Study Challenges Abstinence as Crucial to AIDS Strategy (2)
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Perhaps this study is being misrepresented; in any case it cer-
tainly does not show that fidelity, partner reduction & absti-
nence does not work.
Here is the link to my letter published in the New York Times:
http://www.nytimes.com/2005/02/26/opinion/l26aids.html?
Uganda AIDS Study
Published: February 26, 2005
To the Editor:
Re. the AIDS study in Uganda ("Study Challenges Abstinence as
Crucial to AIDS Strategy," news article, Feb. 24): There in fact
were profound behavioral changes in the Rakai district of
Uganda, and in Uganda as a whole, between 1987 and 1995 - that
is, before the time period used in the new study: less casual
sex, more monogamy, fewer youths ages 15 to 19 sexually active.
There was some more condom use, but consistent use was too low
to have made significant impact.
As for death being the cause of declines in H.I.V. infection
rates, why did this not occur anywhere else in Africa? The same
can be said of increased condom use in Rakai: why did even
higher levels of condom use not lead to the decline of H.I.V.
prevalence anywhere else in Africa?
The basic behavioral changes in Uganda of 1987-95 have kept
H.I.V. prevalence declining up until now. But there are indica-
tions that Ugandans may be returning to riskier behaviors. This
may be because we Western donors have moved Uganda away from its
home-grown AIDS prevention program to a medicalized, risk-
reduction approach focused on condoms, drugs and testing.
Edward C. Green
Cambridge, Mass., Feb. 25, 2005
The writer is a senior research scientist, Harvard School of
Public Health, and the author of "Rethinking AIDS Prevention."
--
And here is the (US) National Public Radio link to the show that
discussed the same study
http://www.npr.org/templates/story/story.php?storyId=4511418
I have not read the full paper about the Rakai study, which is
not published. But apparently it shows that HIV incidence (the
rate of new infections) increased somewhat in Rakai in recent
years. What was going on when this happened? Not increases in "A
or B" behaviors, but in "C" behaviors--condom use. It seems con-
doms were not protecting people adequately in Rakai, not if in-
cidence rose.
So here we have headlines are flying around the world asserting
that ONLY CONDOMS WORK!! ABSTINENCE FOUND NOT TO WORK!! Clearly,
a lot of people wish these headlines were true.
Research published in the past year in Science, British Medical
Journal, The Lancet and the Journal of International Develop-
ment, among others, show that the ABC model is indeed the best
prevention strategy for generalized epidemics and that decline
in casual sex (the B component of ABC) was the single most im-
portant factor accounting for success in Uganda
Edward C Green
Harvard Univerity
mailto:EGreendc@aol.com