This article appears in the February 2003 edition of the Catholic Medical Quarterly

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December 13, 2002 Volume 5, Number 51

Condom lobby drives AIDS debate besides Abstinence success in Africa

As AIDS sweeps across Africa, Uganda remains a lone success story, as millions of Ugandans have embraced traditional sexual morality, including sexual abstinence outside of marriage and fidelity within marriage, in order to avoid infection. But the international AIDS community has been reluctant to promote this strategy elsewhere, continuing, in stead, to place its faith in condoms.

According to a US Agency for International Development (USAID) study of Uganda, "HIV prevalence peaked at around 15 percent in 1991, and had fallen to 5 percent as of 2001 .This dramatic decline in prevalence is unique worldwide." USAID believes "The most important determinant of the reduction in HIV incidence in Uganda appears to be a decrease in multiple sexual partnerships and networks."

In comparison to other African nations, "Ugandan males in 1995 were less likely to have ever had sex, more likely to be married and keep sex within the marriage, and less likely to have multiple partners." USAID concludes that "the effect of HIV prevention in Uganda (particularly partner reduction) during the past decade appears to have had a similar impact as a potential medical vaccine of 80 percent efficacy. A comprehensive behaviour change-based strategy may be the most effective prevention approach."

However, the Ugandan experience is not being promoted elsewhere, which leads some observers to conclude that ideology may be playing a role. In fact, as news of the Ugandan success has spread, the defence of condoms has grown more insistent.

Specifically, international AIDS activist have in creased their attacks on the Bush administration, which now seeks to incorporate abstinence training into the US international AIDS program. Amy Coen, president of Population Action International, recently stated that "the importance of condoms can not be overstated. Yet here in the United States, we are witnessing a retreat on the part of the government and a wall of silence descending around condom use. The case for condoms is indisputable." And, according to a column by Marie Cocco in Newsday, "President George W. Bush has begun appointing critics of condoms to a presidential advisory panel on AIDS. They include social conservatives who question the international scientific consensus that condoms are highly effective in AIDS prevention."

This promotion of condoms continues, despite the mounting evidence that they have failed to stem the spread of the disease. For instance, led by Nelson Mandela, South Africa has firmly embraced the "safe sex" strategy, and condom use has increased. But South Africa remains the world leader in AIDS infection, with 11.4 percent of its population currently infected.

The international AIDS community appears deter mined to find a technological solution to the epidemic, rather than to suggest the types of behaviour-change that have succeeded in Uganda. On Tuesday, the Mercury News of Miami reported that the Bill and Melinda Gates Foundation will spend $28 million to study the potential of birth control diaphragms to combat AIDS in Africa. The Mer cury News cautions, however, that "the scientific basis for diaphragms preventing AIDS is more theoretical than clinically proven."

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