In a lengthy but rather well constructed and documented article published online in The East African, Curtis Abraham steers the charge against UNAIDS “for perpetuating the myth of condom effectiveness in Africa in the face of all evidence.”

Abraham rightly identifies that in a country like Uganda, the reduction in HIV incidence was not the result of condom-only prevention interventions (thanks to Helen Epstein for casting some light on the subject in her book “The Invisible Cure”) but was owning to behaviour changes and in particular partner-reduction campaigns such as that of “zero-grazing” promoted by President Museweni.

Referring to various studies, published or not, Abraham challenges UNAIDS (who commissioned some of these studies) for castigating the evidences that “condoms were seen as ineffective in preventing the spread of HIV/AIDS in generalized epidemics like those taking place in eastern and southern Africa. […] For years various UNAIDS reports maintained that condoms, not partner reduction had been the major reason for Uganda’s success against AIDS.”

Abraham marvels “Why would UNAIDS, a renowned global organization dedicated to educating governments around the world about the greatest plague of our times, behave in such a manner unbecoming of a world institution?”

The answer is simple: at UNAIDS “ideology [is] taking precedence over epidemiological facts.” I know some who would probably agree with that and I might well be one of them. Now things may not be that simplistic and to recognise that behaviour change is as important as condom use in the fight against HIV (if not more) but to ignore that this same behaviour is influenced by ideologies and beliefs generated and disseminated by media acting too often as the mouthpiece of some dubious organisations is not really sign of discernment.

There is a profound and fundamental difference between saying that condoms are ineffective and that condom use is ineffective. When used consistently and properly condoms are the best protection available against HIV infection. Now as noted by Abraham, condoms are seldom used in long term relationships, even concurrent ones, which are believed to fuel the HIV epidemic in some African countries. In these circumstances, no surprise that they do not work!

In a climate where condoms are already challenged on various grounds most notably religious with for example huge billboards being set up in Tanzania by Christian fundamentalist organisations to discourage people to use them, what will people remember of Abraham’s article? That condoms in Africa are ineffective to fight HIV. Those not already using them will feel vindicated in their choice, those who used them irregularly will probably use them less often and those who hesitated might join those who did not use them at all.

Maybe UNAIDS is politically driven, ideologically constrained but one should remember that UNAIDS is swimming if not drowning in a sea populated by life-threatening ideologic sharks. Two wrongs do not make a right but with HIV prevention trapped in a conundrum of beliefs that can’t rarely be fought by reason or by facts, the means might justify the end.

Back to Uganda or any other country dramatically affected by HIV, what should be done? Throw away condoms and promote monogamy, abstinence until marriage and faithfulness? Oh but wait, hasn’t this been tried and found wanting?

HIV prevention can’t be monolithic and must include a variety of approaches. To write bluntly that condoms are ineffective is pointless and dangerous. Condoms are an essential tools in the fight against HIV, and they work, when they are used – properly and consistently.

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