By BRIAN CLOWES
Part 3
(Editor’s Note: Brian Clowes has been director of research and training at Human Life International since 1995. For an electronic copy of the book The Case Against Condoms, e-mail him at bclowes@hli.org.)
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There is not a lot of debate about the best way to stop or stem the AIDS epidemic, but there certainly should be. The “family planners” have based their entire modus operandi on a flawed premise — that people are basically animals that cannot control themselves.
Tragically, this assumption has led to millions of deaths.
Clinical studies are essential, but there is nothing like real-world experience to settle a scientific debate. There are several such scenarios in the developing world that demonstrate beyond any possible doubt that condoms actually promote the spread of HIV/AIDS, and which demonstrate that the only realistic solution to the epidemic is behavior change.
Case Study #1: Uganda. In 1991, Uganda had one of the highest adult HIV infection rates in the world at 15 percent. Try imagining an entire country where one in every seven adults carries this dread disease! However, ten years later, Uganda had cut its HIV infection rate by two-thirds, to only five percent. It was one of only two nations in Africa that cut its HIV infection rate during this time period, and its decline in HIV prevalence was the greatest of any country in the world.
The key to this tremendous success was an approach that other nations either ridiculed or declined to embrace: President Yoweri Museveni’s ABC Program — Abstain from sex until marriage, Be faithful to your partner, and use Condoms if you simply cannot practice abstinence or fidelity. The entire focus of the message was not simply to “condomize” the population, but to reduce risky sexual behavior.
In time, the constant broadcasting of the ABC message through all governmental, educational, religious, and communications networks built up what researchers called a “highly effective social vaccine against HIV,” or a massive behavioral change among the people of the nation.
By 2000, the Ugandan Demographic and Health Survey found that 93 percent of Ugandans had changed their sexual behavior to avoid HIV/AIDS.
The lessons we learned from Uganda’s experience were simple but profound. Most important, we learned yet again that human beings are not mindless, deterministic automatons. We can think — and we can change! After all, we have implemented persistent and very successful publicity programs that discourage smoking, illegal drug use, and excessive alcohol consumption, as well as healthier eating patterns. Uganda showed us that high-risk sexual behaviors can be modified into healthier options, such as “zero grazing,” or faithfulness to one partner.
The second lesson we learned from Uganda is that abstinence and marital fidelity are the most important factors in preventing the spread of HIV/AIDS. Contrary to all expectations, young Ugandans widely embraced the pro-abstinence message. From 1989 to 1995, the percent of unmarried young men having sex plunged from 60 percent to 23 percent, and the percent of unmarried young women having sex dropped from 53 percent to 16 percent. This proves that not all teenagers are helpless slaves of their “raging hormones.”
The final lesson is that condoms do not play a primary role in reducing HIV transmission. As President Museveni remarked, “We are being told that only a thin piece of rubber stands between us and the death of our continent.”
The Ugandan government targeted only extremely high-risk groups such as prostitutes and truck drivers with condoms, but the vast majority of Ugandans rejected their use. Anne Peterson, MD, USAID’s director of Global Health, asserted that “condoms play a role. They are better than nothing,” but added that “the core of Uganda’s success story is big A, big B, and little C.”
The ABC program has been intensively studied and deemed effective by many leading international health organizations, including the Joint United Nations Program on HIV/AIDS (UNAIDS); the United Nations World Health Organization (WHO); the Harvard Center for Population and Development Studies; and the United States Agency for International Development (USAID), which said that “this dramatic decline in [HIV/AIDS] prevalence is unique worldwide, and has been the subject of intense scrutiny;” However, all of these groups still aggressively promote condom use all over the world.
In 2004, the journal Studies in Family Planning concluded: “No clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion.” This is still true a decade later.
Case Study: Africa in General. An examination of the HIV/AIDS rates in all of the nations of Africa reveals some very interesting patterns regarding religious practice and HIV prevalence. In Africa, Catholics and Muslims take their faith seriously, and generally do not use condoms. Africans are not “cafeteria” Catholics and Muslims, like many North Americans and Europeans; they generally either accept their faiths in whole or not at all. Also, African nations that have a high percentage of Catholics and Muslims have very low rates of HIV/AIDS, and countries that have fewer Catholics and Muslims have higher rates.
There are 16 African nations in which Catholics and Muslims account for an average of 95 percent of the population. These nations have an average of a minuscule 0.4 percent HIV infection rate. By comparison, there are 15 African nations where Catholics and Muslims make up an average of only 26 percent of the population. These nations have an average HIV infection rate 17 times higher, at 6.8 percent. In fact, it is easy to plot a smooth curve showing that, the fewer Catholics and Muslims there are in an African nation, the more HIV/AIDS cases there are going to be.
Case Study: Thailand and the Philippines. The third real-life example showing how condoms fail to stop the spread of HIV/AIDS is presented by the Philippines and Thailand, two Southeastern Asian nations with roughly equivalent populations.
In 1983, the first case of HIV was detected in both of these nations. By 1987, Thailand had 112 cases of AIDS, and the Philippines had 135 cases. In 1991, the World Health Organization predicted that, by 1999, Thailand would have suffered 70,000 deaths from the disease, and the Philippines would have lost 85,000 people.
In 1991, both nations took concrete measures against the spread of the human immunodeficiency virus — but in completely different directions. The Thai minister of health enacted a “100 Percent Condom Use Program.” All brothels were required to have supplies of condoms, and condom vending machines were installed in all supermarkets, bars, restaurants, and other public gathering places. This program was widely accepted and implemented by the government and the people of Thailand.
Two years later, Rene Bullecer, MD, received authorization from the Catholic Bishops Conference of the Philippines (CBCP) to establish the organization AIDS-Free Philippines as its official program to combat HIV/AIDS nationwide. The government signed on to this effort as well. By the end of 2003, the disparity in the effectiveness of both types of programs had become glaringly obvious.
There were 9,000 people living with HIV in the Philippines by 2003; the number was 63 times higher (570,000) in Thailand: 500 Filipinos and 58,000 Thais had lost their lives to AIDS. In other words, for every Filipino who had died, 116 Thais had died.
The latest numbers show that about 15,000 people are living with HIV/AIDS in the Philippines, and about 440,000 in Thailand. So the HIV infection rate per million population is 43 times higher in Thailand than it is in the Philippines.
However, the latter nation is being flooded with condoms after the passage of its 2013 Reproductive Health Bill, so we can expect the Philippines to soon start suffering a significant upswing in its HIV infection rate.
Interestingly, the current rate of HIV infection in the United States, with all of our sex education, all of our sexual freedom, all of our advanced antiretroviral drugs, and all of our tens of billions of condoms, is 30 times higher than in the Philippines. USAID has concluded that the reason that the Philippines has such a low incidence of HIV/AIDS is that youth have a very high rate of abstinence and married people largely remain faithful to their spouses. The USAID report even grudgingly admitted: “The Catholic Church must be credited with influencing sexual behavior.”
Behavior Change
Conclusions. “Family planners” and other advocates of the Culture of Death pride themselves on their rational thinking, and often claim that they advocate only the most “realistic” solutions. But, as we have seen so many times, these “realistic” solutions invariably end with lethal results at the worst, and mediocre results at the best.
The worst thing we can do is accept the “common wisdom” associated with condom use. As we have seen, using condoms lowers risk in individual cases, but national reliance on them as a solution is disastrous due to the behavior of people who act recklessly in the belief that they are “safe.”
Behavior change is the answer. And when people criticize the Catholic solution of abstinence before marriage and fidelity during it, we should ask them how many people would be infected with HIV and other sexually transmitted diseases if everyone followed this formula.
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