Politics & Policy

Life Aid

Saving Africa, despite elite disapproval.

If you’re beginning to lose ground, start name-calling. That seems to be the strategy of some elites when it comes to AIDS and Africa.

In an unfair and myopic column on Friday, New York Times columnist Nicholas Kristof revealed “The Secret War on Condoms” coming from the right, and, specifically, from the Catholic Church.

The opposition coming from religious types to condom use is, he says, “downright weird.” In fact, however, it’s the pro-condom focus from the likes of Kristof and aid agencies that is weird, especially as it pertains to AIDS and Africa. It’s weird, given the evidence of what works in Africa; it’s also weird given that some of those most convincingly promoting alternatives to condom use are anything but religious Right types.

First off, condoms are not foolproof — for preventing pregnancy, sexually transmitted diseases, and HIV infection. But that is nothing new. What’s breaking news — news Kristof is missing — comes out of Uganda, where something of a miracle has occurred over the course of the last decade. A nationwide campaign, lead by Uganda’s president and supported by the whole of the government and church-based relief agencies, has focused on behavioral change in combating AIDS, rather than the easier, less-effective, more-accepted Western approach: condoms.

According to a remarkable study published by the U.S. Agency for International Development, “What Happened in Uganda?: Declining HIV Prevalence, Behavior Change, and the National Response,”

the experience [in Uganda] and in other countries that have achieved some success suggests that a comprehensive behavior change-based strategy, ideally involving high level political commitment and a diverse spectrum of community-based participation, may be the most effective prevention approach.

It should be noted that the statisticians who have put the Uganda experiment on display for the world to learn from have not given up on condoms completely (a difference they have with some conservative religious groups); they still encourage condom use, especially for the most-high-risk groups, like sex workers, whose behavior isn’t likely to change.

The Uganda behavior-change approach is not yet prevalent. In fact, one of the study’s coauthors, Edward Green of the Harvard School of Public Health, recently wrote: “There have been few resources allocated to . . . risk avoidance interventions such as promotion of abstinence including delay of sexual debut, or promotion of mutual fidelity to one partner.” Tellingly, he found that in a survey of abstracts coming out of the international AIDS conference in Barcelona last summer, “‘Condoms’ came up 777 times, compared to 16 for ‘faithfulness’ or ‘fidelity’; and 74 for ‘abstinence.’” And even the latter is not as encouraging as it might sound: Green reports that “many or most of the ‘abstinence’ abstracts proved to be about abstaining from drugs, and many others just used the word in passing without evidence of any intervention related to promoting sexual abstinence.”

Given the West’s attachment to condoms, the overwhelming evidence coming from Uganda will no doubt be the catalyst for more columns like Kristof’s (many of them, no doubt, in the “paper of record,” too) — especially since some of the most-ardent condom advocates seem to be breaking. In the final days of 2002, the U.S. Agency for International Development instructed its missions to balance the scales when it comes to AIDS awareness, and to promote the A’s and B’s of AIDS prevention: “Abstain, Be Faithful, and Wear Condoms.” It’s an encouraging sign, for those still alive; a tragically belated move for the millions who have died or are already infected or orphaned.

Uganda is not the only success story, either. Green says that faith-based organizations working in schools and communities “promoting abstinence and delay of age of first sex” seem to be producing results in Senegal, and perhaps in Jamaica, the Dominican Republic, and Zambia.

In some southern African countries, more than 30 percent of the adult population is infected with the AIDS virus. This is no time to be stubborn and ignorant. If it really is “the most effective prevention approach,” there is no reason it should not be embraced — even if backward folks who fall back on religion caught onto it first.

Currently Botswana is gearing up for what its president has called a “war” on AIDS. According to the Washington Post, “The virus is still spreading much faster than it is being treated, with an estimated five new infections per hour and 75 deaths per day — among a population of about 1.6 million.” Why not try what we know works? Africa can’t wait forever — or too much longer.


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