Thursday, July 23, 2009

Condoms Are NOT the Answer for Africa's AIDS Epidemics

Edward C. Green is a Senior Research Scientist at the Harvard School of Public Health. From 2006 (and for just a while longer now) he has served as director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies. He has over three decades of experience in international development with much of that work done in Africa.

He is a liberal and claims no religious affiliation. Nevertheless, the liberal secularists have created a chorus of protest over Green's findings -- protests that are shutting down the work at Harvard.

Why?

After all, Green's ideas are wise, relevant, compassionate and solidly backed by the evidence. But then, when your ideas are politically incorrect, facts really don't matter.

Here Green responds to questions from the New Oxford Review. It's compelling stuff.

...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...

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...


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...


In your book you have written: “Whatever the failure rate of condoms in contraception, it should be higher in HiV prevention” (p. 97). This sends shivers down the spine. How high is failure rate of condoms in contraception?
It is about 75-80%. The two rates are probably comparable. I was referring in my book more to the fact that pregnancy can only occur during certain days of a woman’s cycle, whereas HIV infection can occur at any time...