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Daily link icon Monday, July 12, 2004

AIDS prevention

This was a fascinating article on AIDS prevention from Reuters: Abstinence, Condom Controversy Erupts at AIDS Meet

A controversy erupted at a global AIDS conference on Monday over whether abstaining from sex or using condoms was more effective to prevent the disease.

Duh?

Ugandan President Yoweri Museveni brought the issue, which has set many AIDS activists at odds with Washington, into the open at the first full day of the AIDS conference by saying abstinence was the best way to stem the spread of the killer virus.

The remarks by Museveni, whose country is a rare success story in Africa's war on AIDS, were at odds with health experts who back condoms as a frontline defense against the incurable disease.

"I look at condoms as an improvisation, not a solution," Museveni told delegates on the second day of the 15th International AIDS Conference in Bangkok.

Instead, he called for "optimal relationships based on love and trust instead of institutionalized mistrust which is what the condom is all about."

Museveni added fuel to a debate within the AIDS community over the best way to halt the spread of a disease that has killed 20 million people and infected 38 million. Uganda's "ABC" method (Abstinence, Being faithful and Condoms) is a model for the AIDS policies of the administration of President Bush and which are under fire at the conference for advocating sexual abstinence to stem infection.

Official figures suggest six percent of Uganda's 26.5 million people are now infected, down from 30 percent in the 1980s.

But, this sensible approach has a minority of adherents at the conference, and crazy Representative Barbara Lee (from California, where else), argues that this approach is ideological nonsense and calls it "inhumane" because people can't control themselves and really don't have a choice in the matter:

"In an age where five million people are newly infected each year and women and girls too often do not have the choice to abstain, an abstinence until marriage program is not only irresponsible, it's really inhumane," Lee said.

"Abstaining from sex is oftentimes not a choice, and therefore their only hope in preventing HIV infection is the use of condoms," she added.

To me it seems much more inhumane that she thinks people are like animals that have no control over their actions.

Then Reuters quotes a guy from Planned Parenthood who calls "religious conservatives" an "extremist constituency":

But Uganda's success has been twisted by the U.S. government in an effort to keep the support of religious conservatives, said Steven Sinding, director general of the International Planned Parenthood Federation.

"It appears that this is naked pandering to an extremist constituency," Sinding said.

Reuters points out that using condoms has been an effective measure for people in Thailand's sex trade (of course using condoms is more effective at preventing AIDS than not using condoms if you're having sex regardless, but that kind of begs the question of what this article is about) and mentions an alternative named-after-a-TV-network plan called "CNN" aimed at drug users and homosexuals:

Health experts point to countries such as Thailand where a heavily promoted condom campaign is credited with slashing infection rates among sex workers in the 1990s.

In Asia, where infection rates are rising among injecting drug users, young people and homosexuals, some NGOs advocate the "CNN method" which stresses condoms, needles and negotiation.

Finally, according to "Helene Gayle, head of AIDS programs for the Bill and Melinda Gates Foundation", neither "approach" is superior. The logic is staggering. Say you live in Botswana or Swaziland (UN Statistics), where an astounding ~40%[1] of the population has AIDS. Of course, having sex with infected people with condoms that are only effective a certain percentage of the time is just as good as not having sex with infected people. Of course she's talking about which approach should be persued as policy, but it's certainly clear which one is more effective as a practice.

Footnotes:
[1]: Update: sorry, ~40% of the population ages 15-49

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Comments XML gif

Mean Dean (http://www.healyourchurchwebsite.com/) wrote:

Interesting premise for the debate. What kills me is the reticense of some to admit that abstinence works 100% every time it is practiced. Whereas condoms are cleary marked by the manufacturer a "an effective means" of preventing STDs (so I've read) ... leaving them some legal wiggle room with regards to their failure rate.

The real question is, are people serious about wiping this out? Like many things, it comes down to personal responsibilty in the end.

∴ Mean Dean | 12-Jul-2004 4:21pm est | http://www.healyourchurchwebsite.com/ | #4986

Ian Bicking (http://blog.ianbicking.org) wrote:

Yes, obviously, abstinence is perfect. It's also existed as a viable alternative all along, yet STDs have still become rampant in some areas. Abstinence is practiced to different degrees in different areas, and yet it does not necessarily relate directly to STDs -- there are many societies (and segments thereof) where abstinence is not the norm, and yet STD rates are reasonably low.

The idea of abstinence education is rather silly. You think abstinence is some sort of novel idea? That education will lead to some a-ha moment? As a response to STDs, it requires a change in social norms and standards, which is much more dramatic and much more difficult to implement than mere education.

The abstinence education I received was patronizing and filled with lies -- luckily other sources of education existed (like my parents, and more honest sex education teachers). Many anti-condom, pro-abstinence advocates are simply advocating lies. This is why their opposition has so little respect for them.

For example, during a pro-abstinence section of a sex education in high school, the teacher told us how condoms can't protect from a virus. Why? Well, though condoms can obviously hold water, viruses are much smaller than water, and they can go right through the condom. If this is what abstinence education looks like, then it is inhumane.

∴ Ian Bicking | 12-Jul-2004 5:03pm est | http://blog.ianbicking.org | #4987

caiuschen (http://fallenearth.org/blogs/caiuschen/) wrote:

There was an interesting bill that was passed in Washington last summer that banned the use of medically inaccurate data. Interestingly, most of the people that were against it (that I knew of) were those who supported abstinence-only education.

While I am personally for abstinence until marriage myself, I don't feel that sex should necessarily be reserved in that way. It seems obvious that not participating in sexual activities prevents sexually transmitted diseases 100%, but with that method you don't get the sex. It's completely possible to have recreational sex and be reasonably safe doing so. And it's not that people can't control themselves, but many even knowing the risks don't agree that abstinence is worth the lack of sex. With that perspective, which I think people are perfectly entitled to have, it's better for them to know about contraceptives and their real success rates.

Abstinence is more effective, no doubt, for those willing to take it. The problem most people find is that many pro-abstinence people in the United States are also pro-abstinence-only sex education. Is abstinence-only education more effective? I don't think so. It's clear that alternatives exist, and by refusing to talk about them or lying about them, it encourages people to trust less reliable sources or even rebel. Also, education shouldn't be about impressing only certain perspectives to people. It should be about informing people and letting them make the choices for themselves.

Interestingly, in the Netherlands they have very early and much more comprehensive sex education; but teenage pregnancy rates and abortions are much lower than they are in the United States. It just goes to show that if you treat people with respect and give them the facts in a way they understand, they'll make good choices. I did a quick search and came up with these two links regarding the topic: http://www.huppi.com/kangaroo/8Comparison.htm (search for sex in the document) and http://www.ageofconsent.com/comments/netherlands.htm

∴ caiuschen | 12-Jul-2004 11:26pm est | http://fallenearth.org/blogs/caiuschen/ | #4988

Selkirk (http://www.procata.com/blog/) wrote:

Condoms are highly effective: Condoms are 100% effective at preventing HIV transmission when neither partner has AIDS (duh), and 98% to 100% effective when one partner does (even with repeated sexual contact).

Abstinence may be perfect but people aren't. If you tell kids that condoms don't work, then when they finally do have sex (and they do), they are less likely to use one. Abstinence pledges do not reduce rates of STDs

The problem is not the abstinence pledge (a good thing), but the comorbidity of condom misinformation or lack of information with the abstinence pledge (a bad thing).

Preparing for mass abstinence and faithfulness

∴ Selkirk | 13-Jul-2004 1:37am est | http://www.procata.com/blog/ | #4989

Mean Dean (http://www.healyourchurchwebsite.com/) wrote:

Imagine telling your kid he's going to walk onto a plane with a 1/50 chance of crashing?

Moreover, if a person can't practice abstinence, what makes you think they can handle a condom with any greater affectiveness?

The real issue is for parents to take control of sex education. Birds, bees, birth control and babies ... instead of sluffing it off on the schools.

∴ Mean Dean | 13-Jul-2004 1:32pm est | http://www.healyourchurchwebsite.com/ | #4990

Ace wrote:

NYT magazine had an interesting article in mid June about relationships in Africa that were "transactional" -- men provided economically, but neither party was monogamous. Severe unemployment, particularly for women, has made this a spreading phenomenon and has drastically increased the HIV infection rate. they are finding that emphasizing monogamy instead of condom use has been more effective in slowing spread.

Rep Lee was not saying that humans are animals that cannot control themselves. She was referring to the epidemic of rape, particularly in Africa, and the use of sex as a means of survival for women in many developing countries. Women around the world simply don't enjoy the level of safety and security that we do here -- often they have very little control over who, where and when they have sex. Its a very disturbing, violent fact of life.

∴ Ace | 13-Jul-2004 11:49pm est | #4995

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