Stupidity - as Contagious as HIV

First Things has a great article AIDS and the Churches: Getting the Story Right. Edward C. Green and Allison Herling Ruark explore the implications of the evidence available on the fight against the AIDS epidemic.

Many times I have heard that the only practical solution to slowing down the spread of HIV is to provide an unlimited supply of condoms. The implication is that the poor and sex hungry will be unable to change their sexual behavior so we must accommodate a solution within their current sexual practices. My common sense response has always been that people need to exert self-control. Currently evidence is showing that emphasizing sexual responsibility actually has positive effects in reducing infections whereas condom usage has failed to render any visible results that this method is working.

Consider this fact: In every African country in which HIV infections have declined, this decline has been associated with a decrease in the proportion of men and women reporting more than one sex partner over the course of a year—which is exactly what fidelity programs promote. The same association with HIV decline cannot be said for condom use, coverage of HIV testing, treatment for curable sexually transmitted infections, provision of antiretroviral drugs, or any other intervention or behavior. The other behavior that has often been associated with a decline in HIV prevalence is a decrease in premarital sex among young people.

If AIDS prevention is to be based on evidence rather than ideology or bias, then fidelity and abstinence programs need to be at the center of programs for general populations. Outside Uganda, we have few good models of how to promote fidelity, since attempts to advocate deep changes in behavior have been almost entirely absent from programs supported by the major Western donors and by AIDS celebrities. Yet Christian churches—indeed, most faith communities—have a comparative advantage in promoting the needed types of behavior change, since these behaviors conform to their moral, ethical, and scriptural teachings. What the churches are inclined to do anyway turns out to be what works best in AIDS prevention.

This article also challenges many of the conclusions made by the report from the Berkley Center at Georgetown University called Faith Communities Engage the HIV/AIDS Crisis. This report tends to downplay programs that “emphasize sexual responsibility, behavior change, and moral messages.” In other words, the report praises faith community efforts to nurse people with AIDS while denouncing their attempts to change sexual behaviors.

…A UNAIDS-commissioned 2004 review of evidence for condom use concluded, “There are no definite examples yet of generalized epidemics that have been turned back by prevention programs based primarily on ­condom promotion.” A 2000 article in The Lancet similarly stated, “Massive increases in condom use world-wide have not translated into demonstrably improved HIV control in the great majority of countries where they have occurred.”…

Thus far, research has produced no evidence that condom promotion—or indeed any of the range of risk-reduction interventions popular with donors—has had the desired impact on HIV-infection rates at a population level in high-prevalence generalized epidemics. This is true for treatment of sexually ­transmitted infections, voluntary counseling and ­testing, diaphragm use, use of experimental vaginal microbicides, safer-sex counseling, and even income-­generation projects. The interventions relying on these measures have failed to decrease HIV-infection rates, whether implemented singly or as a package. One recent randomized, controlled trial in Zimbabwe found that even possible synergies that might be achieved through “integrated implementation” of “control strategies” had no impact in slowing new infections at the population level. In fact, in this trial there was a somewhat higher rate of new infections in the intervention group compared to the control group.

The real issue involves our ideology of sexual ethics. Evidence shows that emphasizing abstinence outside of marriage and fidelity within marriage reduces the spread of HIV. “One must ask whether they are more concerned with upholding a Western notion of sexual freedom or with saving lives.” I think this statement identifies the fundamental issue. If encouraging sexual responsibility saves lives, is not this in itself worth the sacrifice of sexual gratification and striving for the virtue of self-control? If people realize that their actions cause people to die, then should not those people reconsider their sexual behavior? In America we are still having our own AIDS epidemic. Self-control and chastity is often treated as religious rhetoric that seeks to control and impede on people’s freedom. However, self-control is a virtue inherent to any healthy lifestyle. Society often teaches its members to forestall immediate satisfaction to become successful in intellectual and worldly matter. Educational, athletic, material, and spiritual goals all involve processes that entail rigorous discipline and self-sacrifice. Why does this emphasis on self-control become a faux pas when we apply this virtue to sexual matters? Why should we value pleasure, wealth, and fame over the well-being of other humans?

Conventional wisdom has blamed “poverty, gender inequality, powerlessness, and social instability for the spread of AIDS.” The implication is that if we solve these problems then AIDS will not be a problem. Yet to truly help fight against gender inequality, “women must be empowered to refuse unwanted sex, not simply to ‘negotiate condom use.’” Statistics show that the wealthy are more likely to have AIDS in Africa than the poor. Areas of social instability may have more people that are ‘prone’ to HIV but that does not mean sexual responsibility programs will not be effective as they has been in areas like Uganda were the reduction in the number of sexual partners helped greatly.

The time has come to question the established wisdom of our day about HIV prevention. We must undercut cosmetic solutions of putting a rubber on it and get to the spiritual problem that undermines our greatest attempts at helping. To change a society you must change its perspective. By default, to change a culture’s sexual problems you need to address its perspective on sex. Despite the evidence and common-sense approach of many faith Communities, popular opinion seems to still frown upon faith initiatives that emphasis sexual chastity to prevent HIV. Hopefully this new evidence will revive and encourage more people to be open to the idea that encouraging sexual chastity might be the way to go. Especially since evangelizing these areas requires nothing less than bringing the truth of the Gospel message and emphasizing the transforming power of love.