peripheries

HIV on the rise in the Philippines: Will condoms do any good?

Since the papal comment about condoms and the HIV epidemic, there has been a flurry of articles written in support of the pontifical nonsense. These often call upon a comparison between “sinful” Thailand, awash with HIV and condoms, and the “holly” Philippines where there is not such thing as HIV or condoms (a bit like in Iran).

Does this sound slightly over the top? Not really. Kathleen Gilbert writing for the LifesSiteNews website quotes Yolly Eileen Gamutam, head of the Asia’s Catholic Association of Doctors, Nurses and Health Professionals (ACIM-Asia) saying that “Condoms are highly dangerous.” Gilbert added that “by the end of 2003, Thailand, with a population of 63 million, registered 570,000 HIV-positive adults and children. Gamutam compared the statistic to the Philippines, where only 9,000 Filipinos were HIV-positive out of a population of 80 million. 500 died of AIDS in the Philippines that year, while 58,000 perished in Thailand.”

peripheries has already addressed this misleading and inappropriate comparison but it is necessary to add that comparing two countries at one time point is rather meaningless. That the head of an association of doctors allows herself to be so unscientific is rather disappointing, if not telling that religion and science are definitively two nonoverlapping magisteria.

But let’s look at the figures available from UNAIDS and let’s compare the number of People Living with HIV and AIDS (PLWHA) at two time points:

In 2001 there was 660,000 adults and children living with HIV and AIDS and this figure dropped to 610,000 in 2007. In the Philippines, the number of PLWHA rose from less than 1,000 to 8300 and has been continuously on the rise since 2006.

Without fear or shame and against all evidences, Yolly Eileen Gamutam concluded that “the condom use program in Thailand is not effective.” Mechai Viravaidya, politician and leading Thai AIDS activist who introduced a 100% condoms policy in brothel where HIV was raging and henceforth contributed to a reduction of the number of PLWHA from 2% to 1.4% in 10 years (1997-2007) and the successful containment of the epidemic, will appreciate how his work and continuous efforts are being so promptly dismissed.

The rise in the number of HIV infections in the Philippines may not seem dramatic now but it may have some serious consequences later if not controlled. Conscious of the consequences of inaction, the Filipino government, who in the past adopted an approach to the epidemic that limited its progression in the general population, was considering a controversial bill on reproductive health at the end of 2008.

Another worrying concern about the rising HIV epidemic in the Philippines is that it is so far mostly observed amongst Men who have Sex with Men. The health departmental HIV/AIDS registry recorded 210 new infections among MSM in 2005, 309 in 2006 and 342 in 2007 and from January to September 2008, there were already 395 cases, up 96 percent since 2005.

And as we all know, before or next to condom, homosexuality is the next “abomination” that the Catholic church condemns with wrathful vehemence.

“The Catholic Church’s centuries-old doctrine, created by a bunch of celibate priests, on sex only for procreation leaves many people ignorant about sexual health. This is the sad reality.

Taking away people’s right to protect themselves, and their right to education and to responsibly manage their sex lives is certainly taking away some of their humanity.” write William Sparrow for the Asia Times.

But not all Catholics are dogmatic or blinded by credo and for example, Catholics for Choice an organisation initially founded to support women’s moral and legal right in a world led by Bishops, started an unprecedented worldwide public education effort to raise public awareness about the devastating effect of the bishops’ ban on condoms. In a recent press release the organisation wrote:

“According to a recent poll commissioned by Catholics for Choice, which interviewed Catholics in Ghana, Ireland, Mexico, the Philippines and the United States, support for condom use among Catholics is overwhelming. When asked if “using condoms is pro-life because it helps save lives by preventing the spread of AIDS,” 90% of Catholics in Mexico, 86% in Ireland, 79% in the US, 77% in the Philippines and 59% in Ghana agreed. Unfortunately, the Catholic hierarchy’s position holds the most sway in the countries least able to deal economically and medically with the disease.”

A sway leading to death. And as for the role of condoms, they certainly won’t do any harm.

Condom War: Another Catholicus Ignoramus: Cardinal Pell from down under

The head of the Catholic Church in Australia has open his mouth to add primate bunk to previous pontifical nonsense.

Unsurprisingly, the Cardinal Pell from down under endorsed the papal comment made in Africa that condoms “can even increase the problem” of HIV, adding that, “The idea that you can solve a great spiritual and health crisis like AIDS with a few mechanical contraptions like condoms is ridiculous”.

HIV and AIDS have been jumbled with quite a lot of nonsense but to relate it with a great spiritual crisis is a rather interesting novelty. With the Church in charge of the spiritual (alongside our sex-life), one wonders is the Cardinal is advertising for his own business on the back of HIV infected people.

Reporting a conversation with “a non-Catholic health worker”, the Cardinal added that “people in remote areas are too poor to afford condoms and the ones that are available are often of very poor quality and weren’t used effectively.” For crying out loud, isn’t that saying that what is needed are good quality condom provided as an affordable price? What about fre condoms?

But of course not, because and without a shred of evidence Cardinal Pell added that “Condoms are encouraging promiscuity. They are encouraging irresponsibility.” How could condoms encourage promiscuity? And if they were, would it matter as long as people are using them whilst being promiscuous? There is no evidence that people who started anti HIV treatment or men who were circumcised became more promiscuous. So why the idea of using a condom or their availability would be any different? There is little hope that the Cardinal could understand what is sacerdotal vestments forbid him to know.

Adding misinformation to ignorance the prelate could not refrain harking back the old red herring of Thailand vs. the Philippines: “If you look at the Philippines you’ll see the incidence of AIDS is much lower than it is in Thailand which is awash with condoms.”

The myth was debunked here on peripheries, but it might be wise looking at more recent data from UNAIDS. For example at the estimated number of people living with HIV in 2001 vs. 2007 in the Philippines, <1000 vs. 8300 and Thailand, 660,000 vs. 610,000. Of course the number of people living with HIV is much higher in Thailand (see previous posting for an understanding of why) but it has also decreased between 2001 and 2007 whilst the figure has increased in The Philippines and is set to increase even more in the coming years if nothing is done now to ensure that the virus does not find a fertile Christian soil to multiply, like it did in Africa.

The catholic’s answer to HIV? As always, abstinence and faithfulness. But as pointed out by Don Baxter in The Australian, the pontiff’s comments about condoms could easily be misunderstood in Africa, where it is common for men and women to have several concurrent sexual partners but still see themselves as being faithful. “Calls for not using condoms and being faithful are heard by Africans to mean if they have regular partners, they don’t need to wear condoms,” said Baxter.

Abstinence is one method of preventing the transmission of HIV, condom is another one. To discourage the use of one or the other is plain stupid and irresponsible. Is it even stupider if it is done on spiritual background, because the HIV virus can be killed with a sign of the cross over someone and a few drop of holy water.

Cardinal Pell is not alien to controversy, in October 2007 he challenged the cause of climate change: “I am certainly skeptical about extravagant claims of impending man-made climatic catastrophes, because the evidence is insufficient. Climate change has always occurred. Scientific debate is not decided by any changing consensus, even if it is endorsed by public opinion.”

It is definitively a hard time for enlightenment, especially within the Catholic Church.

Do condoms obstruct the fight against AIDS?

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.”

The Madness of Pope Benedict XVI

Africa and in particular sub-Saharan Africa is the continent the most affected by the HIV epidemic. During the last 25 years more than 20 millions people have died of AIDS in Africa. There, the epidemic particularly affects women, HIV transmission is mostly through heterosexual sex, and concurrent relationships have been identified as a force driving the spread of the virus in the population. In Africa, HIV is mostly about sex. Prevention interventions have been difficult, hindered by limited political commitment, if not political denial of the cause of AIDS, religious interference and lack of resources (amongst many other factors).

Today His Holiness Pope Benedict XVI made his first papal visit in Africa and dropped a bomb on an already decimated population.

Speaking in Cameroon, the not-so-holy head of the Catholic Church argued that HIV is “a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which can even increase the problem.”

Against all common sense, against all scientific evidences, against a background of one and a half millions death a year, 12 millions of African children orphaned by HIV, 23 millions infected people, Benedict XVI believes that the answer to HIV is to be found in a “spiritual and human awakening” and “friendship for those who suffer.”

The BBC reports that “While in Africa, the pontiff is expected to talk to young people about the Aids epidemic and explain to them why the Catholic Church recommends sexual abstinence as the best way to prevent the spread of the disease.”

Let it be clear, to date there is no scientific evidence to support that condoms have increased the problem of HIV, but there is plenty of evidences supporting that abstinence, or “spiritual and human awakening” as Benedict now calls it, has failed preventing HIV transmission.

Let it also be clear that condom are not the all-in-one solution, as demonstrated -only briefly, in Uganda before Christian pastors start burning condoms in front of Makerere University, but they are not part of the problem as an old age ignorant prelate would like a vulnerable and sometimes desperate people to believe (see H. Epstein God and the Fight Against AIDS)

The pontiff wants young, energetic, hormonally-driven and sexually attractive and curious young people to sacrifice their natural attraction to the opposite sex in favour of spiritual and human awakening. Welcome to Planet Vatican, where sex is the enemy, where it must be controlled by men who know nothing about it, or so we would like to think.»

One can only supports a spiritual and human awakening, an awakening that would lead to evidences-based prevention interventions and discourses, an awakening that would lead to a reduction in HIV transmission. But it is doubtful that this is the kind of awakening the pontiff has in mind.

How can a man with so little legitimacy but so much power on other’s decisions in life be left airing such dangerous ignorance in public without a global outcry? Nobody expects the head of the Church to change his mind or the credo,  but showing a minimum of respect for human life by having the decency to remain silent on issue the pontiff knows nothing about would be a minimum.

Burning condoms literally or metaphorically does not and is not going to help fighting HIV. Burning a backward and irrelevant institution might. By the time you finish reading this post 20 people will have been infected by HIV, 17 of them in Africa. In most case, a condom, properly used could have prevented the infection.

No evidence to support funding of abstinence-only programmes

A special issue of Sexuality Research and Social Policy, the official journal of the National Sexuality Resource Center (NSRC), examined a broad range of problem associated with abstinence only programmes.

Having reviewed 56 studies assessing the impact of abstinence programs and that of comprehensive programmes on adolescents’ sexual behaviour (pdf) Douglas B. Kirby, concluded that “abstinence programs have little evidence to warrant their widespread replication; conversely, strong evidence suggests that some comprehensive programs should be disseminated widely.”

More to the point (emphasis mine)

When comparing recent studies of the effectiveness of abstinence and comprehensive sex education programs, the following conclusions are dramatically evident:

1. Some evidence (but no strong evidence) currently supports the supposition that any particular abstinence program is effective at delaying first sex for adolescents.

2. Abstinence programs are not more effective at delaying initiation of sex than comprehensive sex education programs.

3. Abstinence programs are not sufficiently effective to eliminate teens’ sexual risk or to eliminate the need for comprehensive sex education programs.

4. Much strong evidence supports the supposition that comprehensive sex education programs can both delay initiation of sex and increase condom or other contraceptive use among youth.

Not only abstinence-only programmes are failing adolescents but they also put restriction on teacher’s ability to teach, they violates adolescent’s human rights to receive a comprehensive sexual health educationn (pdf), but they often mislead if not prohibit information about the benefits of condoms and contraception and in particular about condom’s effectiveness against HIV (pdf).

In another a report to be published in the January issue of the American Journal of Public Health “Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use”, John Santelli, MD, MPH, department chair and professor of Clinical Population and Family Health at the Mailman School of Public Health observed that “eighty-six percent of the recent decline in U.S. teen pregnancy rates is the result of improved contraceptive use, while a small proportion of the decline (14%) can be attributed to teens waiting longer to start having sex” reports Science Daily.”

Meanwhile, in Florida where abstinence-only sex education is allowed, “teens who believe drinking a cap of bleach will prevent HIV and a shot of Mountain Dew will stop pregnancy have prompted lawmakers to push for an overhaul of sex education in the state”

In a press release the Guttmacher Institute observed that “Most abstinence-only programs of the type that have received $1.5 billion in federal funding do not help teens delay initiation of sex, and there is no scientific evidence to warrant their widespread use”

Why and how long are these programmes going to be promoted and implemented in the USA, and around the world, by zealous missionaries through abstinence-only tied-up funding programmes that are doing nothing to tackle teenage pregnancies and HIV transmission?

Time to implement evidence-only based programmes?

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