us first acknowledge and applaud existing models of male sexuality that are non-violent and which centre their psychological reference to emotions and fantasies that are positively creative, respectful and non-harmful to others. Let us pay special attention to the undervalued men and boys who only have sex within equitable and consensual relations. We must thank the mothers and fathers who nurtured such men and boys and the individuals themselves who uphold these positive male sexual values, despite tremendous peer pressure, ridicule and sometimes physical risk. 

Unfortunately such men and boys are still in the minority regardless of whether they practice homosexual or heterosexual sex, within or outside marriage, with partners they love or partners they pay for their services. In short we must seriously and urgently address the violent, possessive and controlling model of male sexuality into which most African boys are shaped. We must also look at the local and imported contributors to these values. 

Economic, legal, educational and employment policies must aim, as one of their goals, to break the link between sexuality, social power and control over resources. Male sexuality must be defined outside of control, power and wealth and female sexuality must not be subservient to economic dependency, absence of autonomous decisions and control. If men and women are socially, legally and politically equal, and have equitable access to education, skills and economic resources, then maybe, sexuality will cease to be a tool of gender oppression or a vehicle for the spread of a killer disease.

Role of Donor Community
I turn next to the role of the donor community in how sexuality was dealt with in Africa in the past and the way in which the future is being shaped. For over twenty years the international donor community had focused their attention on the problem of rising populations in Africa. Family planning programs and clinics have been the best-funded health-related service for the past thirty years. There was no talk about sex. The fact that sex has to happen for contraception to be needed or that negotiating the use of contraceptives was directly related to gender power relations within sexual unions was completely absent from the formula. Such basic, everyday associations seemingly did not enter the consciousness of these donors and the agencies they chose to contract for hundreds of millions of dollars. Or, if they were indeed conscious of these issues, it did not show in the way they designed services and conducted training.

Even after 20 years of the HIV/AIDS epidemic and after THE ICPD and Beijing conferences, there is still serious discomfort and outright neglect of sexuality and sexual power relations within the priorities and programs of most donors. The Africa Regional Sexuality Resource Centre is a welcome exception to the rule and, hopefully, a first step in donor and government recognition of the importance of sexuality to many fields, and in particular the health and human rights fields.

Sexuality: Safe, Creative, Pleasurable
In conclusion, I hope that I have impressed upon the reader that sex and sexuality are very serious matters indeed and if neglected will lead to problems that will result in the loss of lives and valuables resources. But sex and sexuality need not be too serious or problematic. In the age of advanced contraception, heterosexual intercourse has been liberated from its ominous link to pregnancy. Our understanding of healthy sexuality has evolved away from compulsory or forced intercourse to all forms of safe, creative and pleasurable exchanges among consenting adults of either sex. It does not even have to be between two adults but a matter between the individual and the flight of his or her fantasy. In a democratic secular system, sex and sexuality should be protected as a matter of personal ownership and choice. When we have reached that point, we will know that we have reached the threshold of holistic human development.

This article is an adaptation of a paper presented at the official launching ceremony of the Africa Regional Sexuality Resource Centre on June 11, 2003 by guest speaker, Dr. Nahid Toubia, the first woman surgeon of Sudan, and President, Research Action and Information Network for Bodily Integrity of Women (RAINBO).