Affirming Love, Avoiding AIDS
by Michael Cook
The best research shows that restraint and fidelity are the solutions to the devastating epidemic. But the bureaucrats aren’t listening.
Earlier this year, the journal PLoS Medicine published a stunning report about the prevalence of AIDS in Zimbabwe. Over the ten years to 2007 HIV prevalence was halved. This decline is almost unique in sub-Saharan Africa.
Aha! you might say. Despite the disastrous state of its economy, Zimbabwe has been distributing condoms by the millions to bring down adult prevalence from 27 percent to 16 percent. But you would be quite wrong. It is not condoms which are saving the lives of thousands of Zimbabweans, say researchers, but changes in behaviour, “mainly reductions in extramarital, commercial, and casual sexual relations”.
In other words, it looks like abstinence and fidelity are the secret to turning around the devastating AIDS epidemic which has killed 30 million people and infected 33 million and orphaned 16 million children.
Not condoms.
This report supports the thesis of the authors of the fascinating book Affirming Love, Avoiding AIDS, Matthew Hanley and Jokin de Irala. The orthodox view of fighting AIDS assumes that it is nearly impossible to change people’s behaviour. Therefore, condoms and counselling about safe sex are the best weapons. Bureaucracies in the United Nations and in government health departments argue strongly that abstinence, fidelity and monogamy are impossible for Africans. Columnist Nicholas Kristof even wrote in the New York Times that “The stark reality is that what kills young women here is often not promiscuity, but marriage. Indeed, just about the deadliest thing a woman in southern Africa can do is get married.”
This is complete twaddle. Hanley and de Irala show that “primary behaviour change” is the best weapon for fighting AIDS, not “harm reduction”. In fact, the rapid spread of AIDS in sub-Saharan Africa, despite a thorough understanding of how it spreads and billions spent on risk reduction, is “one of the greatest failures in the history of public health”. The South African strategy assumed, for instance, that the spread of AIDS has little to do with sexual responsibility. Authorities there promoted condoms with a “have fun but play safely” campaign. The results have been disastrous. About 18 percent of men and women between 18 and 49 live with HIV/AIDS.
The AIDS bureaucracy is committed to technical fixes despite lip service to abstinence and fidelity. Condoms, voluntary counselling and testing and treatment of other sexually transmitted diseases are their strategies. All of these are effective to some degree, but they ignore mounting evidence that HIV transmission rates remain high despite widespread distribution of condoms. In Botswana, the authors point out, condom sales increased from 1 million in 1993 to 3 million in 2001, while HIV prevalence rose from 27 to 45 percent among pregnant urban women. Between 1990 and 2002 life expectancy fell by 30 years in Botswana, a decline “unprecedented in the history of the human race”.
Why don’t condoms work? It’s not a question of permeability or breakage, but of how they are used. For one thing, only consistent condom use is effective in warding off AIDS. Yet it appears that most men use condoms very irregularly. And the evidence is mounting that condoms actually promote risky sexual behaviour because users feel that they are protected.
The engine of the epidemic is multiple sex partners, a growing number of AIDS researchers believe. When people have stopped engaging in casual sex and participating in a web of sex relationships, as has happened in Uganda and Zimbabwe, AIDS rates have fallen dramatically.
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