From Entebbe, Uganda - The New Vision, a Uganda daily, reprinted today an article by Irish Times writer John Waters lambasting the Western media for pumping out its partisan propaganda about HIV prevention through the distribution of condoms.

The western media has been pumping out its partisan propaganda about prevention of AIDS
through the distribution of condoms (original caption)

Beyond taking the defence of the Pontiff’s unfounded claim that condoms aggravated the problem of HIV, Waters’s proposition is that “once you advocate condom use, you are accepting that abstinence is no longer a persuasive option”. Deliberate or not, the description of abstinence as “a persuasive option” rather than as “an efficient option”, which it is not, is revealing of the swamp the Catholic Church is trying to get out from.

Waters based its argument on the successful fight, at least until recently, against HIV/AIDS in Uganda where President Museveni’s “Zero grazing” policy contributed to a decline in the number of HIV infection and a decrease in the number of HIV-infected people.

“State sponsored programmes reduced AIDS prevalence from over 30% to about 6%. Fidelity to a single partner was the dominant message of early HIV prevention campaign”

However, Waters is confusing AIDS and HIV, the former being a disease caused by the later and gives more credit to fidelity than it deserves.

“Zero grazing” did contribute to a decrease in the number of HIV infection, but only as a contributing factor in a broad range of interventions including condoms. There is little evidence that “zero grazing” translated in monogamy, but rather in a reduction in the number of sexual partner. Epidemiologically speaking, partner reduction may have been enough to reduce the number of infection but during the 90s, when no treatment was available, a large number of people simply died of AIDS, contributing to an even greater reduction in the number of HIV infections and HIV infected people: dead people don’t infect other (see the reliable Avert website for a more comprehensive description).

In the recent years, Uganda has seen a resurgence of the number of HIV infections. Whilst Waters believes that this is because of the introduction of condoms it is in fact compatible with an observed delayed start of sexual activity amongst young people rather than abstinence only or monogamy.

Wrongly, and against a general consensus in the field of HIV prevention, Waters conclude that “ideally one might think that abstinence programme and safe sex strategies should complement each other. But in practice the approaches are mutually incompatible. Once you advocate condom use, you are accepting that abstinence is no longer a persuasive option. And if you argue, as the Catholic Church does, that promiscuity promotes HIV/AIDS, it would be ludicrous to recommend measures that, implicitly, suggest that this position can be relativised.”

There is at least one situation when this reasoning does not hold, it is in sero-discordant couples where one of the partner is HIV-infected and the other is not. It is in this case ludicrous to advocate that fidelity is incompatible with condoms. Unfortunately, millions of couples are in this situation in Africa.

Reducing the problem of HIV to promiscuity alone is ignoring the epidemiological complexity of the disease. Promiscuity alone is not enough to explain the spread of the disease. In absence of virus, being promiscuous does not have any consequence in the population. This is a textbook case where large population remains relatively free of HIV whilst still enjoying sex and not only monogamous sex, simply because no virus has entered their social ecosystem.

HIV/AIDS and its propagation are multifactorial. In absence of a favourable ground the virus does not and can not spread. One’snumber of sexual partner, gender, social and economic situation, education, health, infection with other sexually transmitted disease and cultural environment are, together or in various combinations, what make the ground propitious for the development and propagation of the HIV epidemic.

All considered, abstinence is no longer a persuasive option not because of the introduction of condoms, but because its rate of failure is much higher than that of condoms and because it can not address all the factors contributing to the HIV epidemic. It is as simple and as evidence-based as that.

“HIV is a complex issues” write Waters, and having recognised this reality, he should have accepted that it can’t be dealt with a simplistic one-fits-all solution. Dogmatic religious propaganda masquerading as scientific evidence can’t replace “a full and truthful discussion.”

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