28 agosto 2009

Scientist: Pope Was Right About AIDS

Says Abstinence, Fidelity More Effective than Condoms

RIMINI, Italy, AUG. 27, 2009 (Zenit.org).- The director of Harvard's AIDS Prevention Research Project is affirming that Benedict XVI's position was right in the debate on AIDS and condoms.

Edward Green stated this in an address at the 30th annual Meeting for Friendship Among Peoples in Rimini, sponsored by the lay movement, Communion and Liberation.

Green, an expert on AIDS prevention, said that "as a scientist he was amazed to see the closeness between what the Pope said last March in Cameroon and the results of the most recent scientific discoveries."

He affirmed: "The condom does not prevent AIDS. Only responsible sexual behavior can address the pandemic."

Green continued, "When Benedict XVI said that different sexual behavior should be adopted in Africa, because to put trust in condoms does not serve to fight against AIDS, the international press was scandalized."

The Pope made this statement in a meeting with journalists en route to Africa last March.

The scientist affirmed that the Holy Father spoke the truth. He noted, "The condom can work for particular individuals, but it will not serve to address the situation of a continent."

Change habits

Green added: "To propose the regular use of the condom as prevention in Africa could have the opposite effect."

He explained the phenomenon of human behavior called "risk compensation," whereby a person "feels protected and thus exposes himself more."

The researcher and medical anthropologist asked: "Why has an attempt not been made to change people's customs?"

"The world industry has taken many years to understand that measures of a technical and medical character are of no use to solve the problem," he added.

Green highlighted the successful policies that have been implemented in Uganda to battle AIDS, programs based in the "ABC" strategy: "Abstain, Be faithful, and, as a last resource, use a Condom."

He reported: "In the case of Uganda, an impressive result has been obtained in the fight against AIDS.

"The president was able to tell the truth to his people, to young people, that on occasions some sacrifice, abstinence and fidelity are necessary.

"The result has been formidable."

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On the Net:

Rimini Meeting: www.meetingrimini.org/default.asp?id=825

Admittedly liberal Washington Post article by Edward Green admitting the Pope is probably right:

The Pope May Be Right

By Edward C. Green
Sunday, March 29, 2009; Page A15

When Pope Benedict XVI commented this month that condom distribution isn't helping, and may be worsening, the spread of HIV/AIDS in Africa, he set off a firestorm of protest. Most non-Catholic commentary has been highly critical of the pope. A cartoon in the Philadelphia Inquirer, reprinted in The Post, showed the pope somewhat ghoulishly praising a throng of sick and dying Africans: "Blessed are the sick, for they have not used condoms."

Yet, in truth, current empirical evidence supports him.

We liberals who work in the fields of global HIV/AIDS and family planning take terrible professional risks if we side with the pope on a divisive topic such as this. The condom has become a symbol of freedom and -- along with contraception -- female emancipation, so those who question condom orthodoxy are accused of being against these causes. My comments are only about the question of condoms working to stem the spread of AIDS in Africa's generalized epidemics -- nowhere else.

In 2003, Norman Hearst and Sanny Chen of the University of California conducted a condom effectiveness study for the United Nations' AIDS program and found no evidence of condoms working as a primary HIV-prevention measure in Africa. UNAIDS quietly disowned the study. (The authors eventually managed to publish their findings in the quarterly Studies in Family Planning.) Since then, major articles in other peer-reviewed journals such as the Lancet, Science and BMJ have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa. In a 2008 article in Science called "Reassessing HIV Prevention" 10 AIDS experts concluded that "consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa."

Let me quickly add that condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex and where it has been possible to enforce a 100 percent condom use policy in brothels (but not outside of them). In theory, condom promotions ought to work everywhere. And intuitively, some condom use ought to be better than no use. But that's not what the research in Africa shows.

Why not?

One reason is "risk compensation." That is, when people think they're made safe by using condoms at least some of the time, they actually engage in riskier sex.

Another factor is that people seldom use condoms in steady relationships because doing so would imply a lack of trust. (And if condom use rates go up, it's possible we are seeing an increase of casual or commercial sex.) However, it's those ongoing relationships that drive Africa's worst epidemics. In these, most HIV infections are found in general populations, not in high-risk groups such as sex workers, gay men or persons who inject drugs. And in significant proportions of African populations, people have two or more regular sex partners who overlap in time. In Botswana, which has one of the world's highest HIV rates, 43 percent of men and 17 percent of women surveyed had two or more regular sex partners in the previous year.

These ongoing multiple concurrent sex partnerships resemble a giant, invisible web of relationships through which HIV/AIDS spreads. A study in Malawi showed that even though the average number of sexual partners was only slightly over two, fully two-thirds of this population was interconnected through such networks of overlapping, ongoing relationships.

So what has worked in Africa? Strategies that break up these multiple and concurrent sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones. "Closed" or faithful polygamy can work as well.

In Uganda's early, largely home-grown AIDS program, which began in 1986, the focus was on "Sticking to One Partner" or "Zero Grazing" (which meant remaining faithful within a polygamous marriage) and "Loving Faithfully." These simple messages worked. More recently, the two countries with the highest HIV infection rates, Swaziland and Botswana, have both launched campaigns that discourage people from having multiple and concurrent sexual partners.

Don't misunderstand me; I am not anti-condom. All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship. This was a key point in a 2004 "consensus statement" published and endorsed by some 150 global AIDS experts, including representatives the United Nations, World Health Organization and World Bank. These experts also affirmed that for sexually active adults, the first priority should be to promote mutual fidelity. Moreover, liberals and conservatives agree that condoms cannot address challenges that remain critical in Africa such as cross-generational sex, gender inequality and an end to domestic violence, rape and sexual coercion.

Surely it's time to start providing more evidence-based AIDS prevention in Africa.

Edward C. Green is a senior research scientist at the Harvard School of Public Health & Director of Harvard's AIDS Prevention Project

Heart & Chen Study: Condom promotion for AIDS prevention in the developing world: is it working? (2004)

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