Condoms and Africa
The media expressed shock when Pope Benedict XVI on his trip to Africa said that the promotion of condoms as the solution for the AIDS epidemic may only increase the problem. How, the shocked journalists asked, could Pope ignore science?
The fact is that science is on the side of the Pope, as Edward Green, author of Rethinking AIDS Prevention admitted. Green had gone to Africa accepting the conventional wisdom that condoms were the solution for the AIDS epidemic, but discovered that massive condom education and distribution programs were not working. On the other hand, a program promoting abstinence before marriage and fidelity in marriage in Uganda was successful.
His conclusions have been confirmed by numerous other studies. In 2003, Norman Hearst and Sammy Chen conducted a condom effectiveness study for the U.N.’s AIDS program. They concluded that “In many sub-Saharan African countries, high condom use has yet to produce demonstrable benefit… sad experience shows that high HIV transmission can coexist with high condom use.”
An article in the prestigious British medical journal The Lancet concluded: “Massive increases in condom use worldwide have not translated into demonstrably improved HIV control in the great majority of countries where they have occurred.”
Those promoting condoms as the solution insist that “correct and consistent” condom use reduces infections. The problem is that no intervention or education program no matter how intense has been able to achieve anything close to consistent condom use over time. No matter how good the intentions of those in the program, after a few months use drops significantly, this is true in Africa and true among men who have sex with men in the U.S. As a result that where condoms are promoted as the answer, the epidemic continues. In the U.S. in 2006 the number of new infections among young men who have sex with men increased 18% over the previous year.
Why have massive condom education and distribution campaigns failed to slow the AIDS epidemic in Africa, while a campaign stressing abstinence before marriage and fidelity in marriage has had positive results?
Both require substantial changes in behavior. The difference is that while the decision to practice abstinence and fidelity is made with your clothes on, the decision to use a condom is made with your clothes off, in the heat of passion and often under the influence of alcohol or drugs. The decision not to engage in sex requires will power, but it is supported by religion and tradition. While condom promoters encourage people to use a condom every time, the fact is that if both partners are HIV free and monogamous, the risk of infection is zero.
The epidemic isn’t driven by monogamous couples not using condoms, but by concurrent multipartner sexual activity. Those pushing condoms as the only solution for the AIDS epidemic, ignore the psychology of multipartner sexual activity. Those who engage in sexual relations with a number of partners, almost be definition, tend to value their personal pleasure over the well-being of their partners. Those most at risk engage in sex with people they don’t know very well. Insisting on condom use in such situations implies a lack of trust, it breaks the mood, it interferes with the seduction that is part of such encounters.
The Pope is right in worrying that condom promotion may actually increase the problem, because condom promotion campaigns necessarily spread a false sense of security. The campaigns don’t say that condoms, even used every time and correctly will only reduce your risk of infection, and you may still contract HPV, which causes cancer and warts. Instead the paint a picture of fun and freedom. According to the Lancet article; “A vigorous condom-promotion policy could increase rather than decrease unprotected sexual exposure, if it has the unintended effect of encouraging greater sexual activity.” And since those who are encouraged to engage in multipartner activity even if supplied with condoms and educated on how to use them inevitably slack on column use off after a few months, but continue multipartnering. The problem gets worse not better.
According to study published in the Journal of AIDS in 2005, when compared to a control group, men supplied with condoms and education “reported a significantly higher number of partners during the six month follow-up period when compared with the six months prior to joining the study” thus increasing their risk of infection.
Condoms may sound like the solution, but governments and funders need to look at the results and back programs with a proven record of success.