AIDS is spread mainly through sexual intercourse. This fact has given the Bush administration a brilliant idea: Why not fight AIDS by discouraging sexual intercourse? Seldom has a U.S. government had such a dumb and dangerous idea.
Moralism has coloured the Bush administration's overseas development policies from the beginning. On George W. Bush's first day in the White House in 2001, he reinstituted a policy that bans private, foreign groups from receiving American family-planning funding if they advise clients to seek an abortion, or even discuss the option. The "global gag rule," as critics call it, was objectionable enough, but at least carrying a baby to term is not usually fatal. AIDS often is.
The administration argues that promoting condom use to prevent AIDS is a mistake because it encourages promiscuity among youth. It prefers the ABC policy: abstinence, be faithful and condoms, with a firm emphasis on the first two. Condoms, it says, should be used only by high-risk groups such as prostitutes or couples with one member who is infected.
This flies in the face of years of experience of AIDS prevention, which shows that the countries that succeed best at controlling AIDS are the ones that speak frankly about the disease and leave moralizing aside. Thailand, for example, got its AIDS epidemic under control with a vigorous public-health program that stressed condom use. Uganda followed a similar tack, encouraging abstinence and faithfulness but also condom use. Under U.S. influence, that policy is beginning to change.
Because the U.S. government is funnelling much of its AIDS money into abstinence campaigns, condom use is getting short-changed. Ugandan President Yoweri Museveni has condemned condoms. Stephen Lewis, the Canadian AIDS envoy for the United Nations, said recently that "there is no doubt in my mind that the condom crisis in Uganda is being driven by [U.S. programs] To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa."
It is hard to argue with that. Abstinence and faithfulness have their place in any AIDS prevention campaign. Promiscuity obviously fuels the spread of the disease, and if young people can be encouraged to delay their sexual initiation, or at least limit their number of partners, so much the better. But many AIDS infections come about within settled couples, when a straying husband inflicts the disease on his wife. It does no good to preach abstinence and faithfulness to a wife who is either unaware of her husband's infidelity or unable to stop it. It does even less good to lecture about abstinence to girls who are seduced, raped or bullied into sex in their early teens. Condoms, which present a physical barrier to infection, are still the best preventive measure against a disease for which there is yet no vaccine.
Washington's bias against condoms is doing real harm. But that's not the only problem. Washington also opposes needle-exchange programs for drug users, who are a leading link in the spread of the disease in places such as India and Russia. Worse, it has come out with an edict that bans AIDS funding to any group that does not explicitly oppose sex trafficking or prostitution. The U.S. government says its aim is to discourage a degrading profession, but the effect is to deny necessary resources to groups that work with prostitutes, as they must do if AIDS is ever to be brought under control. One agency is suing the government after its funding for a project in Vietnam was cut off. Vietnam has one of the fastest growing AIDS problems in Southeast Asia, partly because of infected prostitutes who pass on the disease. The head of the group says condemning prostitutes while trying to help them is self-defeating. Again, it's hard to disagree.
Sex is a private matter, and controlling human sexual behaviour has frustrated do-gooders for generations. Governments that sermonize to those they are trying to help are unlikely to make much headway. Far better to avoid the judgments and tell people about the practical things they should do if they want to avoid contracting a disease that may kill them. One of those things is using a condom.
Marcus Gee