The New York Times reports that China has a new “action plan” for containing the HIV/AIDS epidemic which will focus on — surprise! — blanketing the country with condoms. Public-health authorities typically love to talk about “targeted” interventions, but this plan calls for “governments at all levels to designate public places where condoms or condom vending machines can be made available”; one goal is to make them available in 95 percent of the country’s hotels by 2015.
Such indiscriminate condom promotion — the entire Chinese adult population is an awfully big target — typically involves a corresponding and stupefying lack of emphasis on behavioral changes which, unlike condoms, are always prominent when AIDS rates decline. Rather than leading to a technically engineered, disease-free utopia, it’s far more likely that this approach would lead to another failure; we’ve been down this path before, and it is not a promising one. It is a profitable one, however, for condom suppliers and program managers. So what if its track record suggests it is not warranted? So what if such a policy would actually inflame the situation by increasing risk-taking and disease? The introduction of an array of technical measures has tended to do that elsewhere.
The one African country — Uganda — which conspicuously rejected the condom-centered model and encouraged fidelity and restraint instead was for many years the only one to enjoy a reversal, while those African countries that enthusiastically embraced the technical, “risk reduction” philosophy only further languished. HIV incidence has remained constant in the U.S. and in the U.K. for the last decade, and this is not for lack of condoms or even treatment.
For years, the AIDS establishment has errantly and sometimes disingenuously cautioned that a number of countries were on the cusp of a major AIDS explosion. Author Elizabeth Pisani, a former UNAIDS employee, acknowledges that they knowingly presented AIDS statistics in the gravest possible terms, principally to elicit funding from Western governments. But there was also an ideological interest: By portraying everyone as being at serious risk, all forms of sexual behavior could more easily be presented as being of equal moral value.
A World Health Organization bulletin now echoes that refrain, asserting that “there is still time for China to slow the spread of HIV and to prevent a wider epidemic” — that is, if only we can flood the country with condoms and clean needles. Despite what the WHO might lead us to believe, however, it is unlikely that AIDS rates will explode in China. Monster epidemics (excluding the serious epidemics driven by injection drug use) such as those in southern and eastern Africa, occur because both men and women have multiple and concurrent sexual partnerships (thus forming networks through which the virus is more easily transmitted), and because large percentages of the men are not circumcised. This is not the epidemiological profile for China — or most other countries, for that matter.
The credibility of the WHO, however, has proven to be remarkably immune from damage. The latest hit to their credibility should have come earlier this year, when they convened a meeting to discuss whether or not to revise their guidelines in light of a recently published study in the Lancet, which found that the use of hormonal contraceptives probably doubles the risk of HIV transmission for women (compared to women who don’t use them); this elevated risk also applies to male partners of already infected women.
After a couple days worth of “technical consultation,” lo and behold, they concluded that they don’t need to revise their guidelines after all. And they didn’t even see fit to issue that most ubiquitous of all recommendations — that “additional research” into the matter be conducted. Granted, the nature of the evidence to date is such that we are not able to conclusively say there is a veritable link, but that is a far cry from saying that it is definitely not worth any further investigation.
The mere hint that the risk-reduction philosophy might on balance be counterproductive must be resisted because that would put a damper on the drive to normalize and justify given behaviors by making them “safe.” But we should expect health authorities to promulgate sound public-health policy, not to protect and advance this specific vision — this cultural cause.
The appeal to make inherently destructive behavior “safer” might sound reasonable to many at first, but it is the counsel of despair. And hope for the future is what is needed most — hope to be healed of past traumas; hope to live free of disease, discord, and inner turmoil. This indispensable hope for another way of life is precisely what risk-reduction measures fail to cultivate.
A more constructive and humane approach would take seriously the lessons learned over the past couple decades. This means emulating successes achieved through behavioral change and eschewing the despair (and the self-seeking profiteering) of an inherently defeatist and frequently failed risk-reduction philosophy.
— Matthew Hanley is co-author of Affirming Love, Avoiding AIDS: What Africa Can Teach The West, as well as author of The Catholic Church and the Global AIDS Crisis.