FOR MANY YEARS, THERE was an open secret in the battle against AIDS in Africa. A few of us knew about, and earnestly sought to publicize, crucial findings indicating the most effective approach to AIDS prevention. Yet the "experts" in the field didn't want to hear. Our secret was that the country that had best succeeded in curbing the spread of HIV--Uganda--had achieved this result without following the formula the experts had been pushing for over 20 years, namely, condoms, drugs, and testing. Instead, Uganda had achieved its unparalleled decline in the prevalence of HIV with a home-grown, low-cost program built around something offensive to conventional experts: promotion of sexual abstinence and fidelity, with condoms promoted only quietly, to high-risk groups and those already infected.
The figures are startling. Through a public-information campaign backed by local medical personnel, pastors, and imams and reinforced in schools, Uganda reduced its HIV rate from 15 percent to 4 percent between 1991 and 2004, according to a U.N. calculation.
Not surprisingly, information about what was actually working in Uganda was unpopular. Condoms have been regarded as the first line of defense for everyone, everywhere, and anyone who disagrees with this orthodoxy has been dismissed as a religious fanatic with "an agenda." Hundreds of millions of dollars have been spent on condom social marketing (a field I myself worked in for several years) and on related medical-pharmaceutical solutions. How infuriating that an approach not funded by the big donors and scoffed at by foreign experts should prove to be the very thing that worked best.
Abstinence and fidelity, of course, are precisely what religious conservatives have always argued for, and partly for this reason predominantly secular or liberal AIDS experts dismissed the possibility that they might work. For the fact is, as I learned during my lonely battle to broadcast the truth about Uganda, abstinence and fidelity challenge core values and attitudes enshrined by the Western sexual revolution, which taught that people, whether straight or gay, have the right to express their sexuality however they wish, as long as all participants are consenting adults and no one is hurt. Finally, few AIDS experts wanted to accept the evidence from Uganda because people do not like to admit they might have been wrong, especially in a matter involving countless millions of dollars and the lives of millions of people.
CONSIDER THIS VIGNETTE, from the global AIDS conference in Bangkok in July 2004. When Simon Onaba, a 22-year-old Ugandan university student, told an audience of AIDS experts that he had abstained from sex for three years and intended to continue doing so until his wedding night, he was loudly jeered. "Oh, how nice for you!" went one reaction. "You may be able to abstain, but what about a 13-year-old Somali girl forced into marriage and subjected to genital mutilation? She doesn't have the luxury to abstain!" (As if, by choosing abstinence, Simon were somehow failing to take a stand against genital mutilation.) The experts also hurled hostile questions at Simon: How often do you masturbate, and with whom? What's your real agenda for trying to make people believe you are abstaining?
These critics seem to believe that since abstinence and fidelity may not be workable options for 5 percent of the population, they should be rejected altogether, even if they are the best option for 95 percent of the population. These numbers are not arbitrary: By 1995, only 5 percent of Ugandan males and females were reporting casual sex.
As that last figure suggests, reality is very different from the Western experts' perception. Surveys today suggest that more than half of African males and females between the ages of 15 and 19 are abstaining from premarital sex, and increasing proportions of adults are having sex with only one partner. Yet few who work in AIDS prevention have called attention to these important trends, perhaps because they contradict the image of the hypersexed African that Western AIDS experts have been selling since the beginning of the AIDS pandemic. They depict Africans as "polygamous by nature," and supposedly so driven by hormones and poverty that commercial and transactional sex, and the inability to make responsible decisions about sex, are simply part of what it means to be African. If you accept this condescending view, condoms seem to be the only realistic solution to AIDS.
