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August 12, 2003

Combating HIV/AIDS in Africa: A Success Story

Uganda developed the system called ABC*: Abstinence, Behavior change (monogamy), and Condom Use.

To get the full benefit of this piece, you'll have to invest the time it takes to read the articles I've linked in their entirety.

Study one
This article confirms that significant progress was made in combating HIV/AIDS in Uganda through governmental and non-governmental organizations' advocation of behavior change in the general population. However, the programs had the greatest impact on the young who had not had sexual intercourse before; those who were sexually experienced showed little response to the programs. It seems fairly balanced...

National evidence suggests that changes in all three areas that are targets of current HIV
prevention efforts in Uganda (abstinence, behavior change (monogamy) and condom use) have
likely contributed to the reduction in risk of HIV infection, and therefore to the decline in HIV

Study two
In my opinion, this study is basically an attempt to discredit any attempt to promote abstinence as a solution to HIV/AIDS. While I don't really like their assumption that the lack of confirming data means abstinence had little effect, I do have to agree with the meat of their conclusion:

One thing should be clear, however. Neither Uganda's experience nor current research from the United States on the efficacy of abstinence-only versus comprehensive sex education programs reasonably can be used to justify a single-focus, abstinence-only approach to HIV prevention--either in the United States or for overseas export.

Whether I like it or not (and I don't), I have to concede that abstinence alone cannot work. On the other hand, delaying sexual activity for even one year greatly increases the chance that the choice will be made in a more mature manner, and the lack of definitive evidence to its efficacy is no reason to throw the baby out with the bathwater, as it were.
For instance, isn't this result: "As a result, young adolescent women were less exposed to infection within marriage, but an increased proportion were exposed while unmarried" worthwhile in some manner? Marriage does have a stabilizing effect on society as a whole, so this could be a minor example of evolution in action.
Even in the conclusion, they couldn't resist taking another jab at abstinence:
...the analysis demonstrates that progress on all three fronts clearly contributed to reduced exposure to HIV--although reductions in the number of sexual partners and increased condom use may be playing a more significant role in reducing HIV risk than sexual abstinence by itself.

To me, that seems to be raising the bar for 'abstinence' much higher than the other two factors. I don't think the data supports any conclusion that minimizes any aspect of "ABC". It works, and there isn't enough data to know how it works. Dropping the "A" could result in disaster. When you have something that works, you don't monkey with it on the basis of your own social agenda.
In the same manner, anyone who points to the success of "ABC" as a success for Abstinence Only should be ignored, as well.

So, you ask, how did the reduction in HIV/AIDS actually progress? I'm glad you asked:

In Kampala, the major urban area,
HIV prevalence among antenatal clinic attendees tested increased from 11% in 1985 to 25% in 1990 and then 29.4% in 1992. Beginning in 1993,
however, HIV prevalence among antenatal clinic attendees began to decline in Kampala reaching 13.8% in 1998 and 11.25% in 2000. Median
HIV prevalence among antenatal clinic attendees outside of the major urban area has declined from 13% in 1992 to 5.9% in 2000. In 2000, HIV
prevalence from 12 sites outside Kampala ranged from 1.9% to 10%.

This came from a cool report with lots of graphs and pictures. Spend some time looking at it yourself.

This article is interesting in that it clearly states what the most problematic populations are:

Uganda's program "resists an ideological label" because it emphasizes abstinence and monogamy and works with religious organizations but also promotes condom usage and is "non-judgmental" in its work with high-risk groups, including prostitutes and gay men, Rosenberg says.
I find this fascinating since homosexual advocacy groups and individuals always hasten to point out that it is not a gay disease. They forget to recognize that it isn't now, but originally...? ...and the juxtaposition of homosexuality with prostitution is even more interesting to me. I may investigate this at my own blog soon...

This opinion piece is more about persuasion through emotional appeal than about analysis of raw data. The writer has an agenda, or a bias toward Islam at the very least. But the facts he does cite are difficult to dismiss:

Fred De Sam Lazaro of PBS observed that in Senegal the rate of HIV infection is barely one percent. The country is 95% Muslim and they are mostly devout. Homosexuality and marital infidelity are outlawed by Islamic law. Islam does not allow taking liberties with one's sex life. It was foretold by Prophet Muhammad that people who have adulterous relationships will suffer consequences, like incurable diseases. The Koran teaches us: "Do not approach adultery. It is an obscenity and has evil consequences." 17:32. While not condemning people with HIV, we should seriously consider educating people about the practicality of religious teachings in correcting people's sexual behaviour.

The most interesting aspect of this article is that it details three "success" stories (please note the use of Reuters "quotes"), but when you actually read the article, the standard of measure is rather skewed. Two, Uganda and Senegal, are clearly success stories. But the third, Botswana, has done nothing more than institute a broad, expensive drug program that amounts to socialized medicine: just what liberals usually want. Let's face the facts here, most medicines do nothing to prevent the transmission of HIV/AIDS, but actually help the spread and the development of drug-resistant strains. The earlier studies show that behavior doesn't change significantly after a person has sexual experience; thus, life-extending drugs merely provide an illusion of safety. If there is one thing I've learned from this research, it is that the only possible solution is to prevent people from contracting the virus in the first place. From where I stand, I can see that both conservatives and liberals have their own agenda to promote. The conservatives want to promote Abstinence Only, which is not enough to solve the problem. Liberals want to promote universal, free drug coverage, and they want US taxpayers and pharmeceutical companies to pay for it. While both positions are equally dangerous in their naivete and lack of efficacy, the current predominance of liberal thinking makes their advocacy all the more diabolical: it would appear that they would rather millions of people contract HIV and die before they would admit that the only proven way to effectively curtail the transmission of HIV/AIDS in any nation or population is through altering behavior to be more moral: abstain from sex until marriage, remain monogamous, and use a condom. These guidelines have a common theme: sexual activity demands responsible thought and behavior. The liberal opposition to these three aspects also has a common theme: sexual pleasure is too important to place any restrictions on its expressions. Obviously, not all liberals, but enough...

All partisan sniping aside, advancing agendas at the risk of the health and life of whole peoples is ridiculous and evil. We know what works: Abstinence, Being Monogamous, and Condom Use. Let's stick with this and implement it both in Africa and here in the US. It works. And if it works, what possible argument is there against it?

Finally, Here are some general facts about HIV/AIDS in Africa.

*Also known as "Abstinence, Be Faithful, Condom Use". How that translates into Ugandan, I have no idea. I suspect it isn't half so clever.

Posted by at August 12, 2003 06:33 AM

i have been studying the problem with aids in my speech class and it is very hard not to burst6 out in tears.


Posted by: christina nichols at October 7, 2004 10:30 AM

i have been studying the problem with aids in my speech class and it is very hard not to burst6 out in tears.


Posted by: christina nichols at October 7, 2004 10:30 AM
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