Bill Weintraub

Fidelity vs condoms in Africa

7-13-2004

Yesterday, President Museveni of Uganda, whose brilliant "ABC" program has reduced AIDS prevalence in his impoverished country for 12 consecutive years, spoke at the International AIDS conference in Bangkok.

Because his speech was mis-represented in the press, I'm posting here a Reuters report, which I've annotated.

Museveni deserved a better hearing than he got from the assembled condom campaigners and bottom boyz who run AIDS Inc.

Reuters

July 12, 2004

Abstinence, Condom Controversy Erupts at AIDS Meet

By Darren Schuettler

BANGKOK (Reuters) - A controversy erupted at a global AIDS conference on Monday over whether abstaining from sex or using condoms was more effective to prevent the disease.

Ugandan President Yoweri Museveni brought the issue, which has set many AIDS activists at odds with Washington, into the open at the first full day of the AIDS conference by saying abstinence was the best way to stem the spread of the killer virus.

[Museveni did not say that. His remarks, like his program, were far more nuanced, as can be seen in the direct quotes from his speech.]

The remarks by Museveni, whose country is a rare success story in Africa's war on AIDS, were at odds with health experts who back condoms as a frontline defense against the incurable disease.

"I look at condoms as an improvisation, not a solution," Museveni told delegates on the second day of the 15th International AIDS Conference in Bangkok.

Instead, he called for "optimal relationships based on love and trust instead of institutionalized mistrust which is what the condom is all about."

["Institutionalized mistrust" is exactly right and a brilliant turn of phrase.]

Museveni added fuel to a debate within the AIDS community over the best way to halt the spread of a disease that has killed 20 million people and infected 38 million. Uganda's "ABC" method (Abstinence, Being faithful and Condoms) is a model for the AIDS policies of the administration of President Bush and which are under fire at the conference for advocating sexual abstinence to stem infection.

[What ABC actually stands for is "Abstain, Be faithful, use a Condom if you can't or won't do the first two" -- it's a sensible and moderate approach, which Chuck Tarver has reworked for gay and bi men as "Avoid anal, Be faithful, use a Condom if you can't or won't do the first two" -- also a moderate approach which if followed, would wipe out HIV and a host of other anally-vectored STIs.]

[And for the record, under President Bush, the US has distributed more condoms than ever before: 550 million this year alone, at a nickel apiece, at the cost to American taxpayers of $27,500,000.]

This year's smaller U.S. delegation, which the United States says reflects a desire to cut costs, is seen partly as a sign of Washington's displeasure that its approach appears to have had little influence on the agenda.

"I AM ABSTAINING"

U.S. Congresswoman Barbara Lee, the only member of Congress to attend the week-long meeting, accused the Bush administration of using ideology, not science, to dictate policy.

She said the U.S. AIDS initiative requires that one-third of prevention funding go to "abstinence until marriage" programs.

"In an age where five million people are newly infected each year and women and girls too often do not have the choice to abstain, an abstinence until marriage program is not only irresponsible, it's really inhumane," Lee said.

[Ted Green: "I wonder if telling young people to abstain from drugs and alcohol is also considered irresponsible and inhumane?"]

"Abstaining from sex is oftentimes not a choice, and therefore their only hope in preventing HIV infection is the use of condoms," she added.

[She may be a congresswoman, but her reasoning is specious, and moreover, makes no attempt to empower women. Museveni, on the other hand, worked hard to give women the ability to reject sex -- thus empowering them.

[Truth is, the effect of condom campaigns in rural Africa is to actually disempower women, by making it next to impossible for them to refuse sex.]

But Ted Green, a member of Bush's council on AIDS, said programs aimed at changing sexual behavior were not obtaining funding. [He's 100% right.] He also questioned the focus on condoms.

"If you are telling me that people can't stop AIDS unless they buy a product, I simply don't agree with that," he said.

[Nor do we in The Man2Man Alliance -- there are better ways to prevent AIDS which cost nothing and which are guaranteed to protect you.]

Simon Onaba, a Uganda youth delegate who first had sex at age 15 but shunned it for the past three years, said condoms were not a 100-percent guarantee against infection.

[He too is right. The condom failure rate is 20% -- that's based on cumulative effectiveness, which is the only reasonable way to judge the efficacy of that form of "protection." See our Man2Man Alliance Policy Paper Do Condoms Work? for more info.]

"I am abstaining," Onaba said as he described Uganda's campaign to change behavior by urging young people who were most vulnerable to abstain or be faithful, and if needed use a condom.

"I am a sexual being, but I recognize HIV/AIDS is a killer," said Onaba. "I will wait until my wedding night."

[Onaba's brave speech was met with catcalls and boos from the overwhelmingly pro-condom crowd of "AIDS professionals."]

Official figures suggest six percent of Uganda's 26.5 million people are now infected, down from 30 percent in the 1980s.

But Uganda's success has been twisted by the U.S. government in an effort to keep the support of religious conservatives, said Steven Sinding, director general of the International Planned Parenthood Federation.

"It appears that this is naked pandering to an extremist constituency," Sinding said.

"Millions of people around the world have been persuaded by the arguments of the U.S. government and religious right. Their actions represent a setback in bringing HIV/AIDS under control."

[Given Uganda's success, it's difficult to see how this is a setback -- rather it would appear to be a step forward.]

Health experts point to countries such as Thailand where a heavily promoted condom campaign is credited with slashing infection rates among sex workers in the 1990s.

[Except that infection rates in Thailand are now rapidly rising again, as reported by Lawrence Altman, the NY Times leading HIV / AIDS reporter, just two days ago. That wouldn't have happened with genuine behavior change.]

In Asia, where infection rates are rising among injecting drug users, young people and homosexuals, some NGOs advocate the "CNN method" which stresses condoms, needles and negotiation.

[CNN is what we've used in the US for the past 20 years, and as a result HIV prevalence has increased year after year and is now greater than at any time in our history.]

Helene Gayle, head of AIDS programs for the Bill and Melinda Gates Foundation, said one approach was not better than the other.

"The debate is more distracting than it needs to be because we need to get on to the business of saving lives."

[She's right that a balanced approach is best, but that's what ABC is -- balanced. The debate is distracting because the condom campaigners are determined to undermine an intervention of proven efficacy.

Just as here in America they continue to resist our simple request that Frot be put forward among gay and bi men as an HIV-safe alternative to anal penetration, which is responsible for virtually all male-male HIV transmission, and the transmission of most other STIs, including syphilis, gonorrhea, hepatitis, herpes, and HPV (anal cancer).

Make no mistake: in this matter, the ASOs are not your friend, and what happens globally affects you locally.]

Related articles:

If they can do it in Uganda, why can't we do it here?

More from Uganda

Do Gay Men Have To Be Promiscuous?

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