World AIDS Day has not long passed and again we have been presented with the global magnitude of the AIDS pandemic. Africa has been the worst affected area, where the consequences for families, for children left orphaned and for the social and economic well-being of countries at large have been devastating.
Various strategies, mainly the use of condoms, have been advocated to curtail the spread of this fatal disease. However, what is needed, as has been shown in Uganda, is to address the root causes of the spread of the disease.
In 1991 at the International-Conference on AIDS and Sexually Transmitted Diseases in Africa (ICASA) held in Senegal, which I attended, representatives from several African countries met to see how to approach the further spread of HIV/AIDS. The following statement was drawn up:
"We believe that individuals and whole communities have the inherent capacity to change attitudes and behaviours. The power to fulfil this capacity is often denied or is not exercised. This power must now be recognised, called forth and supported.
"We recognise that behaviour change is inextricably linked to such basic human values as care, love, faith, family and friendship, respect for people and cultures, solidarity and support. The present pandemic affects everyone. We believe that behaviour change is the most essential strategy in overcoming the HIV pandemic."
This statement clearly asserts that the most important strategy in AIDS prevention is behaviour change to address the lifestyles that are spreading the disease. Having worked in Uganda, a gynaecologist, serving on the Uganda AIDS Commission, and working on AIDS prevention programs for 10 years, I can recommend this approach.
In 1991 Uganda had the courage to address the attitudes and behaviours that were spreading the virus. Value Based Programs and Behaviour Change Workshops were run throughout the country. Young people were helped to look critically at lifestyles and attitudes, and helped to choices that would promote life and health.
As a result many people made commitments not to have extra-marital sex, and to avoid other behaviours that would put them in a situation where they would not be in control of their lives, e.g., drunkenness, drugs.
This approach was supported by Uganda's leader, President Museveni, churches, as well as many prominent people.
A Harvard study on prevention of HIV in Uganda credits abstinence education with "significant effectiveness in reducing AIDS in Uganda". The study found that from the late 1980s to 2001 the number of pregnant women infected with HIV dropped from 21.2% to 6.2%. By contrast, in Botswana, where condoms are offficially promoted as the solution rather than part of the problem, 38% of pregnant women were HIV positive in 2001.
The promotion of condoms as a way to stop the spread of sexually transmitted diseases is irresponsible, especially when it is said that condoms prevent infection. The most a condom will do is reduce the risk.
The medical literature clearly shows that condoms have a 10-13% failure rate for pregnancy and a 10-20% failure rate for the HIV virus for a multitude of reasons.
People have the right to be told the truth about condoms so that they can make responsible choices.
Those who promote condoms should take into account the risk behaviours. If the risk behaviour is binge drinking, even if one has a condom, will he think about putting it on?
On the website of Durex, which manufactures condoms, the following is stated: "For complete protection from HIV and other STDs the only totally effective measure is sexual abstinence or limiting sexual intercourse to mutually faithful uninfected partners."
If the money spent on providing condoms was invested in value-based programs and poverty alleviation we would have had much better results. I think it is about time that we start using "common sense" instead of "condom sense".
An article by Dr P.B. Marwood published in the British Journal of Hospital Medicine (1987.37:99), titled "AIDS a conspiracy of misinformation", states: "Church leaders proclaim abstinence as the only real protection. I fear they are correct. It would seem that virginity and faithfulness will once again become fashionable."
At another ICASA conference held in Zambia, in 1999, the Youth Forum made the following recommendation: "You tell us that because 20% of the youth are having sex, you provide us all with 'safe sex' education and a supply of condoms. Why not uphold the 80% who are not having sex and encourage the others to come back on board?"
This sounds like good logic.
Sr (Dr) Miriam Duggan is a member of the Irish Franciscan Sisters for Africa. Her article first appeared in 'The Irish Catholic'.