Saturday, July 25, 2009

A Must Read Article: "Liberal academic Edward Green: the Pope is right about Aids and condoms"

An interview with Harvard Professor Edward Green:
According to Harvard professor Edward Green, Benedict XVI tells the truth about fighting the plague of the millennium in Africa: fidelity and abstinence promotion are better weapons than preservatives.

During his latest visit to Africa pope Benedict XVI told the journalists: “Condom distribution is not the solution to Aids, on the contrary they worsen it”. An editorial comment of The Lancet retorted that the Pope's comment was “outrageous and wildly inaccurate”. Based on your experience about the issue, is the Pope right or wrong?
As I have said in the Washington Post and elsewhere, the Pope is basically right – about Africa. It will be easiest if we confine our discussion to Africa, because that’s where the Pope was en route to and that is the place he was talking about. There’s no evidence at all that condoms have worked as a public health intervention intended to reduce HIV infections, at the “level of population.” This is a bit difficult to understand. It may well make sense for an individual to use condoms every time, or as often as possible, and he may well decrease his chances of catching HIV. But we are talking about programs, large efforts that either work or fail at the level of countries, or, as we say in public health, level of population. Major articles published in Science, The Lancet, British Medical Journal, and even Studies in Family Planning have reported this finding since 2004. I first wrote about putting emphasis on fidelity instead off condoms, in the book AIDS in Africa, in 1988.
Condoms fail because people do not use them consistently, because they are not used once people get to know someone, and because they provide a false sense of security, allowing people to take greater risks then they would take if condoms were not used at all. They also divert resources from interventions that work better, such as promoting faithfulness.

In your books and articles you emphasize that the ABC approach in Africa works. At first sight it doesn't sound possible, since Abstinence, Partners sexual fidelity and Condom are three very different things. What's the right dosing of the three?
Abstinence and fidelity are different from condom use. They avoid the risk of infection altogether (assuming mutual fidelity). This approach is also known as risk avoidance. Condom use introduces risk; it not a form of risk avoidance, but rather risk reduction. Consistent condom use is only 80-85% protective when practiced consistently, although under real-life conditions, such as those most of us live in, condom use is much less protective. We actually knew condoms were not very effective for HIV prevention, from our experience with family planning, before the advent of AIDS.
Part of the genius of Uganda’s original ABC program is that it addressed the immediate or “proximate” causes of HIV infection, namely avoiding the risk of infection, reducing the risk of infection, or decreasing the efficiency of infection. It separates these basics from all the other things that might or might not be involved (such as poverty, gender inequality, human rights, stigma, etc).

What are the most important things about Aids and Africa that the outside world, and especially journalists, seem not to understand?
That we cannot have complete Sexual Freedom and effective prevention at the same time; that Africa is different from the rest of the world (because condoms do work quite well in some types of epidemics); and that sexual behavior must change in basic ways for HIV infection rates to decline (except that there is an epidemic curve effect, that will temporarily make infection rates go down for a period, after those at highest risk of infection have died off faster than new cohorts enter the sexually active years).

Why, in your opinion, did international organizations and governments react so harshly to the Pope's words? Do they really believe that condoms are tool N.1 for Aids prevention, or are they influenced by some vested interests they have, and that we suspect but can't see?
They reacted as they did for a number of reasons, starting with the deep-rooted belief that condoms work much better than they actually do. We cannot really blame journalists for being ignorant of the evidence, especially when leading experts keep saying that condoms are the number one weapon we have against AIDS. And yes, people including scientists are influenced by vested interests (most American money for AIDS prevention goes through family planning or reproductive health organizations.) A factor usually overlooked is the ideology of sexual liberation. Those of us who work in AIDS don’t realize how much the values and ideology of sexual freedom and liberation influence our thinking. It helps explain why until very recently, faith-based organizations were largely excluded from AIDS prevention even though FBOs run many of the hospitals, clinics and schools in Africa. It also explains the strong emotional reactions we see when the AIDS establishment is challenged...
Rest of Interview  (Unfortunately this interview is no longer posted on-line;  A similar interview with Dr. Green can be found HERE)

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