This article appears in the August 2002 edition of the Catholic Medical Quarterly
Down with Condoms
According to a United Nations report released on June 23, the United Nation's massive, effort to supply the world with condoms in a bid to stem the spread of HIV/AIDS is failing. After exhaustive analysis of survey data from developing countries around the world, the Population Division of the UN's Department of Economic and Social Affairs has concluded that the ready availability of condoms has not significantly altered individual sexual behaviour.
In "HIV/AIDS, Awareness and Behaviour" the Population Division bluntly asserts, "Much effort has been spent on promoting the prophylactic use of condoms as part of AIDS prevention. However, over the years, the condom has not become popular among couples." The report goes on to claim that, despite widespread knowledge of AIDS and easy access to condoms, "only a small percentage of respondents began using them to prevent HIV transmission. Fewer than 8% of women in all countries surveyed reported that they had changed their behaviour by using condoms. Among married women, the percentages were particularly low."
The report claims that most women desire children and are thus unwilling to use prophylactics that also act as contraceptives. It states that "In a number of Western and Central African countries, the difficulty in promoting the use of condoms is compounded by the fact that the large majority of women who are sexually active intend to become pregnant; therefore they are not likely to resort to using the condom."
In what may come as a surprise to "safe sex advocates such as the International Planned Parenthood Federation (IPPF) and the United Nations Population Fund (UNFPA), the report contends that the only significant behavioural change has been towards more monogamous relationships. It states that "Among those respondents, whether male or female, who did change their behaviour, the most frequently cited change had entailed confining sexual activity to one partner." The study also concludes that "In several countries, a significant number of men reported that they had discontinued sexual contacts with prostitutes to avoid getting infected."
During the recent UN Child Summit, the US delegation's efforts to further encourage sexual abstinence and monogamy were defeated, mainly at behest of the European Union. It is possible that, in the light of the findings of the Population Division, the US position will gain prominence in future UN debates on AIDS prevention.
On May 24, UN Secretary General Kofi Annan appointed former UNFPA Head Nafis Sadik as his special envoy for HIV/AIDS in Asia. Under Sadik's direction, UNFPA was the world's largest supplier of condoms, and UNFPA's AIDS prevention programme focused overwhelmingly on the promotion of condom use. It is unclear how Sadik will integrate the conclusions of this new report into her new initiative. According to a UN press release, Sadik will be responsible for spear-heading "an expanded multisectorial response to HIV/AIDS" throughout Asia.
Further criticism against the promotion and distribution of, and education in, the use of condoms as a means of combating AIDS transmission 'came from Archbishop Javier Lozano, president of the Pontifical Council for Health Care. He commented that UN officials had been "saying the same thing for the past dozen years" even though there were no visible results of the success of such policies.
The 14th International AIDS Conference in Barcelona which has just concluded highlighted the immensity of the epidemic. The horrifying figures have spiralled remorselessly, and, by their very size, have induced their own immunity to shock by horror. Forty million people are estimated to be living with HIV. Africa is home to nearly 70% of adults and 80% of children living with HI V/AIDS, and it has buried more that three quarters of the 20 million who had died from the disease. In South Africa it is estimated that by the end of the decade, of the 7 million infected more than half will die before they reach 35. As if that was not enough, the Indian Health Organisation forecasts that India is becoming the epicentre of the world AIDS crisis with an estimate of 20-50 million HIV positives in four years time.
The debates at the conference ranged from prevention to treatment; but it is obvious that with such figures and in such an environment drug treatment is not going to achieve much. A vaccine has been heralded in five years time.
At the end of the conference the World Federation of Catholic Medical Associations succeeded in presenting its manifesto to the delegates. It warned that preventative "campaigns based solely on condoms are dangerous and not very human. Young people, especially need to be educated and to learn to be responsible in respect of sex and affectivity." The manifesto went on to point out that "What should be promoted are ways of behaviour, such as delaying the age when sexual relations start, to abstain before marriage, to believe in healthy couples and in monogamy."
The doctors who signed the manifesto committed themselves to promote medical and educational programmes to help AIDS patients. They also added it was essential "to struggle against drug trafficking and the consumption of drugs throughout the world."