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.
The real question, then, is why have public health officials been so blind? This is the main contribution made by Hanley and de Irala in their extensively documented book. They frame the debate over HIV prevention as a clash between two views of human sexuality. The Judaeo-Christian view believes that self-restraint and reserving sex for marriage leads to fulfilment and well-being. But the modern Western view condemns limits, exalts the autonomous pursuit of pleasure, and believes that technology will remedy any ensuing problems.The AIDS bureaucracy is fully committed to the latter.
In their opinion, the best-informed research vindicates the Catholic Church's stand on AIDS - that, as Benedict XVI said in 2009, "the scourge cannot be resolved by distributing condoms; quite the contrary we risk worsening the problem." This was condemned as heartless ideological blather by the media. But Hanley and de Irala contend that it is the only view worthy of human dignity.
"The Church's view that all people have the capacity to change stands in conflict with the AIDS Establishment's view that people are powerless victims of passions and circumstance. The entire harm minimization, or risk reduction approach, however technically sophisticated or bureaucratically cumbersome it comes to be, ultimately depends on this latter, deeply condescending view of the person...
"It confirms low expectations about the possibilities of human behaviour and tacitly concedes the inevitability of destructive behaviours. Not to acknowledge the ability of young people and adults to respond to messages about abstinence and fidelity in a context that affirms the precious gift of human sexuality is ultimately a disservice."
The AIDS bureaucracy is pressing ahead with its campaign to throw condoms at the epidemic. In June to mark the 30th year since AIDS was first identified, the United Nations General Assembly gave the most explicit UN backing yet to the use of condoms. Instead of talking simply about the importance of abstinence and fidelity, the statement stresses the "correct and consistent use of condoms."
"We are very happy about this," said George Tembo, head of the AIDS/HIV department at the UN Population Fund. "It is very explicit and will definitely help our work to overcome resistance and fears about condoms."
The madness continues. Could someone send him a copy of Affirming Love, Avoiding AIDS?