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Sexual Behaviour and Risks of HIV Infection

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Michel Hubert

I. Understanding Sexual Behaviour: Some Perspectives in the Context of HIV Infection

The Contribution of Anthropology to the Understanding of Sexual Behaviour Changes in the Context of AIDS

José A. Nieto

Texte intégral

1Understanding sexual behaviour changes in the context of AIDS, or previously in the context of the so-called sexual revolution, the recently named sexual conterrevolution, or any other context implies, first of all, an understanding of sexual behaviour. Social scientists have to know what sexual behaviour is and how it is expressed in order to understand how changes are made. In other words, social scientists need to know former patterns of sexual behaviour if the comparison with present ways of sexual expression is going to be developed. Unfortunately, we know very little about sexual behaviour by itself. We know even less in comparison with the scientific knowledge we have of others human behaviours, at least with regard to anthropology. Conscious of these limitations on implementing prevention programmes, the World Health Organisation (WHO) is gathering data and information on sexual orientation, sexual practices, attitudes and beliefs about sex, sexual ideology, selection and number of sexual partners, risky sexual behaviour, knowledge about risk reduction alternatives and other topics related to human sexual expression. A data base must be compiled, and be compiled systematically. Then comparisons may be made.

I. Ethnography and anthropology of sexual behaviour

2Anthropologists traditionally use the Human Relations Area Files (HRAF) to analyse and compare ethnographic data. However the data on sexual behaviour that HRAF offers are rather insufficient. We do not find detailed sexual descriptions. We now know that anthropologists have silenced sexual reports because of a puritanical approach and/or because they were afraid that their professional reputations would suffer neglect, disdain or disregard if they devoted time and energy, reflexion and theory to investigating sexuality. In short, due to the insufficiency of sexual information, plus others weaknesses, the HRAF requires considerable improvement to become the backbone of a future "sexual building". At present, the most we can get from it is accurate statistical results based on unreliable sexual foundations.

  • 1 P. gebhard (1971) divides anthropologists into three groups: a) the Conservatives b) the Progessiv (...)

3It should be kept in mind that I have said "accurate statistical results" when the general criticism levied against anthropology, from other social sciences, is precisely to point out its inability to produce statistical measurements and validations. From a statistical point of view, anthropological studies are unrepresentative, considering the sizes of the populations that anthropologists deal with. Paul Gebahrd's so-called "synthetizer" anthropologists,1 i.e. those who approach sexual behaviour in order to make statistical inferences, have to overcome methodological difficulties from the very beginning.

  • 2 Furthermore, it implies a rigid, static understanding of normality.

4It is crucial to understand that the concepts of sexual normality and abnormality are concepts based on statistical paradigms.2 Clinical approaches to sexuality have systematically sustained sexual value judgments in terms of normality and abnormality. In-depth descriptions of sexual behaviour should not play a role in making differentiations about what constitute normality. This should be the goal of the anthropological approach and at the same time its comparative advantage, advantage in the sense that a qualitative approach can observe those kinds of "abnormal" sexual behaviour that a quantitative perspective is unable to do it. When translated into medical terms, statistically abnormal sexual behaviour transmits socio-cullural bias, because the scientific objectivity is broken by the professional bias that incorporates in the research the inertia of the unconscious rules of social censorship. Besides, qualitative approaches differ with regard to quantitative ones in terms of lime, with the former taking much more time to clarify results than the latter. In short, quantitative methods require less (shorter) time, larger populations and common practices.

Quantitative Methods

Qualitative Methods

Short duration

Long duration

Large population

Small population

"Normal" behaviour

"Abnormal" behaviour

  • 3 "Four transexuals in my research population took the Minnesota Multiphasic Personality Inventory g (...)

5But even "normal" sexual behaviour presents difficulties when it is understood through survey techniques. The shorter the question formulated by an interviewer, the higher the level of defense shown by the interviewee. People try to protect their forms and manners, specially when they are conscious they do things that "should not be done". People seek shelter in answers that conceal their real behaviour when this behaviour docs not reach the social standard set by society. In so doing they protect their image and reputation. Therefore, even the most normal sexual behaviour conducted in a "classical" marriage life could be distorted if a partner has to recognise in a questionnaire his/her lacks and unskilfulness. Nobody wants to show himself/herself "naked" during the short time a questionnaire last. "If I know I am doing wrong why should I say it to an unknown person who all of a sudden knocks at my door?" By the same token, questions that require self-evaluation tend to score higher than when respondents are evaluated by others. Furthermore, in order to conform to professional expectation, in fact, to conform with requirements needed to reach a particular goal, people make unreliable statements. For instance, transsexuals will be selected for a surgical program only if they score feminine enough in psychological tests. Otherwise, surgery will not be available for them and they will be eliminated from the data on transsexuals in spite of their felt transsexualism. Bolin makes this point quite clear.3

  • 4 Nevertheless, the Global Programme on AIDS of the World Health Organization, aware of the urgent n (...)

6The aforesaid reflexions on survey methods raise serious doubts about the validity of questionnaire techniques to obtain certain kinds of sexual information related to sexual behaviour. One thing is what is thought, another is what is said and still another what is done. It seems that sexual behaviour information is better obtained through qualitative approaches rather than through a survey approach, despite the intrinsic difficulties of obtaining information through that methodology. Observing people's daily sex lives, paying attention to the symbolism of their actions, recording (registering) the way they play their roles, and carrying out in-depth interviews and group discussions could provide the researcher with fuller, more solid and more reliable information on sexual activities that would be unattainable by other means.4

II. Anthropological foundations

  • 5 I develop this point in my paper (Nieto, 1989: 64-72).

7Whithin the context of any society there is no universal pattern of sexual behaviour. Sexual ideology is one thing, sexual legislation is another and sexual behaviour still another. Discrepancies between the legal norm and the way people internalise it, on the one hand, and the way they act, on the other, are common. When legislators invoke the written norm in order to channel the sexual-social order, they proceed in a messianic way, because they confer on the legal norm a sacred value, as if it were a kind of "Holy Scripture". But the intention to control sexuality to society through legislation is an illusion. Transgression exists within all societies. It does not matter how deep sexual attitudes and beliefs are rooted-every single society has transgressors.5

8From an anthropological point of view this is a parameter of extreme magnitude. Transgression is precisely the main element that shapes the concept of atypical behaviour. And transgressors are these people who, in violating the legal norm, define its content. Therefore, if "unusual", "abnormal" or "atypical" sexual behaviour should be contemplated by anthropological methods in order to get a better understanding, anthropologists investigating sexual changes in the context of AIDS should give special significance to transgression and transgressors.

9Fixing the idea, giving the legal norm a universal expansion is a claim of legislation that has no correspondence in practical terms. It is just the reverse: sexual behaviour that transgresses the legal norm constitutes a universal principle. We need, then, to focus on transgression if we really want to know about risky sexual behaviour and to implement prevention programmes based on risk-reducing alternatives. We shall focus on transgression using two approaches, the holistic approach and the comparative approach.

A. Holistic approach

  • 6 This point is considered in more detail in Nieto (1988)

10Unusual sexual behaviour should not be investigated in isolation. As a matter of fact, if a particular type of sexual behaviour is considered unusual, it is considered unusual with respect to the norm. We can not define one without the other. We have to relate one to the other. Usual and unusual sexual behaviour are interconnected. The anthropological holistic approach means interconnexion, that is, relationships. Holism is a recurrent anthropological approach in general; from the standpoint of sexual anthropology, in particular, it implies the intertwin of opposite behaviours. Intertwining opposite behaviours requires paying equal attention to the different aspects that integrate them. Holism is not mentioning usual sexual behaviour and silencing unusual behaviour. Above all, holism is the significant detachment of silence.6 If human sexual behaviour has multiple ways of expression, if it is shown with numerous inter-and intracultural differences, if sexual variety permeates societies, we should not silence unusual sexual behaviour for it, like its opposite, stems from social reality. We will never be able to understand this reality if we investigate it partially. If sexual expression is not exclusively heterosexuality and even less reproductive heterosexuality, attention must be devoted to all kinds of behaviour. One is tempted to say that, in the context of AIDS, researchers should devote more attention to marginal sexual behaviour rather than to the central one, because in the AIDS era marginal becomes central.

11Marginal sexual behaviour is not homogeneous. It is heterogeneous in all respects. Sexual minorities are composed of people with different needs, who express them differently. Only when contemplated from outside do sexual minorities seem equally homogeneous. When seen from the inside, they differ. The holistic approach, therefore, contemplates sexual behaviour through a double-faced heterogeneity. One side shows society as a whole, without exclusions. The other shows the internal richness of the different (marginal) groups that it contains.

B. Comparative approach

12The more research developed on any subject, the better. This principle works for science in general but it is of extraordinary interest for anthropology, because the chances and opportunities for making comparisons increase. The comparative tradition, it has been said, has always penetrated the anthropological field, but accomplishing the goal is not easy when data are absent and information is scarce, as is the case for sexuality. Fortunately, things are changing, gradually, but changing nevertheless, and there is more and more anthropological interest in human sexual behaviour. The fact that the World Health Organisation, European Community and other international and national agencies are gathering data on sexual behaviour is an unprecedented endeavour of extreme relevance for comparative purposes. There is no doubt about - this is a scientific sexual revolution.

13In this way, the traditional Victorian vicious circle is broken. Basically, the structure of the circle was founded in the argument: "There is no sexual research because there is no financial aid for it and there is no financial aid because research proposals are not submitted". With the intervention of the international agencies in an effort to control and, ideally, to stop the spread of AIDS, the vicious circle will become a virtuous circle. The acknowledgement by the international agencies of the lack of scientific sexual information will lay, for the first time, solid foundations for comparing sexual behaviour.

14Concretely, for anthropology this means: (a) an increase in the attention paid to sexuality, since anthropologists will feel motivated to abandon their apathy to research in that direction. At the same time, the old reason to justify silence and omissions, the "bad professional reputation excuse" will be meaningless, since sexual research is supported by international agencies; (b) a decrease in the intrusion of other professionals in the anthropological field. This is a consequence of the former point. The more anthropologists get involved in sexual research, the less initiative is left for dilettantism, for people, without the necessary background and methodological equipment occupy, a space that is not warranted by their legitimate interests; (c) a potential contribution to the advance of multi-and interdisciplinary sexual studies, for two reasons: firstly, because to control AIDS one need a common effort of both the biomedical and the sociocultural approach and, therefore, medicine and psychology, sociology and anthropology must interact to generate as much efficiency as possible; secondly, because the decrease in dilettantism supposes the liberation of additional undertakings, which, in turn, will facilitate a better and larger concentration on specific purposes suitable to the particular field of specialisation. As a result, the scientific community will gain a better understanding of the phenomena, a clear improvement in its knowledge and, in the final analysis, more efficiency and more bases to foster the increase of the needed interdisciplinary dialogue.

15Under these auspices anthropology will show, as has already been shown in other aspects, that its methods and techniques can apply to understand the sexual behaviour of developed and underdeveloped societies, rural and urban areas alike. This is its usefulnes and its contribution to our basic need, i.e., the designing of models for the purpose of comparison.

C. Participant observation

16The traditional anthropological methodology is "participant observation", in which the anthropologist participates in the way of life of the people being observed. This methodology is so common that to refer to anthropology is automatically considered to refer to participant observation, and vice versa. Anthropological observation through the active methodological involvement of the observer has been understood traditionally and metaphorically as a prism that basically combines: (a) the sociocultural aspects of the investigated object, (b) the ethnogaphic presentation, that is, the sharp description of the object of observation, and (c) the neutral participation of the observer.

  • 7 For this purpose the reader is directed to Hymes (1969).

17However, "ethnography mixes science and art, analysis and intuition, detachment and intimacy in ways that call into question the value of those distinctions for characterizing the experience... A language of ethnography is a natural area for growth in our discipline in terms of method, theory and epistemology" (Agar, 1986: IX). And, under this light, neutral participation becomes an impossible objective. The aforementioned Agar's thesis, although expressed in a different context, is, in fact, a thesis defended by Hymes (1969), Diamond (1969), Scholte (1969) and others long before.7 This must not be held against Agar. On the contrary, Agar's statement evidences clearly the persistence of Douglas Dowd's affirmation: "To be uncommitted is not to be neutral but to be committed-consciously or not - to the status quo - to celebrate the present" (Berreman, 1969: 90). And if the present is AIDS, should we celebrate it? It is precisely this kind of uncommitted presumptuously neutral anthropology that has permitted sociocultural sexual information and knowledge to be as scarce and deficient as it is.

18Neutral commitment has been presented as equivalent to detachment and, similarly, scientific detachment has been considered to be the validation and proof of objectivity. Much criticism of this scientific understanding has been levelled at the philosophy of science and the social sciences. If these critiques are, in general, correct, they are even more correct in particular, because in sexuality "our much-vaunted dedication to detachment and objectivity not only does little to help on its own but may be a positive hindrance" (Turnbull, 1986: 17). The assumed objectivity of the role of the professional vis-à-vis the subjects of study defines the borderline of the persons integrating both sides. Moreover, it is done in such a way that the "not trespassing condition" implies unlevelled power relationships. This, in turn, leads to falsification of situations and forging of declarations in order to have what otherwise would be unreachable, as in the case pointed out by Bolin, of transsexuals with respect to their therapists. As she was on an equal footing with her subjects and had associated with them voluntarily, the transsexuals whom Bolin researched had no vested interest in fabricating or lying to her about some aspects of their lives, as she pointed out (Bolin, 1988: 37). In short, either we introduce a certain degree of personal involvement in the research or the reliability and validity of the sexual study will be nil.

19Turnbull said that anthropologists should take advantage of and leant from the discipline, methods and techniques of drama. He recalls Grotowski's "Poor theatre" and finally he decants himself in the sense that anthropologists should not appropriate theatrical techniques in toto, but should combine both experiences, theirs and the theatre's, and adapt them to the anthropological framework (Turnbull, 1986). Bateson (1980) refers to "disciplined subjectivity", Schwartz and Schwartz (1955) to "empathetic observation" and Warren (1974) to "reflective subjectivity". Nieto talks of subjective-objective observation and of discerner participant-observation (Nieto, 1989: 72).

  • 8 This point may be contrasted in Thompson (1978).
  • 9 About anthropological reformulations G. Marcus (1986: 166) says: "In anthropology and all other hu (...)

20It seems that anthropologists are enhancing more and more the possibility of transforming abstract questions into new ones. They are altering experience in a thompsonian8 way which, in turn, will make it possible to know more and more concrete details of sexual behaviour. The reluctance major barrier to investigating sexual behaviour through ethnographic inquiry is the resistance of AIDS. Consequently, the understanding of sexual behaviour will contribute to the defeat of AIDS. In other words, sexual behaviour, AIDS and anthropology are a kind of archipelago, a chain of islands united by the same link that separates them9.

III. Some strategies for sexual practices research

  • 10 To be published.

21Very few systematic attempts have been made by anthropologists to facilitate the comparison of investigations on human sexual behaviour. Suggestions for data gathering, outlines for comparative anthropological studies and attempts to bring the literature together can be found in Suggs (1966), Gebhard (1968), Marshall (1971) and Davis and Whitten (1987). Diamond and Nieto10 offer a check list for anthropologists, in which ethnographies and societies may be compared. Cross-cultural perspectives of human sexual behaviour may be found in Caplan (1987), Davenport (1977), Ford (1949), Frayser (1985), Gregersen (1983), Honigmann (1954), La Barre (1971), Reiss (1986), Sonenschein (1968), Trager (1962) and Whitehead and Conaway (1986). If the data and literature on sexual practices provided by anthropologists are scarce, fragmented and scattered, now that there is an increased interest in understanding the sociocultural aspects of sexuality the following two goals must be achieved: (a) an international centre or clearinghouse (a proposal already made by Gebhard in 1968) to centralise sexual information must be set up and (b) national centres for the same purposes must be created. If this is done, channels of international communication and information sharing will develop. It is important to keep in mind that if anthropology fits cross-cultural studies better than other sciences, at the present time it should carry out the endeavour not only through its traditional study of vanishing preliterate societies, but also by focusing on (and emphasising) contemporary societies.

22With regard to AIDS, priority should be given to investigating:

  1. High-risk groups
  2. High-risk practices11
  3. Circumcision, subincision, clitoridectomy and infibulation practices
  4. Sexual tourism
  5. Birth control and fertility practices
  6. Control of sexual behaviour changes in ritualised and non-ritualised practices

23Separate attention, for its special interest, should be paid to sick persons. Under such conditions, people might disclose details never mentioned. Extreme conditions favour sincerity and scientific knowledge will benefit from it.

  • 12 For more specific, detailed information, see Parker et al., 1990.

24Shortly, priorities should be understood at two different levels: individual and sociocultural12. Particular behaviours and social networks are extremely important to explain meanings and to explain them interpretatively. We need interpretation because not only meaning or meanings of an individual or social action are important, but also the way the meaning is scientifically apprehended, transmitted and disseminated.

Bibliographie

References

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Bateson M.C. (1980), Continuities in insight and innovation: toward a biography of Margaret Mead, in American Anthropologist, 82(2): 270-77.

Berreman G.D. (1969), Bringing it all back home: malaise in anthropology, in Hymes D., Reinventing Anthropology, Random House.

Bolin A. (1988), In Search of Eve: Transsexual Rites of Passage, Bergin & Garvey.

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Davis D.L., Whitten R.G. (1987), The cross-cultural study of human sexuality, in Annual Review of Anthropology, 16: 69-98.

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Notes

1 P. gebhard (1971) divides anthropologists into three groups: a) the Conservatives b) the Progessives, and c) the Synthesizers.

2 Furthermore, it implies a rigid, static understanding of normality.

3 "Four transexuals in my research population took the Minnesota Multiphasic Personality Inventory given by a local psychologist in order to fulfill requirements for continued hormone therapy. Information about this test, what types of questions were asked, and a strategy for answering, rapidly spread among these transsexuals. All scored femininely on the index, and all claimed it was not difficult to see questions directed at the issue of masculinity and feminity. Therefore, an individual's desire to score femininely when she believed her hormone therapy or surgery was at risk could offset the validity of such test" (Bolin, 1988: 109).

4 Nevertheless, the Global Programme on AIDS of the World Health Organization, aware of the urgent need for baseline data on a series of issues that have previously received little or no research attention, gives special importance to quantitative methods combining them with qualitative methodologies.

5 I develop this point in my paper (Nieto, 1989: 64-72).

6 This point is considered in more detail in Nieto (1988)

7 For this purpose the reader is directed to Hymes (1969).

8 This point may be contrasted in Thompson (1978).

9 About anthropological reformulations G. Marcus (1986: 166) says: "In anthropology and all other human sciences at the moment, high theoretical discourse-the body of ideas that authoritatively unify a field-is in disarray. The most interesting and provocative theoretical works now are precisely those that point to practice, that is, to a bottom-up reformulation of classic questions, which hinges on how the previously taken-for-granted facts of high theory are to be represented".

10 To be published.

11 Although it is more correct to refer to "High Risk Practices" rather than to "High Risk Groups", in order to avoid "methodological alibis", I think it is useful to maintain this dual presentation.

12 For more specific, detailed information, see Parker et al., 1990.

Auteur

Universidad Nacional de Educacion a Distancia, Madrid

© Presses de l’Université Saint-Louis, 1990

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