Tuesday, August 30, 2005

Uganda and AIDS prevention

It's unusual for me to find myself more closely aligned with the US than the UN, but this story led to that response.

At issue is the Ugandan AIDS prevention policy. Under it, infection rates have decreased from around 15% to 5% - which for sub-Saharan Africa is good. It is based on three strands, which are memorably abbreviated ABC - "Abstinence, Be faithful, Condoms".

According to the BBC report on the internet, Stephen Lewis the UN Special Envoy said:
Over the last eight to 10 months, there's been a very significant decline in the use of condoms, significantly orchestrated by the policies of government.

At the moment, the government of Uganda appears to be under the influence of the American policy through the presidential initiative of emphasising abstinence far and away over condoms
As it was presented by the UN, a proven, successful policy was failing for reasons to do with the religious right in the US.

In actual fact, the truth is that the price of condoms has tripled due to high demand - a Ugandan health minister reports that 145 million condoms have been procured in the last few months.

What wasn't reported on the internet report, but did make it to the World Service report this morning were comments from Mr Lewis along the following lines: "How can a young bride expect that her husband will remain faithful? How can sexually active teenagers suddenly start practising abstinence." It was these remarks that rattled my cage.

In answer to these questions, how do you avoid getting shot when playing Russian roulette? I would have thought the answer is: stop playing. If people understand that being sexually active with multiple partners runs the risk of HIV infection, surely this ought to be a discouragement from being sexually active with multiple partners. Of course condoms reduce the chance of transmission of STD's - but you can eliminate the chance if you don't sleep with different partners. You don't have to have sex. Condoms aren't a foolproof way of stopping the spread of HIV. Abstinence and being faithful are.

And why should the young wife expect her husband to remain faithful? Well, isn't that a normal assumption made by married couples? Surely the question ought to be the other way around. What is happening in their society that the young wife has the expectation that her husband won't be faithful? And how would greater availability of condoms protect her? Presumably within a marriage relationship, the expectation will be that sex without contraceptive protection would be the norm at some stage. So how is a greater emphasis on condoms going to help her? On the contrary, a greater focus on faithfulness would be much more important to her.

And why should teenagers be expected to abstain from sex? Well, surely if a teenager sees that sex isn't simply a guilt free high, but it has consequences - both in terms of the risk of unwanted/unaffordable children, and in terms of spread of sexually transmitted disease, some of which are incurable - then this ought to change their behaviour.

The greater problem is the liberal western approach, of denying individual responsibility and expecting continual easy gratification, and a society that is continually prepared to pick up the tab - which seemed to underlie Mr Lewis's comments. That's what's destroying society in Britain and the US, and with their affluence frankly no amount of moral crusading is likely to make a difference. At least the Ugandan policy has the potential to change societal attitudes there.