There is a real risk in the near future that avian flu may mutate into a form that is easily transmissible between humans. Imagine if, when that happens and the world is facing an epidemic, a large influential group goes out spreading disinformation about the value of facemasks. They aim to discourage use of masks, and if possible, to bar any mention of it in public health messages. This group advises that the best way to stop the spread of flu is for people to abstain from breathing.
If you think this is too far out as an instructive parallel to what's happening in our fight against HIV/AIDS, you're only partly right. It is extreme only in the question of degree, but a parallel it remains, for both involve the irresponsibility of pushing for a theoretically neat solution, but one that is in reality unachievable.
No human society in history has ever not breathed. Nor has any human society ever failed to indulge in sex outside of morally approved relationships.
To dismiss the usefulness of condoms is irresponsible to the extreme. Yet, moral conservatives, especially those galvanised by Christian groups, are doing precisely this.
In the face of a steady rise in HIV infections, many churches and conservatives continue to oppose the promotion of condom use. In Singapore and the Philippines, they have used their weight to compel the respective governments to play down this part of their public health campaigns. In addition, individuals and organisations have been busy putting out false information about condoms, in an attempt to scare people away from condom use.
Disinformation
In a report filed by Ted Lerner, the Asia Times reported (April 2003) that one Catholic-affiliated NGO, Pro-Life Philippines, "actually altered a Johns Hopkins University report on condoms - which stated that condoms do indeed work - then distributed the information in its own pamphlets, saying the report states that condoms leak the virus."
No competent authority, including the US Centers for Disease Control (CDC) and the World Health Organisation, says this. In fact, they have strenuously maintained over the years that condoms are essentially impermeable barriers to the virus.
Meanwhile in Singapore, there is a steady drumbeat of letters to the press, claiming that condoms are only 85-90 per cent effective.
This has no scientific basis, and a simple rebuttal can be found on Avert.org. It says,
"Studies have shown that if a latex condom is used correctly every time you have sex, this is highly effective in providing protection against HIV. The evidence for this is clearest in studies of couples in which one person is infected with HIV and the other not, i.e. "discordant couples". In a study of discordant couples in Europe, among 123 couples who reported consistent condom use, none of the uninfected partners became infected."
The CDC too says this:
"[T]he ability of latex condoms to prevent transmission of HIV has been scientifically established in 'real-life' studies of sexually active couples as well as in laboratory studies."
Epidemiological Data
"After peaking at 3 per cent in 1997," the report said, "the national adult HIV prevalence in Cambodia fell by one third, to 1.9 per cent in 2003."
Among the reasons was high condom use. "80 per cent or more of the clients said in 2003 that they consistently used condoms during commercial sex in the previous months, as did sex workers."
Thailand, a widely hailed example, reported its lowest level of HIV prevalence in 2003 - approximately 1.5 per cent of adults. UNAIDS said condom use reached 96 per cent among sex workers in 2000, though there is now concern about complacency setting in.
From Africa, UNAIDS cited a study conducted in Rakai, in the south of Uganda. Among males, HIV prevalence fell from 15 per cent in 1994/5 to 9 per cent in 2003. Among females, it fell from 20 per cent to 13 per cent in the same time period.
The report noted that evidence of behavioural change "has been uneven, with researchers observing no significant increases in abstinence or fidelity."
On the contrary, the "proportion of teenagers who say they have had multiple non-marital partners has increased considerably (from under 25 per cent in 2000 to almost 35 per cent in 2003)."
UNAIDS noted that "condom use with casual partners, however, is now more commonplace.... and has probably helped lower HIV prevalence (Wawer et al, 2005)."
In short, promoting condoms work.
A common rejoinder to these statistics about receding HIV prevalence rates is that they fall because HIV-infected persons have died. The rejoinder to the rejoinder is that they did not pass on the infection while they were still asymptomatic, when they could so easily have. What held back the passing on of infection?
Hijacked
How realistic is it to expect people to hold off on sex? The abstinence brigade thinks this can be achieved and that moral exhortation is enough. But any unbiased look around the world will tell you this is a pipe dream.
Even in strait-laced Singapore, where some Christian-affiliated groups are particularly shrill, a recent survey showed that 46 per cent of teenagers aged 15 - 19 said they would agree to pre-marital sex. Of those aged 20 - 24, 73 per cent said yes.
Most people would say it doesn't hurt to plug the abstinence message, but the moral conservatives do more than that. They go out of their way to spread disinformation about the effectiveness of condoms, and to push health authorities away from promoting condom use. Rather than demonstrating sincere concern for public health, the issue is being hijacked for a moralistic agenda.
Too often, instead of seeing the role of condoms in saving lives, people get overly focused on their fear that it "promotes promiscuity". This puts the cart before the horse. Humans have never needed the condom to be promiscuous. We shouldn't imagine that sex is the problem; it is unsafe sex and unwanted babies that we should worry about.
Tied as it is to a mindset where any sex outside of morally approved relationships is cast as sin, the abstinence message itself may even work against HIV prevention. When it is overplayed, it creates a climate of moral stridency that marginalises and stigmatises sexually active persons, gays, lesbians, and especially sex workers. This is pernicious for it makes outreach, education, testing and treatment difficult, and above all, it undermines social trust. As the UNAIDS 2005 report said, to be effective, HIV prevention must "take into account the growing linkages between AIDS and factors that put people at greater risk of HIV infection, such as poverty, gender inequality, and social marginalisation of specific populations."
Thus, an obsessive focus on sexual morality distracts from the broader and more realistic strategies needed. It is particularly reprehensible when some even resort to misleading statements about the effectiveness of condoms.
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