The Greening of AIDS Prevention
Don’t bet the house and farm on drugs and condoms.


Broken Promises: How the AIDS Establishment Has Betrayed the Developing World is the recent book by Edward C. Green, the former director of the AIDS Prevention Research Project at the Harvard School of Health. He has been conducting research in Africa, Southeast Asia, and other parts of the world for upwards of three decades, in the fields of applied anthropology and international health. In an interview with National Review Online, Green, current director of the New Paradigm Fund, talks about clarifying recent AIDS research and how it vindicates some controversial positions taken by the likes of the Pope in Rome and George W. Bush.

: In 2009, on his way to Africa, Pope Benedict XVI said: “If there is no human dimension, if Africans do not help by responsible behavior, the problem cannot be overcome by the distribution of prophylactics. On the contrary, they increase it.” Does this recent study even the New York Times noticed vindicate Pope Benedict with science?

EDWARD C. GREEN: Yes, and Broken Promises is an extended vindication of Pope Benedict, at least as far as the so-called generalized HIV epidemics of Africa are concerned. And this is in fact what the Pope was talking about. To summarize: We have seen HIV decline in Africa when the number of multiple and concurrent sexual partnerships has declined and when more people have been faithful. The role of condoms in HIV success stories such as Uganda and Zimbabwe has been debated, but we have certainly never seen more condom use alone bring about declines in HIV. The parts of the continent with the highest condom use — in southern Africa — have the highest HIV rates, and at the level of individuals, there tends to be an association between condom use and being HIV infected, perhaps because people who use condoms take more sexual risks. When you stop and think about it, who uses condoms? It’s rarely married people or even familiar partners in ongoing relationships. Condoms are mostly used with sex workers and casual sex partners. When condom-user rates rise, it might be because casual or commercial sex is on the rise.

There is, by the way, some evidence that consistent condom use among sex workers reduces risk of HIV transmission to customers. The Pope even said something along these lines (in 2010, as I recall). The evidence for this is strongest in Thailand. Yet even there, considered a model for a condom-focused AIDS-prevention program, high condom-user rates proved hard or impossible to sustain over time.

: The latest study, though, comes from The Lancet. Why should we buy anything The Lancet sells? Isn’t it the same place that called the Pope’s previously noted comments “outrageous and wildly inaccurate”?

: You have a point there! Although we are talking about one of the most prestigious medical journals in the world, the recent editor (and I haven’t checked to see if he’s still there) certainly had a pro-condom bias. On the other hand, Dr. Norman Hearst and I published a letter in defense of the Pope’s comments in The Lancet, a few months after its anti-Pope editorial. So one hopes that truth and science prevail in the end. At least unpopular viewpoints are more often getting published nowadays.

: Has AIDS aid, when it comes to Africa, been co-opted by ideology? Is this an opening for something to change?

: Co-opted by ideology? Indeed it has. The original title for my new book was to be AIDS and Ideology, but my publisher thought that sounded too cerebral. In my book, I describe not only the financial self-interest of organizations geared to continue lucrative U.S. government contracts and grants in family planning (contraception); I also show how an ideology of Sexual Liberation über Alles has pretty much removed most public health or medical value from what we call global AIDS prevention. Now, as an aging hippie who came of age in the 1960s, I know all about sexual liberation and I like to say I was at least a two-star general in the Sixties Sexual Revolution, but we have to ask ourselves, when we are using literally billions of taxpayer dollars, is our aim to spread the Gospel of Sexual Freedom, or is it to reduce HIV infections? When you break down the elements of global AIDS prevention, it’s hard to escape the conclusion that it’s often more about the former, although I think that much of this operates below the level of conscious decision-making, and/or disguises itself as political correctness or being non-judgmental.

I sometimes put it another way: If our aim is to reduce HIV infection rates (and that’s a big “if”), then why are we so reluctant to talk about partners’ being faithful to one another, or to mention the dreaded A-word, abstinence (which was known in Uganda as “delaying sexual debut”)? Why do we restrict ourselves to drugs and devices (such as condoms)? Actually, things have changed for the better, to some extent.