It is 9pm in a mud-brick hut in the slum neighborhood of Bbunga in Kampala, Uganda.
Zedmu Nassanga, 33, has just arrived home from the street market, where she earns $25 a month by selling a roasted plantain-banana dish called matoke. Her words sound matter-of-fact through an interpreter, but her embittered eyes tell the deeper story. Her unfaithful husband died last year of AIDS, which he caught from his mistress.
Did he give Zedmu the AIDS virus before he died? She shrugs. One HIV test said No, but the tests can’t always be trusted.
Meanwhile, she struggles to feed and clothe six little girls. Even in the flickering lantern light, one can see her children are severely malnourished. The 9-year-old, the eldest, is so tiny she resembles an American toddler.
In this encounter with an exhausted widow, one begins to understand why sub-Saharan Africa has the highest HIV/AIDS rate on earth.
Zedmu’s late husband was just one of many who have sex with a “main” partner (usually their spouse) plus a secret lover or two on the side.
Heterosexuals in the United States, on average, have more sex partners over a lifetime than Africans do, but tend to break up with one person before having sex with another. In HIV-plagued Botswana, in contrast, 21% of men and 20% of women have sex with more than one partner, according to “Multiple Concurrent Partnerships Among Men and Women Ages 15-34 in Botswana,” a study conducted by PSI-Botswana in 2007. On Malawi’s tiny Likoma Island, scientists have found that 65% of men and women in seven villages were interconnected in one intricate sexual web.
“In such a widespread, near-invisible network, one person’s health affects almost everyone else’s,” observes Edward “Ted” Green, former director of the AIDS Prevention Project at Harvard’s School of Public Health.
Most AIDS establishment experts have long regarded this African sexual behavior to be set in stone. “You can’t ask an African to be faithful,” the predominant thinking has gone. “That’s just the way Africans are.”
In his new book, Broken Promises: How the AIDS Establishment Has Betrayed the Developing World, Green challenges this thinking.
Confronting the problem head-on, Green insists the AIDS establishment has wasted billions of dollars and caused millions of deaths by refusing to give the African people the AIDS-prevention message they desperately need to hear to save the most lives: Be faithful to one partner.
At best estimate, over the past quarter of a century, the HIV virus has infected 48 million Africans, 18 million of whom are already dead. Each day in the sub-Saharan region, some 6,000 new cases erupt. As Green tells the story, Zedmu’s husband might be alive today if Western AIDS experts had listened to their wiser African brothers.
When Ugandans realized AIDS had struck their nation in the late-1980s, they took immediate action. Schools, churches, businesses, pop singers and politicians loudly proclaimed the same public-health message: “Be faithful.” “Love carefully.” Don’t stray. If you’re single, wait for sex until marriage. If you have sex outside a relationship, use a condom. In response, national HIV rates plunged from 15% in 1991 to 5% in 2001. By the mid-1990s, 95% of adults said they had only one partner or none at all.
In 1991, USAID found “Love Faithfully,” aimed largely at men, was remembered more than any other slogan. Further, the campaign cost only 25 cents per person a year.
Green calls Uganda’s success astonishing: “A tiny, impoverished African nation reeling from decades of cruelty had notched one of the greatest public-health achievements in history.”
Cambridge University epidemiologist Rand Stoneburner would later estimate that Uganda’s program “might have saved 3.2 million lives in South Africa from 2000 to 2010 and prevented 80% of HIV infections in the worst-hit lands of the sub-Sahara,” Green writes.
But this good news did not happen. That’s because, as Green tells the story, when Western activists from UNAIDS, USAID, World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and others arrived on the scene, they had pictures in their heads of gay bars in San Francisco and bordellos in Bangkok.
Never having seen a population-wide pandemic like those in Africa, the powerful alliance Green calls “AIDS World” scorned Uganda’s marital-fidelity message as backward and unenlightened. When Kenya developed a similar fidelity campaign called “One Man, One Woman,” Green says, “Western activists expressed outrage at this ‘narrow’ concept of marriage.”
Certain the knowledge they’d acquired by studying homosexuals, prostitutes and injecting-drug users was everything they needed to know to fight AIDS in Africa, AIDS World bulldozed Uganda’s 25-cent message and replaced it with many expensive marketing campaigns of their own. “Have sex with whomever you please, just use a condom” was their overriding philosophy. Prevention messages in the media, on billboards, radio and TV changed from “Love Faithfully (or Die)” to “Anything Goes.” The happy-go-lucky picture of a winking cartoon “condom man” on billboards told the trendy new story.
A campaign in Swaziland adopted the slogans: “Fun and sex are part of my life. So is HIV” and “Condoms … where the fun is at.”
Mention of fidelity at global AIDS conferences was “typically met with jeers and catcalls,” Green observes in a second new book, AIDS, Behavior and Culture: Understanding Evidence-Based Prevention, co-authored with Allison Herling Ruark.
Armed with billions of tax dollars to force their sexual ideologies and commodities on cash-poor African nations, AIDS World was an unstoppable force. As U.S. politicians fruitlessly debated abstinence (sex with no one) vs. condoms (sex with anyone), the fidelity message (sex with only one) was thrown down the well and lost.
When recently asked to name the main AIDS message they’d heard or seen during the past six months, three-quarters of Ugandans answered “testing” or “condoms.” No one mentioned “Love Faithfully,” the most remembered slogan in 1991.
Meanwhile, Uganda’s HIV rates are again climbing. Exported to Africa, the West’s “anything goes” sexual agenda has spawned what Green calls a holocaust “equivalent to Hiroshima about 90 times over.”
Throughout the 1990s, AIDS World banged the drums loudly for money. In response, the U.S. launched the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest international health initiative ever dedicated to a single disease. PEPFAR I, begun in 2003, gave away $15 billion over five years. PEPFAR II, passed in 2008, authorized another $39 billion for AIDS — mostly to buy and promote condoms, HIV test kits, antiretroviral drugs and other man-made commodities sold for a profit.
Such commodities will never stop AIDS in Africa, Green observes, because they fail to address the root cause of the problem.
“We should stop handing out AIDS funding unless recipients know how to spend it effectively,” declares Green, a self-proclaimed political liberal. “Money alone isn’t the solution: In fact, it makes AIDS World bigger, more resistant to self-examination or change, and more demanding of cash.”
Calling on America to rethink its approach to AIDS prevention in Africa and to put fidelity first, Green writes, “There is simply no alternative. We’ve spent a quarter century and billions of dollars treating the hyper-epidemic with unproven, unsuccessful programs backed by falsehoods and stigmatizing. As a result, countless Africans will soon face AIDS without drugs.”
“We cannot reverse this betrayal,” he concludes. “But we can change our own behavior. It is never too late.”
But is there the will to change? That’s the question. AIDS, it has been said, shines a spotlight on what’s wrong with the world. Deceit shouts loudly from the marketing mouths of AIDS World’s profiteers. Reality speaks silently through a widow’s eyes in a mud hut in Bbunga. Green, a scientist, has written a book that speaks truth to power.
Whose voice do you think Congress will hear?
Sue Ellen Browder writes from Ukiah, California.