Thursday, February 24, 2005

From the Executive Summary of "The White House Initiative to Combat AIDS: Learning from Uganda" by Joseph Loconte, Heritage Foundation Backgrounder #1692, September 29, 2003:

Beginning in the mid-1980s, the Ugandan government, working closely with community and faith-based organizations, delivered a consistent AIDS prevention message: Abstain from sex until marriage, Be faithful to your partner, or use Condoms if abstinence and fidelity are not practiced.

The link between Uganda's "ABC" approach and the dramatic reduction in the country's HIV/AIDS rate is now widely acknowledged. Based on research data collected over the past decade, several lessons can be drawn from the success of Uganda's strategy:

* High-risk sexual behaviors can be discouraged and replaced by healthier lifestyles.

* Abstinence and marital fidelity appear to be the most important factors in preventing the spread of HIV/AIDS.

* Condoms do not play the primary role in reducing HIV/AIDS transmission....

Got that? Right-wingers don't really like ABC -- they like AB. (C is just an icky add-on.)

Too bad there's now evidence that A and B aren't all that effective in stopping HIV.

From today's Washington Post:

Abstinence and sexual fidelity have played virtually no role in the much-heralded decline of AIDS rates in the most closely studied region of Uganda, two researchers told a gathering of AIDS scientists here....

And from the San Francisco Chronicle story about the same study:

Research from the heavily studied Rakai district in southern Uganda suggests that increased condom use, coupled with premature death among those infected more than a decade ago with the AIDS virus, are primarily responsible for the steady decline in HIV infections in that area.

This is a good study, the Chronicle tells us:

The Rakai findings are based on an extensive and continuing process of interviewing 10,000 adults each year -- a so-called population-based survey that is considered the gold standard for this kind of epidemiological research."

And here are the numbers, as reported in the Post:

In the Rakai district, the percentage of women infected with HIV fell from 20 percent in 1994 to 13 percent in 2003. For men, the rate of infection declined from 15 percent to 9 percent, a decline of roughly one-third.

Over that same period, however, the fraction of men reporting two or more sexual partners in the previous year rose from 28 percent to 35 percent. The fraction of young men ages 15 to 19 who were not sexually active fell from about 60 percent to just under 50 percent. For women that age, the proportion not having sex remained at about 30 percent through the decade.

The median age of first intercourse for men fell from 17.1 to 16.2 years, and for women from 15.9 to 15.5 years.

Condom use, however, changed markedly over the survey period. In 1994, only about 10 percent of the men said they consistently used condoms with non-marital partners, compared with 50 percent in 2003. For women of the same age, the rate of condom use in non-marital sex increased from 2 percent to 28 percent.

Professor Maria Wawer of Columbia University, who presented the study, said that the benefit from increased condom use (C) was canceled out by the decreases in abstinence and those who chose to be faithful (A and B). The decrease in infection in Rakai was actually caused by deaths of infected people.

But since Uganda is now facing a condom shortage, infection rates may go up again.

More at this NPR audio link.

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