World AIDS day

Thirty years into the AIDS pandemic, UNAIDS estimates that 33.3 million people globally are living with HIV. This number includes an estimated 2.5 million children under the age of 15 years.The number of people receiving antiretroviral therapy in low- and middle-income countries has increased thirteenfold since  2004, to more than 5 million. However, only 35 percent of people in need of treatment are currently receiving it. Roughly 10 million people cannot get the medication they need.

The Catholic Church is playing its part, operating 117,000 centres to care for AIDS victims throughout the world. 27% global institutions caring for AIDS patients are run by Catholics. The South African Catholic Bishops Conference AIDS office supports projects and programs in Namibia, Botswana, Swaziland, Lesotho and South Africa, making it one of the largest anti-HIV/AIDS programmes in Southern Africa and active in many of the countries with the world’s highest rate of HIV infection. The Church cares for orphans of the AIDS epidemic, it works to place them in foster homes and helps to support foster families, it runs education and prevention programs for primary and secondary school students, home care and counselling programs for those who are HIV-positive, it provides patient units for the terminally ill who have no-one to care for them and a program to provide drugs to reduce the incidence of mother-to-child transmission.

The spread of HIV is not confined to the developing world. In 2010, 69, 424 people were treated for HIV in the UK, a 6% increase on the number in 2009 (65,292) and a 166% increase since 2001 (26,088). According to the most recent figures of the UK Health Protection Agency, there were an estimated 80,800 people living with HIV/AIDS at the end of 2009, of whom 67% were male and 33% female.

A recent review of 14 studies showed that in discordant couples a consistent use of condoms leads to an 80% reduction in HIV incidence.

HIV transmission is reduced by approximately 80% when condoms are used correctly 100% of the time.

80% reduction is good, but it is not enough. Doesn’t everyone deserve adequate protection? There is a method of achieving 100% risk avoidance. Why settle for anything less?  It is World AIDS Day, not World Condom day. There is no such thing as safe sex.

In the meantime we must continue to fight for equal healthcare for all of those affected by the ravages of this dreadful disease.

Stay safe and keep your loved ones safe.

*Sources: The US National Institute of Health & the US National Institute of Allergy and Infectious Diseases

Weller SC & Davis-Beaty K (2007), ‘Condom effectiveness in reducing heterosexual HIV transmission‘.

21 thoughts on “World AIDS day

  1. Good Post. If I had AIDS I would not take the 20% chance of passing it onto my wife (and possibly future kids, if we were younger).

    Continence is not only possible, it is essential in such a situation. The modern myth that we are only fulfilled (or our ‘relationships’ are only fulfilled) by sexual gratification is clearly that: a myth.

    1. “If I had AIDS I would not take the 20% chance of passing it onto my wife” – I feel the same way. In the interest of accuracy however, I would point out that the 80% figure is an odds ratio not an actual risk. So it is 1 minus the ratio of the risk of passing HIV from a positive man to a negative woman while always using a condom for a year divided by 1 minus the risk when never using a condom. From the meta-analysis cited the estimated risk (per person year) without condoms is 5.75% while the risk with condoms is 1.14% (rather than 20%). Of course the risk is cummulative year after year so after 10 years it would be a bit less than 10%.

  2. So – you propose to remove a prevention tool that is roughly 80% effective from a situation where people will – absolutely without question, continue to have sex and take risks. Everyone would deeply appreciate it if people listened to the sex ed on offer that says unequivocally that there is no safe sex, but they don’t. You propose rasing the risk of infection for an individual from around 20% to 100% on the grounds that condoms won’t solve the epidemic. That’s a straw man. Health providers, and users, have always known this.

    To me, it looks like you want to deny that condoms have any appropriate use whatsoever, even if that role is to reduce infection rates, because they also prevent conception some of the time. For that matter, if condoms are not very effective at preventing pregnancy either (those stats are often even worse than 80%) who cares if anyone uses them or not?

    Unless about 80% prevention really does matter. Especially to the people who use it.

    You can minimize condoms or call them mysogynist threats to women’s fulfilment, but they can’t be supereffective and dangerously useless at the same time. Meantime, *some* prevention is always going to be more helpful at easing the burden on palliative care and orphanages than none.

    1. I did not suggest removing condoms, I do not believe in altering free market supply, therefore yours in the straw man.

      My point is simply that condoms are not 100% effective & lead to a false sense of security.

      You may find the following link illuminative. There is not a single country in Africa whereby HIV prevalence has been reduced by condoms. Furthermore it would seem that due to the phenomenon known as risk compensation, actually handing out condoms has exacerbated the problem.

      http://www.washingtonpost.com/wp-dyn/content/article/2009/03/27/AR2009032702825.html

      1. “Furthermore it would seem that due to the phenomenon known as risk compensation, actually handing out condoms has exacerbated the problem.” Really? because the article you cited provides no evidence of a such a thing. In fact, the only examples it gives where condoms did have an effect showed that they were effective at reducing spread of HIV transmission. The articles that were cited within the Washington Post piece suggested that where condoms were not effective it was because of lack of use. There was no evidence at all to suggests that distribution of condoms increased risk in any way.

        “I do not believe in altering free market supply, therefore yours in the straw man. ” Does this mean that you don’t support interference in the heroine trade? Or any restrictions on the availability of needles?

      2. Here’s another link to Professor Edward Green who agrees that condoms could well be exacerbating the problem.

        http://www.catholicnewsagency.com/news/harvard_researcher_agrees_with_pope_on_condoms_in_africa/

        Furthermore the straw man is that not once have I argued for a ban on condoms.

        I do not believe in the principle of banning items even if I do not condone them. In the analogy of drugs/dirty needles, clearly narcotic substances do not fall into the category of things that should be available for public consumption because they cause harm both to the individuals and to society as a whole and are rightly criminalised.

        You are conflating the issues of criminalisation of agreed harmful substances (both in terms of supply, trade, use and effects) and of the effectiveness of condoms.

      3. Not sure why I can’t reply to your nested comment directly. Anyway…

        “Furthermore the straw man is that not once have I argued for a ban on condoms.” Yes, that was a straw man argument (or more likely a misunderstanding).

        “You are conflating the issues of criminalisation of agreed harmful substances (both in terms of supply, trade, use and effects) and of the effectiveness of condoms.”

        No, I’m not. I’m just trying to figure out how far your commitment to free market ideology goes. As an aside, drug prohibition especially including criminalization of drug use is one of the most anti-human, inefficient, exorbitantly expensive, and murderously failed policies in the past 50 years. You should look into it. I suspect you will find, if you look objectively, that it is not supportable on ethical or practical grounds.

        The other link is just repeating the same thing. It is an assertion by Green without evidence. I still see no convincing reason to believe that condom distribution causes a net increase in HIV transmission.

        “There is a method of achieving 100% risk avoidance.” What is it? Total abstinence? Even married sex isn’t totally safe (just ask Christine Maggiore). Or are you talking about the specific case of discordant couples who know their status?

        “There is no such thing as safe sex.” I’m pretty sure you mean 100% safe, right? If so, then the statement is meaningless; it’s just a slogan. Nothing is 100% safe. Not driving, walking, or running (with or without scissors). Not even hot dogs.

        Anyway, I noticed that you made a mistake in your post: “HIV transmission is reduced by approximately 80% when condoms are used correctly 100% of the time.”

        From the abstract you cite: “the studies used in this review did not report on the “correctness” of use, namely whether condoms were used correctly and perfectly for each and every act of intercourse”

        I would also point out that in your post up top, you probably should be discussing the rate that new infections are acquired rather than citing the total number of existing infections if you want to highlight the problem of transmission. Hypothetically, the number of existing infections could increase even if the transmission rate is falling as long as reductions in death rates were greater than the change in transmission rate.

        I am not opposed to the idea that programs designed to reduce HIV transmission by getting people to reduce their number of partners has led to a reduction in HIV transmission in at least a few cases. I think it is probably a good idea to council people to reduce their number of sexual partners. However, that, on its own, is clearly insufficient.

      4. I don’t want to go heavily off-topic into the issue of de-criminalisation of drugs – I think we will need to agree to differ.

        In the second link, Professor Green not only explains why condoms do not have an impact on the AIDS epidemic in Africa, but goes even further as to state that they may well exacerbate the problem, due to risk compensation.

        The stats really speak for themselves, and though you see no evidence, personally I am convinced by the research of someone who has spent 25 years on the ground in Africa, someone who is a leading medical anthropologist and who headed up the Harvard AIDS prevention project. As a liberal atheist, there is no reason to suppose that Professor Green may be culturally biased.

        Total abstinence is 100% effective in terms of preventing transmission of AIDS and advisable if one is HIV positive.

        Married sex within a relationship in which both partners are HIV negative and are totally faithful is also 100% effective.

        Safe sex is a meaningless trope that is trotted out by various “educators”, to indicate that sex with a condom will prevent pregnancy/stis, which is why I debunked the phrase. http://en.wikipedia.org/wiki/Safe_sex

        There is no mistake in my post. Please see this from the American Pregnancy Organisation. http://www.americanpregnancy.org/preventingpregnancy/malecondom.html

        You may also be interested to note that condoms do not prevent HPV transmission and reduce the chances of syphillis transmission by 29%.

        I wish to highlight the amount of existing cases, as well as transmission rates – there is nothing to prevent you from writing your own blog on this matter, if you disagree with how I have chosen to prevent the facts. I also wished to highlight the sheer volume of those with the disease, especially those who do not have access to medicine.

        It is definitely a good idea to counsel people to reduce their sexual partners, but even better is to teach people to abstain until they are in a life-long 100% faithful relationship and to practice fidelity.

      5. “I think we will need to agree to differ.” Ok, but seriously, look into it. If you find contrarian experts with decades of experience persuasive there are thousands of cops, prosecuters, beaurocrats and politicians (strangely they always wait until they are retired) who say that prohibition is not working out. As a free market capitalist you may find the Cato Institute’s sympathy towards decriminalization enlightening. After being commissioned to write a paper for Cato, Glenn Greenwald debates former Bush drug czar John Walters at Brown University (normally I detest debates but this one is good, IMO). Food for thought anyway.

        “The stats really speak for themselves, and though you see no evidence, personally I am convinced by the research of someone who has spent 25 years on the ground in Africa” That sounds like confirmation bias to me. There are many experts with resumes that are at least as good who would disagree with Green. If the stats speak for themselves, why doesn’t he cite any? There are good summaries of the evidence (e.g. the 2008 Durban declaration) and they certainly make it clear where there is evidence that condom distribution has had an effect, where it hasn’t, and where there is insufficient evidence one way or another. I am not aware of any evidence that most programs that include distribution of condoms have made the problem worse.

        “Married sex within a relationship in which both partners are HIV negative and are totally faithful is also 100% effective. ” Yes, I’m sure this will break out in Africa any second now. I want to point out a few obvious things about this. 1) “married” is superflous in that sentence – a ceremony in and of itself has no effect on HIV transmission. 2) This is not a public health strategy – in order to make it one you must have an evidenced based plan to convince people to do this, and you must have a plan to reduce transmission in those that will not 3) even as a personal statement of self-righteousness it is imperfect – it does not address the fact that infidelity both exists, and is common, and no culture has been able to change that fundamental fact – merely nudge how common it is a bit lower or higher. I thought that the church preaches about free will? Faithful wives get HIV from philandering husbands (and vice versa). It happens. Surely a Christian must acknowledge the ubiquity of sin? Speaking of sin, the promotion of particular kinds of relationships over others based on their risk of HIV transmission should definitely favor committed lesbian relationships most all.

        “Safe sex is a meaningless trope that is trotted out by various “educators”, to indicate that sex with a condom will prevent pregnancy/stis” I thought you didn’t like straw man arguments?

        “There is no mistake in my post.” – There very clearly is – the statement you made misinterprets a statistic from the source you cited. Read it, read what you wrote. What else is there to say? Googling around to find a statement that matches what you said doesn’t change that.

      6. May I suggest that you look here for the stats. http://www.newparadigmfund.org/faculty-staff/edward-c-green-bio.html#presentations

        1) Married may be superfluous from your perspective, speaking from mine and a Catholic perspective it is certainly pertinent, however in order to satisfy your pedantry, for a practicing Christian, marriage will have a particular significance.

        2) The successful evidence plans have all involved abstinence and fidelity. For confirmation you need only to look at what happened in Uganda. A strategy focussed solely upon abstinence and fidelity proved enormously successful which saw a significant decline in STDs in the absence of a male condom prevalence rate over 5%. Condoms were only introduced & widely used in Uganda after much of the HIV decline had already taken place.The real reason for the drop in HIV is that between 1989 and 1995 casual sex in Uganda declined by 65%. Some of the sharpest declines took place within the teenage population, which the experts said “took many of us by surprise, since we believed that teenagers are driven by ‘raging hormones,’ therefore abstinence is an unrealistic or impossible objective.” Unfortunately, the success in Uganda has been undermined in recent years. According to The Washington Post, “The Ugandan turnaround was well underway by the time foreign AIDS experts began to arrive in the early 1990s, bringing with them the Western public health approaches—and values. They began to retool Uganda’s AIDS prevention efforts away from abstinence and fidelity—goals that many Westerners felt were unrealistic. As condom use increased, the percentage of young singles having sex rose from 27 percent to 37 percent between 1995 and 2000.” It seems that only sex-saturated Westerners (who have no handle on their own STD epidemics) are naive enough to expect that condoms will solve the AIDS problem.

        In a testimony to congress Dr. Green said, “Many of us in the AIDS and public health communities didn’t believe that abstinence or delay, and faithfulness, were realistic goals. It now seems we were wrong.”

        In a Washington Post article entitled “Let Africans Decide How to Fight AIDS,” he added, “Billions of dollars and the lives of countless men, women, and children will be wasted if ideology trumps proven health policy.” Lest anyone think that such an emphasis on abstinence is the result of conservative religious leaders placing their ideologies above science, Green noted, “I’m a flaming liberal, don’t go to church, never voted for a Republican in my life.”

        It is estimated that had South Africa implemented Uganda’s emphasis on self-control, “3.2 million lives would be saved between 2000 and 2010.” The effectiveness of the Ugandan approach has led scientists to consider it a “social vaccine” against HIV.

        I would also look at the difference between Thailand and the Philipines if you want some evidence-based research. Furthermore the BMJ said this: The greater the percentage of Catholics in any country, the lower the level of HIV. If the Catholic Church is promoting a message about HIV in those countries, it seems to be working. On the basis of data from the World Health Organization, in Swaziland, where 42.6 percent have HIV, only 5 percent of the population is Catholic. In Botswana, where 37 percent of the adult population is HIV infected, only 4 percent of the population is Catholic. In South Africa, 22 percent of the population is HIV infected, and only 6 percent is Catholic. In Uganda, with 43 percent of the population Catholic, the proportion of HIV infected adults is 4 percent.” In the Philippines, over 80 percent of the population is Catholic, and only .03 percent of the population has HIV!

        Do look up Arthur Allen, “Sex Change: Uganda v. Condoms,” The New Republic (May 27, 2002).

        I have not “googled around”. Please don’t be so presumptuous. There very clearly is no mistake, the point is that even if condoms are used 100% correctly there is still a risk of HIV transmission. There, understandably is no data as to how rates vary when condoms are used incorrectly. Or are you stating that it does not matter whether or not condoms are used correctly, which is what you seem to be advocating. You seem to be implying that the failure of condoms is entirely due to user-error, when in fact the evidence does not back this up.

        My original post was written having done the research, the American Pregnancy Association was the first port of call. My post DOES not misinterpret a statement. Go back to the sources and you will see this borne out. This is why I quoted the US National Institute of Health and the National Institute of Allergy and Infectious Diseases.

        Further ad homs will not be published and resorting to insults because you do not like the statistics does not advance the cause of your argument.

        The Church is concerned with spiritual truth, it acknowledges the ubiquity of sin, but it does not seek to facilitate or inherently sanction the sin, which is why it does not permit the use of contraceptives.

      7. I had a much longer reply typed out but lost it. I suppose one day I will learn my lesson and compose longer comments in a word processor rather than the comment field.

        “Further ad homs will not be published and resorting to insults because you do not like the statistics does not advance the cause of your argument. ”
        – I appologize if my remarks came off as insulting, particularly the “googling around” statement was, admittedly, flippant. If you find anything anything else that I said particularly egregious, let me know.

        However… “There very clearly is no mistake, the point is that even if condoms are used 100% correctly there is still a risk of HIV transmission.”

        Yes, obviously condoms are not 100% effective. No one is disputing that. As a general point I do not disagree. However, your sentence very clearly states that the 80% odds ratio figure comes from use that is “correct 100% of the time” when the source that you cited for that figure specifically states that they did not evaluate “correctness” of use. The other source that was cited in the comment to back it up gives a higher odds ratio – 85% – and this may indeed be due to the correctness of use issue. It is not that big a deal. That is why I said that you made a “mistake” rather than that you were “wrong”.

  3. Anyone with a serious interest in Public Health knows about concepts such as Open Systems Theory and Risk Compensation. These both predict what we observe: handing out condoms and preaching ‘safe’ or ‘safer’ sex tend to lead to increased promiscuity which is what drives the spread of AIDS.

    As has been observed before, to every complex problem there is a solution that is easy and obvious – and wrong. Condoms are that solution when it comes to AIDS.

  4. In a way it is like the question about drug users. Clean needles are given out to reduce the spread of AIDS but in reality it is better if users come off drugs all together.

    Some of the drugs used on the streets have medical purposes. When used by trained staff in a hospital they can be life giving.On the streets they destroy. Sex that in a loving committed marriage brings life, in a brothel destroys in many ways not just in terms of the many diseases which can be caught.

    So a response needs to be one that is life giving. AIDS treatment centres, support for the sick and for AIDS orphans is part of the picture. But so is investing in children, helping them out of poverty and giving education so that they don’t end up in the sex trade. Also there is a need for encouraging and supporting good, sound, faithful relationships in adults for their own good and to provide role models for younger people. And there is lots of work going on like this quietly, away from the debate about condoms, as Caroline has pointed out. Less than half the above post is about condoms. Our response to it might be “How can I support the work that goes on at grass level supporting communities and bringing life?” Condoms are like a sticking plaster on a gaping wound, like clean needles for addicts.

  5. One thing which is not discussed enough is mother-to-child AIDS transmission during pregnancy. This would harldy ever happen if every HIV+ mother had access to anti-retroviral drugs and a safe, clean caesarian. However, this is not the case. 😦

  6. Caroline

    The problem is that you have been identified as a heretic for questioning the Condom Orthodoxy, and must be persecuted until you recant (and never mind the evidence…)

  7. “There is not a single country in Africa whereby HIV prevalence has been reduced by condoms”

    Yet condom use has greatly reduced HIV spread in America and Europe… Hence could it not be that you’re building an argument on the wrong premises..? And that the problem is Africa!

    Of course what really helps is good sex education and ease of access to contraception, condoms, but most importantly overall educational attainment.

    Looking at similar, tho’ not as pernicious, social ills – teenage pregnancy and single parenthood – these tend to be higher in overtly religious societies or communities. Indeed in the USA teenage pregnancy and single parenthood (not to mention divorce) is consistently higher in communities/states where there are high levels of congregational Christianity and Christian discourse is more evident in day to day life. The country with the highest proportion of single-parents in Western Europe is the Rep of Ireland, yet still has around 50% regular mass attendance – whereas, oddly enough the country with the lowest (i.e. the highest proportion of two parent families) is Finland. It appears that in the main, countries with good sex education and a tolerant and liberal attitude to sex have far lower rates of teen pregnancy, STDs, divorce, single parents and (as is the case in many northern European countries (except alas the UK) a higher age when teenagers first have sex.

    In the developing world, particularly in South America, high levels of religiosity also equate with high levels of teen parenthood. Yet it is clear religion plays some part in HIV infection rates, as in Africa predominantly Christian countries have considerably higher rates of HIV infection than Muslim countries.

    Clearly abstinence is an effective method of AIDS prevention, but given people have sex and even devout Christians are (this may shock you) capable of having multiple partners, condoms are the next best thing by far. Condoms, plus education, plus better attitudes towards women by men and it is likely there wouldn’t be much difference when compared with abstinence.

    Just as an aside, a good portion of my working life has been spent in palliative care and part of this work involved working with Africans with AIDS defining cancers at one of London’s major cancer centres. (Yes, I bit of hands on experience and not just nosing around the internet cherry picking research that says what you want it to say….) Many of the people I worked with were devout Christians: lots of mention of God in the conversations I had with them (yes, God can be discussed between hospital staff and patients, it is just the Christian Institute, the Daily Mail and similar organs of vitriol that say otherwise!), a larger than was really necessary Bible by the bed and regular scowls aimed at those sinful homosexuals who shared the AIDS ward with them… (Yes, I thought it ironic too!). These patients bored you with their Christian orthodoxy! Which perhaps demonstrates that although you can preach till you’re blue in the face, people are still going to have sex – so plan ‘B’ – condom use – is also necessary! We even treated a Church of England vicar who had contracted HIV – and he was married… I think we had Franciscan Friar too on the ward at one time. Anyone and everyone can get HIV!

    Regards:

    Peter Denshaw
    London

    1. Peter – I have approved this comment, but just as a warning I will not publish any comments containing personal invective or racism, which is why none of your previous comments were published.

      The sarcasm does not help your cause one iota and you should be aware that I have been reading the work of Dr Edward Green and others for over ten years, having a background in economic research.

      You may well have experience of palliative care and working with AIDS victims in the UK, but anecdote is not the plural of data.

      The sub-saharan epidemic is disturbing and clearly all empirical evidence shows that condoms are not the solution to the problem. Anyone and everyone who engages in sex can contract HIV, therefore the answer would seem to be pretty straightforward.

      If you are so bored by Christian orthodoxy then I suggest that you frequent other websites which may be more to your taste.

      1. Where is the racism in Peter’s comment? Were his other comments racist, but not this one? It’s obviously your perogative to filter racist comments, but I’m not sure if it is fair to accuse someone of it publicly without publishing the offending material.

      2. An extract from an unapproved comment.

        It also seems pretty likely that you have not had much experience of African Christianity – I have (indeed my experience forms part of my PhD) and I can assure you there are few African Christians that honour the name ‘Christian’ in London. They might be hot on topics like homosexuality, but stealing, lying and being underhand seem second nature to many. The more vocally Christian are often the ones with the most to hide. It is interesting to note that the ethnic group with the highest proportion of single and teen parents in Britain after Afro-Caribbeans is Black Africans, despite being the group most likely to regularly attend a church. The most important commandment to many of them seems to be the 11th ‘Thou Shalt Not Get Found Out…’.

        I don’t like to host this sort of comment. Apologies for any offence caused.

  8. Caroline:

    Please tell me how much experience you have had of direct, day to day experience of African Christianity? I’d be very interested to know!

    Little anecdote… Many of my friends are ordained and two (married couple) had longed to work for CMS and so went to work in Africa as lecturers of a theological college. They returned pretty sharpish because they had were shocked at just how much a goodly portion of the ‘orthodox’ Christianity they saw was very much concerned with outward appearances (not much different Christianity the world over…). Their orthodoxy often revolved around the ‘finger pointing’ type.

    My own church in North London is a fifth African – they have gravitated towards middle-of-the-road Anglicanism because they found many of the purely African churches in London focused on wealth and ‘outward’ symbols of both blessing and material success.

    I don’t regard my comment as racist (tho’ I admit it wanders on the tasteless side of hyperbole!) – alas we live in an age where middle-class white paternalism is often confused with racism. Do participative research among African Christians – not anecdotal, but methodologically exhaustive doctoral (and Russell Group) level research and you might change your mind!

    Thanks for the newer info re: AIDS – I did my BA dissertation on the medical construction of AIDS, but that was in the early 90s when it was still seen as a mainly gay disease and so there wasn’t as much sympathetic Christian interest…

    Thanks:

    Peter Denshaw
    London

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