AIDS conferees prefer condoms over abstinence

BANGKOK, Thailand – President Bush’s policy of fighting AIDS by promoting abstinence ran into strong opposition Monday from scientists, activists and policy-makers who touted condoms as a trusted weapon in the fight against AIDS.

Ugandan President Yoweri Museveni was the only big-name speaker at the International AIDS Conference to support Washington’s ABC policy: Abstinence, Being faithful and Condoms, in that order.

Museveni said loving relationships based on trust are crucial, and “the principle of condoms is not the ultimate solution.”

“In some cultures, sexual intercourse is so elaborate that condoms are a hindrance,” he told a plenary session. “Let the condom be used by people who cannot abstain, cannot be faithful or are estranged.”

However, U.S. Rep. Barbara Lee and other delegates urged the world’s rich countries to spend more on condoms and other HIV-fighting programs for the developing world.

“In an age where 5 million people are newly infected each year and women and girls too often do not have the choice to abstain, an abstinence-until-marriage program is not only irresponsible, it’s really inhumane,” said Lee, a California Democrat.

Proponents say there is no better way to prevent HIV than by using condoms and giving clean syringes to intravenous drug users. Their philosophy is known as CNN, or Condoms, Needles, Negotiating Skills. The Bush administration maintains that emphasizing condoms promotes promiscuity among youths.

During a debate titled “CNN vs. ABC,” Steven Sinding, director general of the International Planned Parenthood Federation, said “condoms will remain key preventive tools for many, many years to come.”

He said condoms should be seen as the key element of a comprehensive strategy including abstinence. The U.S. policy of emphasizing abstinence is a “serious setback to the AIDS control effort,” he said.

By the end of the debate, ABC proponent Dr. Edward Green, a Harvard researcher and member of the President’s Advisory Council on HIV/AIDS, suggested that a combination of ABC and CNN was the best solution.

Condoms have been promoted as a front-line defense against AIDS by countries such as Thailand, where a campaign to get sex workers to insist on condoms yielded a more-than-sevenfold reduction in HIV rates in 13 years.

Some 25 million of the 38 million infected with HIV worldwide are in sub-Saharan Africa, but the virus is taking root increasingly in Asia, where 7.6 million are infected.

In Asia, the sex trade has been the main engine behind infections in countries such as Thailand and Cambodia, where epidemics exploded by the late 1980s – sparking aggressive responses, including campaigns to boost condom use.

Uganda has waged a successful battle against HIV in a rare success story for sub-Saharan Africa – though some experts say it’s unclear how the success has been achieved. Musaveni credited abstinence.

Uganda has brought its infection rate down from more than 30 percent in the early 1990s to about 6 percent of the country’s 25 million people last year.

A young Ugandan, Simon Onaba, who gave an impassioned speech during the CNN vs. ABC debate, said abstinence works if people have the will.

“It is possible for young people to abstain. We are motivated, we are empowered. If I can start having sex, I can also stop having sex,” he said.

However, epidemiologists tracking Asia’s emerging epidemics told conference delegates the world’s most populous continent faces HIV problems largely driven by prostitution, and that promoting condoms is the best way to block further spread.

“I disagree with (Museveni). … . Condoms are greatly shortchanged in Africa as a prevention method,” said Tim Brown of the Hawaii-based think tank East West Center. “If you increase condom use by 50 percent, I guarantee you that HIV will go down by 50 percent.”

There was consensus at the six-day conference, in its second day, that fighting the epidemic needs money that can only come from rich countries.

By 2005, an estimated $12 billion will be needed annually to fight the disease in developing countries, but current annual global spending now amounts to less than $5 billion.

“The $200-$300 billion spent in Iraq probably could have eradicated this illness,” actor Richard Gere – one of several celebrities at the meeting – told a panel discussion.