AIDS and the Ideological Barrier: The Threat to "Sexual Liberation"
By Douglas A. Sylva, Ph.D.
Published in December 2008 Volume 33, Number 12 edition of the Ethics & Medics, a National Catholic Bioethics Center publication.
There are the ordinary ideological influences on public health campaigns, and then there are the extraordinary ones. The international response to the AIDS epidemic has been hampered by both, making it the most ideologically tainted campaign in modern history.
The most ordinary, in fact commonplace, influence is the desire to place one's chosen cause above others by exaggerating the dimensions of the crisis. A representative statement in this vein comes from Dr. Peter Piot, head of the United Nation's specialized agency on AIDS, UNAIDS, who has said that the "the pandemic and its toll are outstripping the worst predictions."(1)
However, the agency's numbers belie its leader's claims. Only one year after Piot made his dire claim, UNAIDS announced that there were thirty-three rather than forty million people infected worldwide, and that the number of new infections had peaked almost ten years earlier.(2)
According to the UN, this enormous revision was akin to a simple bookkeeping adjustment. Perhaps. But the studies UNAIDS conducted over the years to establish their estimates were plainly flawed. The UN tested patients at urban sexual health clinics—people who had reason to fear that they were infected—and then extrapolated the findings to the general population.(3) This would be like estimating a nation's lung cancer rate by testing only chain smokers. Of course the numbers would be too high.
There were a few people who knew this all along and spoke up, including Harvard University scientist Edward Green. In 2003, Green accused the UN of attempting to create an impression of worldwide catastrophe in order to keep the funding flowing (the UN administers about ten billion dollars a year on AIDS). By now, Green's point is becoming more widely accepted; last year the New York Times admitted that, "in the past, global health officials have treated the epidemic as a cyclone spiraling ever upward with no end to new infections in sight."(4)
But this is just the start; this ordinary deviation from sound thinking in the case of AIDS is joined by the extraordinary: AIDS is unique because, as a deadly pandemic spread mainly through promiscuous sexual activity, it threatens some of the most cherished modern norms concerning sexual liberation. So to promote the most obvious response to such a pandemic—do not engage in promiscuous sexual activity—would in essence be a capitulation, an admission that the dream of consequence-free sexual activity was not only impossible, but perhaps at least partly responsible for the scourge.(5)
Condom as Technological Solution
Enter the lowly condom. As an alternative to a sound and sensible risk avoidance strategy, the international community found the only readily available device that held out some promise of risk reduction, of lessening the risk of infection caused by promiscuous sexual activity. The United Nations launched a massive, worldwide, comprehensive sex education and condom distribution campaign. It has been joined by just about every other institution involved in international development: the European Union, individual nations, foundations, and nongovernmental organizations. This, despite the fact that any significant level of protection would require condoms to be available in their billions, at all possible times and at all possible places, to be used 100 percent of the time, and to be used correctly 100 percent of the time. Nonetheless, condoms and their many imperfections were sold to the people of the developing world as "safe sex."(6) The nations that embraced this program most emphatically, such as South Africa, saw infection rates continue to soar.
At the same time, a few nations promoted traditional sexual morality—abstinence and fidelity—and they succeeded. These success stories were in turn undermined by the very international AIDS community charged with ridding the world of the disease. The victory in the Philippines, for example, was acknowledged by UNAIDS' own research: "The Philippines remains a low HIV prevalence country [0.01 percent]. ... The number of HIV/AIDS cases is not expected to increase substantially over the next few years" (emphasis added).(7) The New York Times even admitted that the victory was because of traditional sexual morality: in the Philippines, "a very low rate of condom use and a very low rate of HIV infection seem to be going hand in hand. AIDS-prevention efforts often focus on condoms, but they are not widely available here—and are mostly shunned—in this conservative Roman Catholic country."(8)"