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Latin American UNAIDS coordinator Alberto Stella has accused the Church of perpetuating the AIDS epidemic by opposing condoms as the best way to prevent the disease.
BY SUE ELLIN BROWDERREGISTER CORRESPONDENT
NEW YORK — As World AIDS Day approached, the United Nations
admitted it had overestimated the number of persons infected with HIV. Might it
also correct its perception about condoms?
The Joint United Nations Program on HIV/AIDS (UNAIDS)
sponsors World AIDS Day, Dec. 1, and this year its slogan is “Stop AIDS, Keep
In a recent interview with Reuters, Alberto Stella,
coordinator for the UNAIDS program in Nicaragua, Honduras and Costa Rica,
blamed the Church’s objection to condom use for spreading AIDS in Latin
“In Latin America, the use of condoms has been demonized,
but if they were used in every relation, I guarantee the epidemic would be
resolved in the region,” Stella said.
But it’s the Church that’s being demonized, an African AIDS
activist said, because condoms “have never reduced HIV/AIDS rates anywhere.”
African AIDS activist Martin Ssempa, a Protestant minister,
firmly denounced Stella’s statement, noting that “UNAIDS is demonizing the
Catholic Church unfairly.”
“There is absolutely no evidence to back up what Mr. Stella
is saying,” Ssempa told LifeSite News. “Condoms have not reduced HIV/AIDS rates
anywhere in the world.”
Meanwhile, global AIDS researchers say this highly emotional
battle can be reasonably resolved.
Edward Green, director of the AIDS Prevention Research
Project at the Harvard Center for Population and Development Studies, said,
“Passionate debates like this typically erupt when people fail to understand
there are two different kinds of HIV/AIDS epidemics.”
Surprisingly, epidemics in the Latin American countries
Stella oversees are fundamentally different from epidemics in sub-Saharan
Africa, where Ssempa lives and works.
“Basically, Stella and Ssempa are comparing apples and
oranges,” Green said.
Most Latin American HIV epidemics — including those in
Honduras, Nicaragua and Costa Rica — are concentrated epidemics, Green
explained. That is, they’re centered mostly in small, high-risk groups (such as
prostitutes, homosexuals and intravenous drug users).
Epidemics in sub-Saharan Africa, on the other hand, are
generalized epidemics, meaning most infections are in the general population,
not in high-risk groups. Sub-Saharan Africa bears the brunt of the global AIDS
burden. Two-thirds of the world’s AIDS sufferers live there. It’s this type of
population-wide epidemic that destroys families, kills millions of people and
leaves behind millions of orphans.
“A ‘debate’ between Ssempa (who is basically correct for
Africa) and Stella (who is talking about Latin America) is a non-starter and
can only create confusion,” said Norman Hearst, a family physician and
epidemiologist at University of California, San Francisco.
It’s easy to grasp how HIV epidemics erupt within high-risk
groups like needle-using drug addicts, homosexual men and prostitutes. But what
causes and drives population-wide epidemics like those in Africa?
“The latest research now proves it [derives from] sexual
networks of people having two or more regular sex partners,” Green said.
The HIV virus can be passed in the blood supply, via needles
shared by drug users, and from pregnant or breastfeeding mothers to their
babies. But the driving cause of population-wide epidemics, Green reiterates,
is “people having sex regularly with multiple partners.”
As for Stella’s claim that if condoms were used in “every
relation” in Latin America the HIV epidemic there would end, first it’s
unnecessary for everybody to use condoms because the epidemic isn’t in the
general population. Second, “It’s a meaningless statement. He’s living in a
fantasy world, because it’s never going to happen,” Green said.
Despite repeated attempts, the Register was unable to speak
Prostitutes may use condoms in 90% or more of paid sex acts
if they’re required to by law, as they were in Thailand and Cambodia. If they
do, HIV rates in brothels (where laws can be enforced if great efforts are
made) may then drop. But among heterosexual couples in generalized epidemics,
“consistent condom use occurs at most in only about 5% of the population,”
In one much-publicized study in the Rakai district of
Uganda, people who said they always used condoms reduced their HIV risk by 66%.
“But in Rakai, only 4% of the population used condoms consistently,” Hearst
“What’s more,” he added, “people who use condoms just some
of the time don’t cut their risk of HIV infection at all.”
“Even some condom promoters know there’s very little demand
for them,” said Green, who once worked for the second largest condom marketer
in the world.
“Many people who consider themselves AIDS ‘experts’ believe
condoms are the only answer. But, in fact, condom promotion has not worked in
population-wide epidemics as a public-health strategy,” Hearst said.
Condom advocates like Stella aren’t villains, Hearst added.
“They often really believe they’re doing and saying ‘the right thing.’ But, in
fact, there’s nowhere in the world where steady couples use condoms regularly —
Some AIDS activists believe that if condoms were only
promoted more aggressively, people would use them and HIV rates would fall.
But, contrary to these expectations, in HIV epidemics like those in sub-Saharan
Africa — where 72% of global AIDS deaths occur — condom promotions may actually
raise HIV rates.
In his groundbreaking book Rethinking AIDS Prevention:
Learning from Successes in Developing Countries, Green points out that as the
average number of condoms per male ages 15 to 49 in African countries rose
between 1989 and 2000, HIV prevalence also skyrocketed. South Africa, Botswana
and Zimbabwe, which had the world’s highest levels of condom availability per
man, also had among the world’s very highest HIV rates (20% to 36%).
When UNAIDS asked Hearst to do a scientific review to see if
condom promotions had reversed HIV/AIDS epidemics, he too concluded the
promotions had not simply failed: They’d backfired. To his surprise, Hearst
found that countries with the most condoms per man tended to have the highest
UNAIDS refused to publish Hearst’s findings.
At last, in March, 2004, Hearst got part of his review
published in the journal Studies in Family Planning. The news was shocking.
Between 1993 and 2001 in Botswana, as condom sales rose from 1 million to 3
million, HIV prevalence among urban pregnant women shot up from 27% to 45%.
During the same period in Cameroon, as condom sales increased from 6 million to
15 million, HIV prevalence rose from 3% to 9%.
“There are loads of things in medicine that look as if they
ought to work. But ought to work and do work are two different things,” Hearst
Enoch Numan, 29, a teacher who lives near Kampala, has
witnessed the tragedy that results when condoms fail. One of his older brothers
is married but has had many girlfriends.
“He had a dresser drawer full of condoms. He always said,
‘Don’t worry about me. I’m protecting myself,’” Numan recalled. Now the
37-year-old brother has AIDS — and he has passed the deadly illness on to his
wife. They have two small children.
“Condom promotion in Africa has been a disaster,” Hearst
“What has worked in real life to stem epidemics in Africa is
partner fidelity among older couples and sexual abstinence among young people,”
In the late 1980s, before Western AIDS experts arrived to
tell Africans they had it all wrong, Ugandans designed their own homegrown
AIDS-prevention health message. It was called ABC (for Abstain, Be Faithful, or
if you cannot or will not do either, use Condoms). The ABC message was
everywhere: on billboards, in churches, in government offices, in schools. As a
result, rates of 13- to 16-year-olds having sex in one district plunged from
nearly 60% in 1994 to less than 5% in 2001. Fewer than 10% of unmarried Ugandan
women reported multiple partners (compared with 20% to 65% of women in other
African countries, such as Kenya and Malawi). Meanwhile, national HIV infection
rates in Uganda dropped from 21% to 6%.
What’s more, Green argued, Uganda’s success was not due to
At global AIDS conferences, Green frequently tells the
success story that occurred in the Karamoja area (two districts in the extreme
northeast of Uganda). A 1997 study of people in Karamoja found: 74.5% had no
formal education, 74% had never listened to a radio, 88.6% had never seen
Yet AIDS awareness was high because people talked about the
disease with their families and friends. When asked, “Have you changed your
sexual behavior due to AIDS? If so, how?” fewer than 1% said they used a
condom. A whopping 91.9% said they were being faithful to one partner. As a
result, Karamoja experienced a drop in HIV prevalence of at least 60%.
“As of this year, the HIV surveillance site for Karamoja
found no cases of HIV infection,” Green said. “It’s the first site in Uganda to
Irene Mirembe, 24, who lives in Kampala, Uganda, and
recently graduated from college with a degree in computer science, saw both her
mother and father die of AIDS.
Seated on a couch, her hands folded quietly in her lap, she
recalled, “All my life I knew my dad would one day die of AIDS. He wasn’t
faithful. I told him to stop going out with other women. He never listened to
me. He got the virus in 1995 and died in May, 2003.
“In the end, he could no longer toilet himself. You had to
clean him up. You had to feed him. He was the only breadwinner. Every day we
became poorer and poorer. If sex is not in a marriage, it has an impact on
everyone in the family. Before my father died, we were tired of him. It has
taken me a long time to forgive him.”
After her mother also died, Irene had sex with several men.
“I used condoms, but condoms didn’t protect my heart. Now
I’m keeping myself for marriage. It’s definitely possible to live without sex,”
she said, gently smiling. “Now there’s a freedom in my mind, a freedom in my
But now that Western experts and foreign donors have poured
into Uganda to save the day, “the A & B messages are disappearing,” Hearst
said, “and HIV rates are starting to tick back up.”
Sue Ellin Browder is based in Willits, California.