African AIDS: The Facts that Demolish the Myths

This piece offers perspective on the "international sensation" provoked by Pope Benedict XVI's comment on the African AIDS crisis: "the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem". Author Michael Cook reviews some of the outrage at this comment, but then proceeds to challenge it.

According to Cook, "many African AIDS strategists are having serious misgivings about an obsession with condoms." He cites, for instance, a Lancet article in which James Shelton of the United States Agency for International Development (USAID) asserts that one of the ten damaging myths about the fight against AIDS is that condoms can have significant impact in turning back a generalised epidemic, as in Africa. Cook bolsters this claim by citing figures from Cameroon, where between 1992 and 2001 condom sales increased from 6 million to 15 million while HIV prevalence tripled (from 3% to 9%).

Cook elaborates: "Benedict's critics blithely assume that the solution is more condoms because AIDS in Soweto is like AIDS in San Francisco. It's not. In the West, AIDS is confined to high-risk groups....But AIDS in Africa is a generalised, heterosexual epidemic which affects ordinary people."

His claim is that Sub-Saharan Africa is most heavily affected region in the world not because of a lack of condoms but - rather - due to the widespread practice of "multiple concurrent partnerships". He explains that it can be difficult to persuade men to use condoms consistently in these relationships, which are not just casual hook-ups but, rather, are based to some extent on intimacy, trust, and friendship. Cook cites Helen Epstein, whose 2007 book The Invisible Cure: Africa, the West, and the Fight Against AIDS characterises multiple long-term partnerships as the "super highway of infections".

Cook goes further, suggesting that evidence exists that "condoms can be worse than just ineffective in a generalised epidemic." As Dr. Edward C. Green of Harvard University (Massachusetts, United States) explained in an interview with MercatorNet, condoms "may even exacerbate HIV infection levels due to a phenomenon called risk compensation, or behavioral disinhibition. People take more sexual risks because they feel safer than is actually justified when using condoms."

"If showering condoms over Africa can't stop the epidemic, what will?" In addition to male circumcision, one strategy that has been proposed is "partner reduction", which Cook says, "sounds remarkably like what the Pope recommends. In Uganda, HIV prevalence reduced dramatically after an intensive 'zero grazing' campaign in the 1990s. A recent decline in Kenya's HIV rate seems to be due to partner reduction and marital fidelity." Yet, Cook asserts, despite this evidence, only "a negligible amount" of the Joint United Nations Programme on HIV/AIDS (UNAIDS) budget is devoted to changing sexual behaviour.

Cook concludes by citing the aforementioned Dr. Green, who wrote (with Allison Herling Ruark, in the April 2008 article "AIDS and the Churches: Getting the Story Right") the following: "...[M]ost faith communities...have a comparative advantage in promoting the needed types of behavior change, since these behaviors conform to their moral, ethical, and scriptural teachings. What the churches are inclined to do anyway turns out to be what works best in AIDS prevention."