Solving AIDS with wishful thinking?

AIDS. It’s a great equalizer. Transmitted by body-fluid-to-body-fluid contact (by needle sharing, or sexual contact), the HIV virus can lay dormant for years before finally suppressing the human immune response and inducing AIDS. Typically, victims die from usually harmless diseases against which they have no defense. It is an entirely preventable disease, at least in theory; proper condom use cuts down AIDS transmission to nearly zero, and responsible needle swapping programs cut the infection rate among intravenous drug users. Abstinence programs are more controversial, largely because they appear to be based in a moral judgement and try to prevent an entire behavior rather than prevent the disease itself by altering that behavior. The CDC’s own website, however, touts the so-called “ABC” program: Abstience, Be faithful, Condoms. They recommend, as per administration policy, that you abstain from sex, but if you’re going to have sex be faithful (one partner), and if not then use condoms.

A lot of people in the AIDS prevention field all over the globe are frustrated that U.S. AIDS money is tied to this philosophy. Ask people to stop, then ask they just stick with one person, and then – oh yes – if you’re going to have it with multiple partners use condoms. Seems like condoms ought to enter at step 2, at least until both people can get a simple AIDS test. The ABC principle also fails to address drug use, bad handling of blood supplies, etc.  While these are not the primary causes of the spread of HIVin places like Africa, they certainly contribute in many places, as in China and in Europe and the U.S.

Recently, Laura Bush has gone to Africa to assess the AIDS prevention efforts there [1]. Her response to questions about the ABC philosophy illustrates the short-sightedness of the problem, in my opinion. “In countries where there are gender issues and where girls feel like
they have to comply with the wishes of men, I think abstinence [and
abstinence education] become even more important. We need to get the
message to girls everywhere, not just in Africa, that they have a
choice, that they can be abstinent and make choices for themselves that
keep themselves safe.” The reality is that the prevalence of rape in many parts of the world, or subjugation of women to the point where they are totally subservient, there is no choice. The idea that there is choice is a convenient fairytale that we in the West tell ourselves. The reality is that many cultures do not hold women as equals, and have policies or practices that keep them uneducated, or domesticated, and in some cases in the grip of sexual slavery. Without changing that culture, without getting the men to change their thinking, how do you actually give women a choice?

Abstinence education only works when the man, in this case, respects the woman’s wishes and when the woman knows she has a right to refuse. I suspect there are many places where men don’t care (even on U.S. college campuses, sadly) and where women also don’t actually have that right, or don’t think they do. In that sense, starting with “A” is the short-sighted part.

Empowering all people to take control of their bodies is clearly the most important thing to achieve. Abstinence is a reality only when you already have that control, by law or by force. Deployment of a female condom, along with education about how to use this, would be one step in that direction. Teaching men more respect, and teaching them to use prophylactics, is also critical to that. Teaching both to be exclusive is another important step.

Currently, 1/3 of the U.S. spending on AIDS prevention must, by law, go to abstinence education. The First Lady argues this is what African governments wanted. That’s a fine argument, but in reality there is a deeper philosophy of those with power which seems to be pervasive right now. The policy starts from the perspective that sex itself is somehow wrong, so abstinence becomes the clear leader of the policy. What is needed is a policy that accepts realities: the reality that not everybody thinks sex is evil, the reality that men and women are not equally empowered in all nations, and the reality that to stop a behavior is a hell of a lot harder than to modify it. Do we really want to gamble the fate of our species’ health on somebody’s moral judgement about the very act of procreation?


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