By Benjamin Castro
Condoms cannot cure Africa. They should not be at the forefront of HIV/AIDS prevention programs, nor should they be considered a top-priority.
These statements stand diametrically opposed to accepted conventional prevention strategies proposed by western nations. Many organizations, UNAids for instance, state that condoms should be at the vanguard of the continental struggle to prevent HIV/AIDS in Africa. Anything contrary to this statement is often labeled as ignorant, misguided, or a product of ultra-right wing radicalism, often religious. In a word, anti-scientific. However, Dr. Edward Green, who served as the director of the AIDS Prevention Project at Harvard University as well as a member of the Presidential Advisory Council on HIV/AIDS (amongst many other positions), would agree with those statements. He provocatively states that condom use, while managing marginal amounts of risk in preventing HIV/AIDS, does not at all address the risky behavior which ought be the focus of prevention strategies.
Green, most famously indicated this in his highly controversial Washington Post article Condoms, HIV-AIDS and Africa- The Pope Was Right. In this article, Green came to the defense of the previous Pope, Benedict XVI, who was criticized for saying that Africa, “cannot resolve [the AIDS epidemic] with the distribution of condoms. On the contrary, it increases the problem.” Now, given today’s social climate, most people denounce the statements of the religious due to the belief that religion and science are incompatible with one another. However, Green states that, “current empirical evidence supports him.” Citing multiple studies, “Reassessing HIV Prevention” to name one, Green says that a myriad of scientist will say that condoms cannot lead the charge against the infectious disease.
For instance, in nations such as Malawi it is estimated that two-thirds of the sexually active population are in the midst of an interconnected web of people with multiple sexual partners. This presents the obvious issue of somebody infected with HIV/AIDS engaging in risky behavior with multiple different people who, if they become infected, can then infect multiple others by themselves. This leaves the country with the evident problem of the exponential growth of the incidence of HIV/AIDS within this web. Now, addressing this issue using condoms was shown in the Malawi National Assembly to be an ineffective method of prevention due to the errors associated with the typical use of condoms (improper use, breakage, slips, etc.) What was much more needed, and much more effective, was the disbandment of plural intimate partners through community education.
Part of the difficulty with condom distribution in Africa is that an entire continent is treated as if it was only a small nation such as Thailand or Cambodia, where, admittedly, condom programs have been effective. In Thailand and Cambodia, where the main mode of HIV transmission was through commercial-sex, “it has been possible to enforce a 100 percent condom use policy in brothels.” (Though he does add that this was not the case outside of the commercial-sex practices.) This means that prevention programs could easily target high-risk situations in Thailand and Cambodia with prophylactics and largely put a stop to transmission. This method of condom distribution won’t work in Africa because typical high-risk populations (men having sex with men, intravenous drug users, sex workers, etc.) associated with successful condom distribution programs are not the ones most affected by the HIV/AIDS epidemic. Rather, it is long-term heterosexual relationships that are “driving” the epidemic. University of California researchers say, “the public health benefit of condom promotion in settings with widespread heterosexual transmission… remains unestablished.” Given this fact, we can’t use generalized, blanketed condom distribution plans to fix problems which are not parallel to countries where similar programs showed some success.
Green asserts that monogamy and fidelity were effective tools to prevention in African nations prior to western influences injecting “condom-mania” into the continent as the main form of prevention. After the introduction of condoms in places such as Uganda, there was a noted increase in the incidence of HIV/AIDS due to what Green says was a decrease in the government’s attention to preventing risky behaviors in favor of new condom policies. In Uganda, Kenya, and Zimbabwe, more community-based prevention programs that target breaking down sexual-web of transmission have proved to be more effective within the framework of existing African populations. These “Zero-Grazing” campaigns encouraged faithful relationships (preferably monogamous), and were successful in African countries even before there was widespread distribution of condoms.
Using similar, effective community-based health programs, we should be targeting the HIV/AIDS risk-factors influencing Africa—not the risks facing Thailand and Cambodia.