Tuesday, 31 March 2009

Book by Edward C. Green: Rethinking AIDS Prevention

Book by Edward C. Green: Rethinking AIDS Prevention: Learning from Successes in Developing Countries, by Edward C. Green (Praeger, 392 pp., $39.95)

Reviewed by Douglas A. Sylva

A few years ago the official in charge of UNICEF's eastern and southern African operations declared that, in the name of AIDS prevention, condoms should be made available "for everybody, everywhere and at all times." "Let us stop the almost metaphysical debate on the pros and cons of the use of condoms," he continued, because "the use of condoms . . . has been a part of all known successes to reduce HIV infections." Such is the philosophy of the international AIDS-prevention establishment: Only condoms can save the world from AIDS, so international funds should ensure that the people of the developing world are ever more securely swathed in latex.

There are, however, no condom "successes" in Africa. Something like 700 million condoms are shipped to the continent, year in and year out, courtesy of the U.N., the U.S., and the EU, yet infection rates remain stubbornly high. The UNICEF official approvingly cites Botswana's commitment to condoms — "Let us follow the decision of the government of Botswana" — but about 35 percent of that country's population is infected. That's the example the rest of the world should follow?

Whenever someone, usually an obscure African churchman, dares to raise such uncomfortable questions, the full might of the AIDS establishment comes down to smite him, and he is condemned as a religious zealot. Finally, though, there is a challenger to condom dominance who cannot be so easily dismissed. He is a distinguished public-health official, a paragon, in fact, of establishment credentials: Edward C. Green, senior research scientist at the Harvard Center for Population and Development Studies. Green has had an epiphany of common sense and now has the courage to criticize the role of his colleagues as prophylactic missionaries to the Third World. In his important new book, Rethinking AIDS Prevention, he exposes the failure of the condom approach, and explains why AIDS experts cling to this failure.

What happened is that Green's colleagues inherited the ideology of the homosexual revolution of the 1980s. Green matter-of-factly states that "gay Westerners" tend to be "sexually hedonistic," that "some in the gay community believe in an 'anything goes' sexual expression that takes as a given that sexuality should be expressed and enjoyed to the utmost, and there be little or no worry about consequences." AIDS prevention was developed for gays, and in many cases by gays; thus, anything that challenged the sexual hedonism of homosexual identity would be out of bounds.

Green quotes at length from one American AIDS expert's web-posted paean to promiscuity: "Unlike gibbons and some other mammals, humans are not naturally monogamous. Some major religions make polypartnering (having sex with several partners) a sin in order to promote monogamy. However, there is nothing intrinsically wrong with polypartnering. Indeed, polypartnering allows participants to enjoy a greater variety of sexual behaviors, with a greater number of persons, to enhance their lovemaking skills." Monogamy, on the other hand, is as dreadful as if "religions were to dictate that it was morally wrong for people to eat out at different restaurants, requiring its adherents to stick to one restaurant for their entire lives; or to stick to one movie — seeing the same film over and over again."

Obviously, such people have a personal interest in ensuring that the basic lesson of the AIDS epidemic — promiscuous sex cannot be made consequence-free — never gets learned. As our "polypartnering" devotee makes clear, "we should not use the HIV/AIDS crisis as an excuse to revert back" to the bad old days of monogamy. And thus enters the lowly condom; it allows proponents of the sexual revolution to trumpet as "safe" risky sexual behavior.

AIDS experts will go to great lengths in order to protect condoms from scrutiny. According to Green, his colleagues have hidden evidence that the HIV virus may be smaller than, and therefore may pass through, the pores in latex condoms. And AIDS experts have denied evidence that traditional sexual morality works — that, where it has been promoted in place of condoms, most notably in Uganda, AIDS has been brought under control. Since risky sex causes AIDS, a significant number of Africans have simply stopped having risky sex. And when governments have encouraged them to do so, to abstain from sex or to be faithful to their spouses, this behavior change has been all the more dramatic.

But Green's colleagues are not interested, are even hostile, to such news. At the 2002 International AIDS Conference, writes Green, "high-ranking officials from major donor organizations were heard to opine that any such ideas were part of a plot from the religious right. Furthermore, they were heard to say, public health would never yield to right-wing or religious pressure (even if millions of lives could thereby be saved)." Green continues: "But what about Africans and others who believed that condoms were 100 percent effective, used them as directed, and then became infected? This is an ethical issue, a serious human-rights issue. The case could be made that health officials from rich countries have withheld information that would allow people in the poor countries to make an informed choice, a choice that has life or death consequences."

Green makes the reasonable request that African public-health measures should be designed with the best interests of Africans in mind; most especially, that the schoolchildren of Africa should not be handed a box of condoms, and subjected to a program designed for the clients of New York's gay bathhouses, but encouraged instead to delay sexual activity.