[afro-nets] CNN and ABC (2)

[Edward C Green <EGreendc@aol.com>]

CNN and ABC (2)
---------------

In a message dated 4/26/2005 6:34:50 AM Eastern Daylight Time,
Claudio Schuftan writes:

 >
 > "DOES "CNN" (CONDOMS, NEEDLES, NEGOTIATION) WORK BETTER THAN "ABC"
 >

I am not able to personally make point-by-point rebuttals to all
the anti-ABC editorials that appear almost daily these days. Es-
pecially since I am outnumbered 100,000 to 1. (Some of you have
written to me privately but seem afraid to support ABC in pub-
lic. How sad when we become afraid to support common sense and
sound public health publicly. Somehow we need to break the si-
lence.)

I debated Steve Sinding at the Bangkok conference last July
("CNN vs. ABC"). He is a nice guy and I have no real quarrel
with him. My argument about CNN remains the same as last July:
sure, let's do CNN. But let's not end it there. Otherwise we
only have one approach for a 12-year old virgin and a sex
worker: the condom (plus STI Rx and testing).

Let's be a bit more flexible. Let's recognize that we need a
multi-pronged, comprehensive approach, one that recognizes dif-
ferences among the people we are targeting.

I must take issue with those like Steve and Peter Piot who have
been criticizing marriage of late. They argue that some women
abstain until marriage and then become infected only when they
are married.... therefore, by at least implication, abstinence
and marriage are of no use.

That's like hearing that someone died of a heart attack during
church, therefore we should do away with churches since no one
is safe there.

Steve Sinding is a family planning expert. I too was working in
African family planning when AIDS broke out. The very first
thought in anyone's head, including mine, was, "Well, now we can
promote the condom for... let's call it duel protection!"

But I have had some additional thoughts about AIDS prevention
SINCE 1983, prompted in part by the harsh finding that even with
all our duel protection and making condoms the first line of de-
fence, no country in Africa has achieved >5% consistent condom
use, nationally.

Does that not call for having some additional thoughts, beyond
latex? Is AIDS really just a branch of family planning, differ-
ent only by testing but not by means of prevention?

I say yes, let's keep on trying with condoms. But when we get
additional prevention funds, should we just allocate ALL of
these to the same programs that have not shown results for 20+
years? I am talking about Africa, NOT Cambodia or Thailand.
There is no country in Africa where more condoms has demonstra-
bly let to lower national HIV infection rates, not surprising
when we consider no country has achieved more than 5% consistent
condom use, at the national level, according to the same Hearst
and Chen that Steve Sinding quoted.

In fact, allow me to quote Hearst & Chen directly: "Indeed,
there are no definite examples yet of generalized epidemics that
have been turned back by prevention programs based primarily on
condom promotion." (So... add most of the Caribbean to what I
have been saying about Africa).

These UNAIDS researchers also wrote: "Unlike in Thailand, condom
promotion has not played a major role in Uganda's AIDS control
efforts until relatively recently. The evidence clearly indi-
cates that Uganda's success was mainly due to changes in sexual
behavior among the population, especially a large reduction in
the number of casual partnerships."

I recommend that we all sit down for a day and just meditate on
these UNAIDS findings. Then we should put aside all ideologies,
left & right, religious and secular, and just ask ourselves if
we REALLY want to limit AIDS prevention in Africa (not Thailand)
to "CNN."

Edward C Green
mailto:egreendc@aol.com