I’ve been working in HIV prevention in Botswana for the last five months and have also been struck by the prevalence of long term concurrent partnerships and casual attitudes towards infidelity. This is a precarious topic, since it treads close to negative stereotypes of African sexuality–one reason for the hesitancy of African leaders to address the issue. But the logic of Epstein’s argument (and the evidence I’ve seen) suggests that changing social norms around multiple sexual partners would go a long way to reducing HIV incidence.

In my work, I’ve found crafting fidelity- based prevention messages to be a major challenge. The problem is simple: you can, in good faith, tell people that if they abstain or condomize (correctly and consistently) then they are protecting themselves from HIV. But fidelity is not foolproof, since partners may not be faithful in turn. (Hence the appeal of A and C for donors).
In low trust situations (e.g. cultures where multiple partnerships are the norm), individuals will not rationally choose fidelity as a tool for prevention, instead perceiving a choice between A, C, and unprotected sex. As Epstein points out, there is a huge positive social externality to an individual’s fidelity; but since, in low trust situations, this benefit is not fully captured by individuals choosing to be faithful, fidelity will be “under-consumed.”
In other words, people can be motivated to choose A and C on the basis of a rational response the threat of HIV to themselves as individuals. People will only choose fidelity on a large scale if they can identify with a larger project of social change. This is what is so fascinating about the uganda case, and why people interested in public health should be interested in the politics of collective action.