Russian Roulette Approach to Battling AIDS?

New Studies Raise Doubts on Condom Programs

NEW YORK, MARCH 1, 2003 ( Commentators regularly excoriate the Catholic Church for its opposition to condoms in “safe sex” and anti-AIDS programs. A recent example is the Jan. 10 New York Times article by Nicholas D. Kristof, in which he described opposition by conservative groups to condoms as “downright weird.” He then cited an unnamed “Catholic site” as saying “the only absolutely guaranteed, permanent contraception is castration,” as if this were the Church’s position. Kristof insisted that Africa needs more condoms as an essential part of the campaign to stop the spread of HIV/AIDS.

But recent reports give good reasons to doubt the mantra of “safe sex” through condom use. An international team of scientists found that only 30% of the initial wave of AIDS cases in Africa (prior to 1988) were sexually transmitted. According to the London Times on Feb. 20, more than half the cases of AIDS in Africa in this early period were caused by unsterilized needles.

The report contrasts with the widely touted claim that around 90% of AIDS cases were sexually transmitted. The team responsible for the new research is led by David Gisselquist, an anthropologist from Pennsylvania, a private consultant, and Dr. John Potterat, an infectious-diseases specialist from Colorado. It also includes experts from Emory University School of Medicine in Atlanta and Albert Einstein College of Medicine in New York.

Their findings were reported in three separate articles published in the International Journal of STD and AIDS. Among the points noted by the team was the fact that the spread of HIV did not follow the same pattern as sexually transmitted diseases. For example, in Zimbabwe in the 1990s, HIV infections increased by 12% a year while sexually transmitted diseases were declining by 25%.

They also observed that the spread of HIV was too fast to have been caused by sexual transmission. To explain the speed, it would have to be as easy to catch HIV from sex as it is from a contaminated blood transfusion. But, in fact, it is much harder. As well, sexually transmitted diseases are usually commoner among the poor and uneducated, yet HIV in Africa is linked to urban living, a good education and higher income.

The following day the Times published the results of another investigation, this time on efforts in the Masaka region of Uganda. The program involved distributing 1.5 million condoms, the treating of sexual diseases, and counseling. Despite significant reductions in syphilis and gonorrhea, there were no changes in the number of new HIV cases.

Behavior shift

Doubts about the success of condom promotion were raised in a report published June 23 by the Population Division of the U.N.’s Department of Economic and Social Affairs.

The document, “HIV/AIDS: Awareness and Behavior,” notes that only a small percentage of people interviewed began using condoms to prevent HIV transmission. Fewer than 8% of women in all countries surveyed reported that they had changed their behavior by using condoms. Figures for men ranged between 15% and 25% in most countries.

Researchers also asked about ways to avoid getting AIDS. The most popular answer, with over 40% of respondents, was having only one sexual partner. Second was condom use, third was abstinence. In some countries, for example, Indonesia and Jordan, fewer than 10% of women mentioned condoms.

Many respondents were also aware that having multiple sex partners increased the chances of getting AIDS, and they said that one could avoid it by sticking to only one partner. More than 60% of women gave this response in Brazil, Colombia, the Dominican Republic, Guinea and Vietnam.

The report noted that much effort has been spent on promoting the use of condoms as part of AIDS prevention. “However, over the years, the condom has not become more popular among couples,” it said.

Uganda’s success story

Confirmation that changing sexual behavior is a more potent remedy against AIDS than promoting condom use came in a report by the U.S. Agency for International Development (USAID), published last September.

The study, “Declining HIV Prevalence, Behavior Change, and the National Response: What Happened in Uganda?” noted that Uganda is “considered to be one of the world’s earliest and best success stories in overcoming HIV.” The U.S. Census Bureau and the United Nations AIDS office calculate that national HIV prevalence peaked at around 15% in 1991, and had fallen to 5% as of 2001. “This dramatic decline in prevalence is unique worldwide, and has been the subject of curiosity since the mid-1990s,” notes the USAID document.

The report observes that Uganda’s falling HIV prevalence is due “mainly to a number of behavioral changes that have been identified in several surveys and qualitative studies.”

“The most important determinant of the reduction in HIV incidence in Uganda appears to be a decrease in multiple sexual partnerships and networks In general,” concludes the report. The USAID report further notes that the promotion of condoms in Uganda has taken place above all in more recent years, when the greatest reductions on HIV/AIDS had already occurred.

Ugandans now have considerably fewer non-regular sex partners at all age levels. In comparison with men in countries such as Kenya, Zambia and Malawi: “Ugandan males in 1995 were less likely to have ever had sex (in the 15-19-year-old range), more likely to be married and keep sex within the marriage, and less likely to have multiple partners, particularly if never married.”

The report notes that Uganda’s president set the example for the nation with his approach to dealing with the HIV threat, encouraging community leaders to “talk candidly to people about delaying sexual activity, abstaining, being faithful, ‘zero grazing,’ and using condoms (roughly in that order).”

Africa is not the only continent where condom programs are failing. In Chile, Father Fernando Chomalí gave testimony to the National Commission on Aids in which he criticized condom promotion. The Chilean newspaper El Mercurio on Jan. 19 reported that Father Chomalí noted that since 1990, imports of condoms have soared to 15 million from 2.6 million. At the same time, sexual diseases have continued to increase.

He commented that numerous studies show that while they reduce HIV transmission they do not eliminate it. So condoms give a false sense of security, said Father Chomalí. Preventing HIV transmission, he said, must be linked to changing people’s conduct, in the context of a program that deals with human sexuality in an integral way and is based on profound human values.

A recent Vatican comment on condoms came from Archbishop Javier Lozano Barragán, president of the Pontifical Council for Health Care Workers. The Associated Press on Nov. 6 quoted the archbishop as he spoke prior to a Vatican symposium on health care. He said there was only one way to prevent AIDS and the HIV virus from spreading: “We say that prevention … is called chastity.” Studies now show the wisdom of this position. “Weird” could perhaps be better used to describe policies that rely on millions of condoms and that only encourage risky sexual behavior.

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