Abstinence for everyone?


The condom vs abstinence debate (wrapped up in an alphabet soup of CNN – condoms, needles and negotiation and ABC – abstain, be faithful, use condoms) is an odd one superimposed over the deaths tracked in places like Uganda – without general access to ARVs.  Death rates affect HIV prevalence, a measure that bundles incident cases with disease latency.  Comparing US and Ugandan prevalence figures are meaningless as HIV disease in the US is practically a chronic condition while in Uganda it is still a highly fatal infection.  Lacking ARVs, death rates will continue to tally winners and losers in Ugandan society in ways we should find morally repugnant.  Debates over behavior seem less pressing so long as lifesaving drugs are not available to those who need them.

 

That said, there is a need to bridge the condom-abstinence divide.  I think it is possible to find consilience in the CNN and ABC debate inspite of the tendency in both camps to practice “intellectual squatting” – each side staking claims to some perceived unique high ground to better attack the enemy.  The CNN folk are loath to admit abstinence within the walls of accepted interventions – treating it for all the world like a trojan horse.  Yet it’s common sense that remaining abstinent reduces to near zero the chance of an HIV infection.  Aside from professional risks in hospitals, dirty needles at informal chemists’ shops and the random misfortune of dirty blood supplies or rape, there is no chance of being infected if a person is abstinent.  The obvious problem though is that sexual abstinence, unlike tobacco abstinence, is not the norm for humans – we wouldn’t be here if it were.  So how practical is it and is it worth spending precious funds to promote a behavior that is largely counter-intuitive to our nature?

 

Public health workers know that at the grassroots fine policy districtions blur and the need is to have available a number of networked and reinforcing resources – public health messages, distribution systems for condoms and medications as well as hospital and clinic services for a wide variety of end-user: pregnant mothers, young students, well travelled truckers, and worried housewives among others.

 

To the extent that ‘being faithful’ and ‘practice abstinence’ messages complement other interventions, they have a productive place.  They may even be an important lever to pry more resources from otherwise indifferent or conservative governments.  But when they crowd out condoms, when resources that could otherwise buy physical protection are diverted to dam human impulse, then there’s tension, confusion, misinformation and as we have seen in many US studies – ultimately more disease.

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2 Responses to “Abstinence for everyone?”

  1. In my view, if some excessive spending on abstinence is the price of getting a major chunk of new money through the U.S. Congress, so be it. If indeed abstinence education is not complementary, then this is a problem. However, it appears that U.S. funding for HIV/AIDS prevention and treatment has expanded considerably under President Bush (even if he has not fully lived up to his grandiose commitments).

    The question then becomes, how much of the money for prevention is allocated to abstinence, how much to condoms, etc. I know the global gag rule on abortion discussion of groups funded by the U.S. may have had a broader chilling effect on NGO’s discussing sex education more broadly. This is the critique of more aggro women’s health groups, but I’d like to know if this is actually true or a worst case scenario that does not affect the bulk of the practice of HIV/AIDS prevention.

    If this fear is overblown, then using some of the money for abstinence may be a political price worth paying to get large amounts of money from the U.S., even if abstinence may be less effective than other forms of policy intervention.

  2. “Life saving” drugs. Have these drugs saved a life? Last I was told, AIDS patients in the US are still dying.

    A largely “chronic” disease – is that true, or hype? Las I heard people with HIV still – eventually – progress to AIDS and die and the time to progression in the HAART era is still 5-10 years. Once there time to death is still 2-3 years. According to Dr. Fauci only 1/10th of 1% of people are long term non-progressors and the 20+ year survivors are the resistant lot from the 79-80’s, a fraction of a population that is already dead. Bell curve effects and they too will die. They must, HIV kills 100% of the people it infects [this is DOGMA], period. If it does not, they are probably mis diagnosed or must be taking life saving drugs or just have not lived long enough to die.

    Labeling “Life saving” these drugs is a roost – a gimmick – good press for dangerous drugs that do not cure.

    We should all feel terrible that older drugs, the real toxic ones, are not available to most African HIV infected people. With their medical infrastructure, giving these drugs to people would delay death? Or just cause an epidemic of side effects, that untreated will be most unpleasant and add to the missery [acidosis anyone? Maybe a little neuropathy?]. The newer HIV drugs will not be available to poor Africans until they are supplanted by more effective drugs and their price plummets – not likely any time soon.

    Why is nobody asking why we can’t make modern antibiotics available to treat infections common to HIV infected Africans?

    It’s all hype – lets feel guilty we cannot make life saving drugs available to African peasants… yea right!