Anglican Mainstream

Matthew Hanley, First Things

The predominant Western approach to preventing the spread of AIDS in Africa has failed. Though in theory the risk reduction strategies favored by Western governments and aid agencies—handing out condoms, promoting counseling and testing, and treating other sexually transmitted infections (STIs) to block HIV transmission—can “work” in theory, they have not done so in practice. In Africa, despite years of promised improvements, they have not brought any downturn at all.

But a handful of African countries have actually forced down the AIDS rates, each of them by changing behavior—particularly reducing sexual partnerships—not through the heavily promoted risk reduction measures.

Well before western donors and condoms arrived on the scene, Uganda had cut its level of casual sex by two-thirds and subsequently its HIV rate by two-thirds. Several years later, Kenya replicated this success. A few other countries have also done so, with partner reduction always the most important factor.

In sharp contrast, South Africa has maintained high rates of multiple (and concurrent) partnerships and, despite its vigorous promotion of condoms, still suffers from persistently high rates of HIV infection. The same can be said of many of its neighboring countries, which lead the world in the prevalence of HIV, with some 15 to 35 percent of all adults infected.

These successes and failures are, tellingly, too often treated in a manner inversely proportional to their merits. Behavior change, though responsible for success, remains the least emphasized approach, while risk reduction invariably receives the benefit of the doubt despite its failure to deliver as promised. Its disappointing results always mean that efforts—along with funding—must simply be doubled.

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