Condoms don't prevent AIDs: Why the Pope knows what he's talking about.
I've been keeping up with this little story:
http://news.bbc.co.uk/2/hi/europe/7950671.stm
I think the public has been giving the Pope a lot of guff for a social situation which he actually seems to understand fairly well, even despite his obvious religious and moral biases.
So the Pope says wide condom distribution is a bad idea. From the London Times:
On Tuesday he told reporters accompanying him on his trip to Africa that Aids was a “tragedy that cannot be overcome by money alone, and that cannot be overcome through the distribution of condoms, which even aggravates the problems” (link: http://www.timesonline.co.uk/tol/comment/faith/article5934912.ece).
I don't know if the Pope is entirely right here, he might be confusing causes and symptoms. It's true that in a culture where condom use is widespread, it's likely that sexual promiscuity will also be commonplace. This is where I think the Pope might not be giving the right idea - condoms certainly don't cause AIDs. I don't think that passing out condoms will make people immediately jump on the sex bandwagon (which sounds like a pretty rowdy bandwagon if you ask me), but condom distribution does make 'risky' sex appear more acceptable to the public, and might change the social perceptions of sex gradually so that eventually more people are having sex with multiple partners. Not all of them will use condoms, so the prevalence and incidence of HIV/AIDs doesn't drop quite as dramatically.
This study gives some pretty persuasive evidence about how to successfully reduce HIV/AIDs infection:
http://www.docstoc.com/docs/891118/What-Happened-in-Uganda---Declining-HIV-Prevalence-Behavior-Change-and-the-National-Response
Uganda has had brilliant success reducing the incidence and prevalence of HIV infection in the past decade. This case study, conducted by the U.S. Agency for International Development, reports that “national HIV prevalence [in Uganda] peaked at around 15 percent in 1991, and has fallen to 5 percent as of 2001.This dramatic decline in prevalence is unique worldwide” (p 2). What makes Uganda so unique? How did they get this result?
The study lists a number of reasons:
1. Strong High-level political support: Uganda's new head of state in 1986, President Yoweri Museveni brought the fight against AIDs to the forefront of the national agenda. He not only supported national programs for AIDs prevention, he made AIDs education and prevention appear patriotic.
2. Grassroots efforts: According to the study, Ugandans are "more likely to receive AIDs information through friendship and other personal networks than through mass media or other sources" (p 10). There is a large local movement to eradicate AIDs - the support of the community appears to play a vital part in reducing infection.
3. Interventions directed at women, youth, stigma and discrimination: Grassroots-level communication for behavior change has been strongly encouraged and implemented since at least 1989, with strong emphasis on female empowerment and anti-discrimination of people living with HIV/AIDs. Teachers have been trained to incorporate HIV education/sexual behavior change into their curricula. The Ugandan President made efforts to give both Ugandan women and youth a more prominent political voice. By law women make up at least one third of Parliament while four members elected by youth caucuses represent youth in Parliament (p 5). The message to the Ugandan public is clear: these people matter - and when they matter, they care more about themselves and what happens to their bodies.
4.Involvement of Religious leaders and faith-based organizations: As the Pope recognizes, internal support from religious groups has a dramatic affect on the sexual behavior of a large social body. Plus, the Catholic church totally rocks here because they provided leadership in designing mobile care units for AIDs widows and orphans (p 6). That's doing more for the Ugandan nation than handing out a few dozen trojans.
5.Africa's FIRST EVER confidential volunteer counseling and testing (VCT): Not only could people get tested with "same day results," they were also able to participate in "Post Test Clubs" to provide long-term behavior change support. This is available for anyone who has been tested, HIV positive or negative. It's like an AA for sexual behavior change (p 7).
6. Condom marketing: Sorry, Pope Benedict, condom marketing has actually worked to some extent. However, the study notes that condom use "played a key but evidently not a major role" in the reduction of HIV/AIDs prevalence in Uganda. The authors of the study explain that "nearly all of the decline in HIV incidence... had already occurred" by the time condom use increased most dramatically (for women it rose from 1 percent to 6 percent from 1995 to 2000, and for men 16 percent to 40 percent during those same years). So it seemed the other efforts to reduce prevalence had already worked their magic by the time condoms really came on the scene. However, with men and women who report having non-regular partners more frequently, the use of condoms has gone up in recent years, thus contributing to prevention efforts. It's also important to note, though, that the incidence of sex with non-regular partners has gone down. The authors of the study suggest that this decrease in risky sex behavior has a more direct affect on the reduction of HIV/AIDs prevalence (p 8-9).
7. Sexually transmitted infections (STI) control and prevention programs have received increased emphasis: Since 1994, when the decline in prevalence rates had been successfully documented, STI care and medication has been more readily available in Uganda. Donors wishing to align themselves with an already-winning cause poured more and more monies into medical efforts in Uganda (p 9).
8. Decrease in multiple sexual partnerships and networks: Authors of the study report that "In general, Ugandans now have considerably fewer non-regular sex partners across all ages" (p 9). Also, the age of what the authors call "sexual debut" has increased as well as the likelihood of sex practiced only within marriage relationships (p 9). The authors report that this decrease in multiple sexual partnerships is the "most important determinant of the reduction in HIV incidence in Uganda" (p 9).
So, in this the Pope is right... the best way to fight the HIV/AIDs epidemic is not to just go around passing out free condoms, or even to improve condom marketing. The most surefire way to reduce HIV/AIDs incidence is to discourage sexual promiscuity.
That's a sex bandwagon I think we can all jump on.