“Responses to the global HIV/AIDS epidemic are often driven not by evidence but by ideology, stereotypes, and false assumptions. Referring to the hyperepidemics of Africa, an article in The Lancet this fall named “ten myths” that impede prevention efforts—including “Poverty and discrimination are the problem,” “Condoms are the answer,” and “Sexual behavior will not change.” Yet such myths are held as self-evident truths by many in the AIDS establishment. And they result in efforts that are at best ineffective and at worst harmful, while the AIDS epidemic continues to spread and exact a devastating toll in human lives.
Consider this fact: In every African country in which HIV infections have declined, this decline has been associated with a decrease in the proportion of men and women reporting more than one sex partner over the course of a year—which is exactly what fidelity programs promote. The same association with HIV decline cannot be said for condom use, coverage of HIV testing, treatment for curable sexually transmitted infections, provision of antiretroviral drugs, or any other intervention or behavior. The other behavior that has often been associated with a decline in HIV prevalence is a decrease in premarital sex among young people. …
… Katherine Marshall and Lucy Keough, lead authors of the report, are clearly uncomfortable with approaches to HIV prevention that emphasize sexual responsibility, behavior change, and morally based messages. They praise the work and compassion of faith communities in treating and caring for people living with AIDS and their families, yet harshly criticize the messages of faith communities for increasing the stigma of AIDS. Their discomfort with attempts to change sexual behavior is evident early in the report, when, for example, they muse: “Should the focus be on changing the behaviors that contribute to HIV/AIDS? (Is that possible? Desirable? How? With what assurance?)”
If Marshall and Keough are undecided as to whether changing sexual behavior is even desirable in the context of an epidemic driven by people who have more than one sex partner, they then need to become educated in the basic epidemiology of HIV transmission. One must ask whether they are more concerned with upholding a Western notion of sexual freedom or with saving lives. Their concern over any prevention approach that might be “moralistic” causes them to miss entirely the evidence for the remarkable success of sexual-behavior change in reducing HIV infections. They miss, as well, the crucial contribution of faith communities to HIV prevention, even while they are producing a report on the role of faith communities in the HIV crisis.
The Georgetown report tells us: “While the ‘mainstream’ HIV/AIDS program and global communities accept that widespread availability of condoms and promotion of condom use are major elements in successful HIV/AIDS prevention strategies, a focus on condoms is contentious for some religious communities because it contradicts the core recommended strategy of abstinence before marriage and faithfulness within marriage.”
In fact, the mainstream HIV/AIDS community has continued to champion condom use as critical in all types of HIV epidemics, in spite of the evidence. While high rates of condom use have contributed to fewer infections in some high-risk populations (prostitutes in concentrated epidemics, for instance), the situation among Africa’s general populations remains much different. It has been clearly established that few people outside a handful of high-risk groups use condoms consistently, no matter how vigorously condoms are promoted. Inconsistent condom usage is ineffective—and actually associated with higher HIV infection rates due to “risk compensation,” the tendency to take more sexual risks out of a false sense of personal safety that comes with using condoms some of the time. A UNAIDS-commissioned 2004 review of evidence for condom use concluded, “There are no definite examples yet of generalized epidemics that have been turned back by prevention programs based primarily on condom promotion.” A 2000 article in The Lancet similarly stated, “Massive increases in condom use world-wide have not translated into demonstrably improved HIV control in the great majority of countries where they have occurred.”