Newspaper Column #15: The Viralness of HIV/AIDs – Part II: The Difference Between Working Hard and Working Smart.

As it appeared in the Sunday Standard, Botswana May 19, 2013, edition.

From a systemic perspective, the causality of HIV/AIDs as a phenomenon will be no different from that of one country to another!  Be it that it is happening in India or Europe or China or here in Botswana, South Africa or Namibia.  Despite races or nationalities or professions.

The circle of causality reinforces or feeds itself, negatively, perhaps at different rates (some slower, others faster), but the reasons or causes that appear in the cycle will be the same.

The reason for transmission of the virus however, for an individual may differ from one person to another.  That’s from the perspective of a medical doctor.  That’s what he sees.  But the systemic causality of the phenomenon will be the same across all them.

Systemic thinking is not interested in the former.  It’s focus and attention is on the latter.

And what would you say this means from a systemic perspective for nations that show low levels of the epidemic numbers?  This would mean that the circle of causality is reinforcing positively rather than negatively or we say virtuously in their instances.  It is the same cycle, just reinforcing positively.

Each time the circle of causality reinforces or as we say the causes feed themselves as a cycle, the community or the country experiences increasingly negligent levels of infections despite the levels other nations may be experiencing around the globe.  And most importantly, they achieve those results with little or no effort (and certainly no resources) on their part.

Whether it is good news or bad news, the cycle of causality will be the same.

This series of articles that we have just begun here, seeks to uncover what is the circle of causality in the case of HIV/AIDs as a systemic or national phenomenon.

Please note however, the doctor, needs to continue to treat or advice the patient, nevertheless.  However, treating a patient will not treat (or reverse the effects of this phenomenon) as a nation.  The cycle will continue to run its course until we treat the cycle with a systemic solution.

That’s not a medical perspective.  It requires the perspective of the nation.  The latter cannot absolve itself from being a part of the solution here.

In last week’s article, we explored and uncovered the following:

Prevalence Levels ß New Infections (identified or otherwise) Levels ßLevels of Transmissions ß ?

And then I left you with the question,” what causes the levels of transmissions to go up?”  Notice again, I did not ask, what caused a transmission.  Instead, the question seeks to understand what causes its relentless upward trend.

And then I clarified the question further by asking which one of the above did you (and your circle of family and friends) think was the MAIN REASON? … the 20% that contributes 80% of the causes!

And I offered five options:  Was it unsafe sexual practices?  Would it be mother-to-child transmissions?  Would it be unsafe use of tainted needles?  Or is it accidents and wounds?  Or was there another reason?

I have posed this question each time with various groups for possibly over thousands of participants.  And there is resounded one unequivocal answer.  I am sure you have guessed it too!

Most, quite easily vouch that the answer is, sexual intercourse.  And should we take you the readers of this newspaper and continue to make that count, we are quite sure that we will arrive at the same answer.

Now, to see that ‘sexual intercourse’ as the “main river” that adds to the “ocean of HIV/AIDs prevalence”, was important.  Here’s why.

When I do this activity with a group of medical practitioners who are tasked to advance the prevention of transmission of the disease from mother to child, it begins to dawn on them that while they work hard at preventing the transmission of the virus to the child from its mother, yet that child when it grows up, it did not have a way to control the transmission of the virus to itself through its own sexual practices.  The child (and that is all of us) has not learned to save itself from the virus.  It just happens.  Sometimes, before we reach our teens!  This clarity floors these organizations every time.

What is the implication of understanding this on resources and effort?  It literally means money down the drain for them.

Why do we do that?

While it was a necessary correction, it was still an easier and costlier route. We would choose this way, because, trying to curb transmission through sexual practices, was a more difficult process, and in our minds, and almost impossible task.

Yes, it is impossible.  That is, if we see all solutions as about controls and monitoring others.

When we are faced with such a systemic situation, it requires learning to work with levers that lead to individuals taking actions for themselves.  This way of thinking is perhaps new for us.

In short, it means, we need to learn how the individual would make those decisions.  Whatever, the reason that leads one to take a decision, when the reason is “not there” it would lead one to decide to take a different course of action.  For oneself!

It is more difficult process to get there.  No doubt.

Unfortunately, however, it is the reality.

When we face that reality, we also learn to face solutions that work.  And when, we get there, it becomes very simple.

So shall we carry on uncovering the reason in the cycle?

So, the next question is what causes transmissions by sexual practices to go up?

Let me frame this differently.  In my workshops, I would typically ask a question, “Should two individuals, both HIV positive stay sexually fidel to each other, would that lead to increased levels of transmissions to individuals outside of the couple’s relationship.  That is, in spite of unsafe sexual practices with each other?

And the answer would be quite simply …. No!  Yes, you are right!

Except for the pair, there would be zero transmissions beyond them.  Something, a lot of nations easily aspires for it to happen but thinks it is difficult to reach.  Yet, it really isn’t that difficult to figure this one out.

Taking this reasoning beyond the obvious reason, lies in asking the question, what causes or encourages the behaviour of discriminate sexual relation by a couple with each other?

Perhaps you may ask, what is that?  It would be the act of engaging in sexual relationship with one person that lasts beyond evenings to a lifetime of days.  Hard as it may sound, we would otherwise refer to as fidelity.

So the next question is, “what causes sexual fidelity”?  Would it need controls?  What encourages its growth?  What discourages it?

We all seem to know what causes infidelity.

But what causes fidelity?  Where does that begin?  What do you think?  What does your wife (or girlfriend) think?

This will be the subject of the column’s discussion for next week.  Happy discovering!

Does it really matter that we know all of the causes of the viralness or we need to figure the  ONE?  Yes, it matters that we figure the “main river”.

It makes all the difference between working hard and working smart.

Ms Sheila Damodaran works as a systemic strategy development consultant currently developing her practice with national planning commissions in southern Africa.  She welcomes comments and queries for her articles and programmes at or call DID: 3931518.