Posted on March 25th, 2005 by Nate
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.
Filed under: Politics and Policy