Who is right on condoms and AIDS?

The DA's Jack Bloom responds to criticism from the TAC's Nathan Geffen


Are you "shocked" that many young people in South Africa think it quite normal to have multiple sexual contacts?

Not if you are Nathan Geffen of the Treatment Action Campaign who attacked me for mildly defending the Pope's views on the efficacy of condoms in preventing HIV/Aids ("Changing mindsets", Citizen, 30 March 2009). According to Geffen, "Bloom's position on condoms appears to be informed by his personal moral judgments" (see here).

The TAC's Zackie Achmat was more vitriolic, campaigning to have me removed as DA health spokesperson in favour of someone who is "non-judgemental" and "understands the Constitutional meaning of the right to access health services including reproductive health services."

For the record, I have always supported the provision of condoms to those who wish to use them.

I am skeptical because the incredibly high number of condoms distributed in Gauteng (one billion in the last 8 years) has had no discernable impact in reducing HIV/Aids.

According to Harvard research scientist, Dr Edward Green, "We just cannot find an association between more condom use and lower HIV reduction rates" in Africa.

One reason is "risk compensation", whereby greater risk is taken because a risk-reduction measure conveys a greater sense of safety than is warranted e.g. putting on sun block may mean spending far more time in the sun.

With condoms, consistent and correct use is critical, which doesn't always happen particularly when alcohol is involved. Even then, the assessed 95% effectiveness of condoms means that infection could occur once in every 20 sexual acts.

Green's research has shown that condoms may be effective on an "individual level," but not on a "population level", although he notes that condoms have been effective in high risk areas like brothels.

A Ugandan study found that gains in condom use were offset by increases in the number of sex partners, which is a key driver of the Aids epidemic.

Why does it help to be "non-judgemental" about multiple sex partners when most people are rightly outraged when they find out that their loved one has been cheating on them?

The Soweto radio station Jozi FM once ran a highly successful show called "Cheaters" that exposed cheating husbands and boyfriends. A presenter said: "We give women a chance to air their grievances and warn our audience how easy it is to spread Aids by affairs."

Stigma is a powerful aid in changing behaviour, and can assist in reinforcing messages like "Love Faithfully" or "Zero Grazing" that proved effective in Uganda.

Condoms should be accessible as a back-up strategy for those who will not or cannot remain in a mutually faithful relationship. This was a key point in a 2004 "consensus statement" by some 150 global AIDS experts, who also affirmed that the first priority should be to promote mutual fidelity.

South Africans generally have conservative views on sexual matters. Even though actual behavior often differs, it is a resource that should be better used to counter the viral genocide of HIV/Aids.

Rather than dishing out condoms in churches, promote the values of sex with commitment, not mere animal lust. And empower women to be less vulnerable in our patriarchal society.

So yes, we should be shocked by people who sleep around, and should say so loud and clear. The alternative can be death.

This article by Jack Bloom, Democratic Alliance member of the Gauteng legislature first appeared in the Citizen May 26 2009

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