Safe sex’s “Big Bad Wolf” responds – Pt. 2

Are AIDS prevention promotions working?

By Mike Edwards 15.AUG.08

A couple weeks ago Alisa Alvis ridiculed my article “Safe Sex? Yeah Right!”, labeling it “Dealing in fear.” Well, “dealing in fear” definitely helped in Uganda! In fact the Ugandan government intentionally used fear to create behavioral change. Green: “An important yet overlooked element of Uganda’s early program is the deliberate strategy of fear arousal. Fear was the weapon used to break through denial. But after arousing fear, people were given clear behavioral options…” (p. 13){{more}}

A few samples of the Ugandan anti-AIDS posters of the time: “Change your behavior or you’re going to die”, “Practice ABC or you will D-for Die!” One poster showed a skull & crossbones and proclaimed, “My quick pleasure led to a slow, painful death.” Green notes, “Ugandan messages even targeted cross-generational sex and long-distance truck drivers. One Ugandan poster shows two schoolgirls (in uniforms) pulling a friend away from a well-dressed middle-aged male with money in his hand (i.e. a ‘Sugar Daddy’). Another Ugandan poster showed a long-distance truck driver pulling out of a roadside stop while two young women run after him. In any other country, the caption would have something to do with not leaving home without your condoms. In Uganda, the caption was, ‘I am driving straight home to my wife.’ …even those at high risk (&) usually thought to be beyond the reach of a ‘Be faithful’ message, were considered capable of changing their sexual behavior.”(Green, pp. 13, 14).

Jesse Kagimba, a longtime AIDS adviser to Museveni says, “You change because of fear. And you change because of love. Fear is stronger than love.’” (Timberg). Did it really work? Consider the following amazing statistics:

“WHO surveys in 1989 and 1995 show that the proportion of males aged 15-24 years reporting premarital sex decreased from 60% in 1989 to 23% in 1995. For females, the decline was from 53% to 16%. Looking at all age groups, 41% of males had more than one sex partner in 1989. This declined to 21% by 1995. For females, the decline was from 23% to 9%. Furthermore, the proportion of males reporting three or more sex partners fell from 15% to 3% from 1989 to 1995. So a large part of the dramatic drop in HIV infection rates in Uganda occurred at the very time when condoms were being presented as a “last resort” and promoted primarily to prostitutes and other individuals determined to continue their “liberated” sexual behavior. How blunt was the message? “President Museveni recalled those days in a recent BBC interview, ‘When I had a chance, I would shout at them, ‘You are going to die if you don’t stop this [risky sexual behavior]. You are going to die!” (Green, p. 13). I’d call that dealing in fear, Ms. Alvis.

Green states: “Contrary to the belief of most AIDS experts, fear is an effective motivator of behavior change. A recent meta-analysis exploring the role of fear arousal in behavioral change shows that Uganda was on the right track. According to Witte and Allen, ‘It appears that strong fear appeals and high-efficacy messages produce the greatest behavior change, whereas strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses.’ These authors also emphasize that low-fear appeals e.g. Zambia: “It’s not worth the trouble” & “Stay focused” [on schoolwork] are universally ineffective.” (Green, pp. 14-15). cf. a recent SVG message: “For carnival, Party Hearty, but don’t get HIV”, a perfect example of a “universally ineffective” message!

Condom success rates? In trying to defend and promote condoms, Ms. Alvis focused on HIV, with a few comments about HPV. There was hardly a word about the protection condoms provide against gonorrhea, syphilis, chalymdia, herpes, tracominiosis, etc. Probably because condoms only provide a 30%-50% success rate in protecting against most of those diseases & virtually none against some STI’s. If you were the head of a security firm hired to protect a bank, but your firm only succeeded in stopping 50% of the attempted bank robberies-or worse yet-stopped virtually none of them, I don’t think you’d be employed very long! No wonder they weren’t mentioned.

Ms. Alvis’ said that condoms “are 98% effective in preventing pregnancy when used correctly.” The critical words though are, “when used correctly.” The problem is, they usually aren’t used correctly i.e. used, used correctly, & used 100% of the time)! Dr. Hearst, who has worked in San Francisco with major HIV interventions bluntly states: “Regarding condom efficacy, people quote figures to say that if condoms are used perfectly, they’re 98%, 99%, or even 100% effective. You actually hear people say this all the time-that you can only get HIV through ‘unsafe’ sex, which implies that condoms are 100% effective if you use them. I have no idea of the source of data on which people are basing these numbers, and it’s not because I haven’t looked. As far as I can tell, they just quote each other.” (Hearst, p. 31).

A number of highly recognized sources and studies have come to a rather different conclusion: condoms when used 100% of the time provide about an 85%-90% success rate in preventing HIV infection. And, as experts at The Medical Institute for Sexual Health state: “One hundred percent use of condoms for many years is so uncommon that it is almost a purely theoretical concept except for a very few meticulous individuals.” (“Sex, Condoms and STDs” What We Now Know”, pp. 5, 4, www.medinstitute.org). Hearst points out a critical distinction: “Efficacy (‘theoretical effectiveness’ or ‘method effectiveness’) is how well an intervention treats or prevents a condition when used perfectly; in contrast, effectiveness (‘use effectiveness’) is how well an intervention works in practice…it seems reasonable to conclude that condoms are roughly 90% effective, a figure close to their effectiveness for contraception.” (Hearst, pp. 31, 33)

Ms. Alvis mentioned two studies of “discordant couples” that she claimed demonstrated a virtually 100% success rate for condoms in preventing HIV infection.

However, 1) Like most such studies, they were for a very limited time period (2 years). But sex goes on for life-at least for most married people!, 2) She herself admitted that in the one study, half the couples couldn’t even make it two years with 100% condom usage-with the ensuing result that twelve of those 122 had become infected with HIV. That’s my whole point i.e. almost no one, even couples where one partner is HIV positive, use condoms 100% of the time over the long haul. Hearst, in reviewing 18 such sero-discordant studies states: “So even over the course of a relatively short-term study in which both persons know their serostatus and are being regularly counseled to use condoms and are being given condoms, far less than half manage to use them always.” (!) He adds, “It makes me shudder when I hear people say, ‘If we just get everyone in for testing that would solve the problem’ Forget it!” (Hearst, p. 33).

Not surprisingly, Ms. Alvis didn’t comment on the study I mentioned that showed an 18% HIV infection rate for sero-discordant couples who used condoms for protection. In looking over the statistics involving sero-discordant couples from 17 studies in 11 countries worldwide from 1987-1997, I find that the 100% success claim cannot be sustained. Out of a total of 1,952 participants in those studies, more than half (58%) failed to use condoms 100% of the time for even that short period-even though they knew their partner was HIV positive & they were being given condoms and encouraged to use them faithfully! The result: 207 out of 1,147 of them (18%) became infected with HIV by the end of the studies. In three of the studies none of the participants managed to use condoms 100% of the time for the duration. Even among the 42% who did manage to use condoms 100% of the time during that brief period, in 6 of the 17 studies individuals still became infected between 1.8-10% of the time. (Condom Promotion for AIDS Prevention…Is it Working? Hearst, citing Weller S et al, Pinkerton SD et al, Davis KR et al, p. 32)

…which may explain this revealing testimony from a “Sexpert.” In the late 1980s, 800 of the world’s leading sexologists met for a worldwide conference in Germany. “Dr. Theresa Crenshaw, (a) past president of the American Association of Sex Education Counselors and Therapists recalls the way her colleagues responded to a question she asked during a seminar she gave: ‘I gave a lecture on AIDS to 800 sexologists at the World Congress of Sexologie in Heidelberg. Most of them recommended condoms to their clients and students. I asked them, if they had available the partner of their dreams and knew that person carried the (HIV) virus, would they have sex (with them), depending on a condom for protection? No one raised their hand. After a long delay, one timid hand surfaced from the back of the room. I told them that it was irresponsible to give advice to others that they would not follow themselves. The point is, putting a mere balloon between a healthy body and a deadly disease is not safe.” (Crenshaw, cited by Dinah Rickard, Ph.D. “Has Sex Education Failed our Teenagers?”, FOFP, p. 25).

The “good old days?” Ms. Alvis mockingly says that “Mr. Edwards wishes for us to go back to ‘the supposedly good old days…’” Well actually I think that many readers would agree that might not be a bad idea. In the 1960’s there were only two primary sexually transmitted diseases to worry about: syphilis & gonorrhea. Today there are approximately two dozen (!), some incurable, others like gonorrhea now called “superbugs” because they’ve developed resistance to almost all antibiotics (see “CDC Warns of Drug Resistant Gonorrhea”, FoxNews.com, 2007). Condoms provide zero to 50% “protection” from many STI’s, which continue to produce infertility, ectopic pregnancies, cervical cancers, HPV, etc. Ms. Alvis, you tell us to “embrace the truth” and “equip ourselves to have a healthy sex life and take measures to have safer sex.” Well, if you think a method that has a 0-50% success rate is good protection, “You go girl!”

Actually, your encouragement to readers to “equip yourself to have a healthy sex life” (i.e. keep right on jumping in and out of bed with whomever you please, as long as you use a condom) is suicide on the installment plan. That’s because one of the greatest “risk factors” for getting STI’s is the number of sexual partners one has. The more people you have sex with, the more you put yourself at risk. That’s called a scientific fact, Ms. Alvis.

By the way, has anyone noticed that the safe-sex crowd act as though sex is just another recreational sport and nothing more. They never seem to get around to talking about the emotional and psychological consequences & scars of engaging in loose sexual behavior. That alone speaks volumes about their lack of genuine concern for people’s emotional and social well being.

The co-chairman of Uganda’s National AIDS-Prevention Committee perhaps answers such safe-sex advocates best:

“Telling men and women to keep sex sacred-to save sex for marriage and then remain faithful-is telling them to love one another deeply with their whole hearts…The solution is faithful love. So hear my plea, HIV-AIDS profiteers. Let my people go. We understand that casual sex is dear to you, but staying alive is dear to us. Listen to African wisdom, and we will show you how to prevent AIDS.” (Ruteikara)

(Note: For readers interested in finding helpful, non-religious, scientific information, materials and documentation, try the website of “The Medical Institute for Sexual Health” (www.medinstitute.org)