A new realism in the struggle

It has been long in coming, but finally delegates to the 15th International AIDS Conference, which just closed in Bangkok, gingerly faced up to the most effective way to deal with the global pandemic. Some 37.8 million men, women and children worldwide have HIV which causes AIDS and 2.9 million died last year alone. Tropical Africa and Asia have been hit hardest.

Until very recently, political leaders, medical experts and AIDS activists have focused almost exclusively on ways to mitigate the ravages of the deadly virus. Some Third World leaders, notably in South Africa, were in denial about how the AIDS virus was contracted and transmitted and what might be done to mitigate its deadly toll.

The United States, working with other developed countries, has committed substantial funds and personnel to meet the scourge. Until now, however, most of the effort has been devoted to mitigating the suffering of those who already have the disease. Even the most sophisticated — and expensive drugs — cannot cure the disease, but only mitigate suffering and postpone death.

The HIV-AIDS crisis in tropical Africa is especially grievous because it comes on top of a succession of other man-made tragedies that have dashed hopes for postcolonial Africa. Tribal wars and genocide have killed millions. The megalomaniac Mobutu Sese Seko plundered the Congo. The late Idi Amin of Uganda slaughtered hundreds of thousands. Most other countries have been burdened by corruption and mismanagement.

As early as March 1990, Archbishop Desmond Tutu of South Africa said: “God’s children in Africa suffer because there is less freedom in their countries than during colonial times… there is totalitarianism and despotism nearly everywhere.”

The AIDS epidemic in Africa has been exacerbated by poor or nonexistent health care, poverty, malnutrition and ignorance. But these depravations are not its cause, which is man-made and preventable.

A sexually transmitted disease, HIV-AIDS is a preventable plague. It is spread mainly by multiple sex partners. Studies suggests tropical Africa has a highly promiscuous culture. Widespread sexual intercourse outside of marriage is rooted in traditional customs and practices and exacerbated by the AIDS plague itself.

Evidence of increasing promiscuity in Africa is offered by Dr. Holly Burkhalter, an AIDS specialist with Physicians for Human Rights. (“The Politics of AIDS,” Foreign Affairs, January-February 2004, Pages 8-14) She cites Dr. Karl Peltzer of Cape Town, South Africa, who said the widespread pursuit of young women by older men “has led to a disproportionate number of girls becoming infected.” Young girls — some under age 5 — are often raped by men, purportedly because of a widespread myth that sex with a virgin can cure or prevent AIDS. This assault has generated “millions of orphans and street children… who are especially vulnerable to rape and to being forced into the commercial sex industry.”

Dr. Burkhalter adds: “The predators who sustain the forced-sex trade and child rape industry … should be punished severely,” but this “almost never occurs.” She calls for new strategies to fight AIDS transmission among both forced prostitution and “voluntary sex workers.”

Uganda shows the way: In striking contrast, the AIDS situation in Uganda under President Yoweri Museveni has been radically different. The country’s HIV infection rate plunged from 22 percent in 1992 to 7 percent in 2002, winning plaudits from the World Health Organization.

Finally, at the Bangkok AIDS Conference, Mr. Museveni was given a global platform for his remarkable story.

In 1986, Mr. Museveni launched a vigorous program to stem promiscuity by promoting abstinence before marriage, faithfulness in marriage, and if these traditional moral restraints failed to hold, he advocates using condoms. He calls this his “ABC” strategy, or “Abstinence, Being Faithful and Condoms.”

Mr. Museveni has been accused of naivete, but his initiative has yielded startling results. And if it were widely emulated, it would drastically reduce the toll of AIDS throughout Africa. His program underscores the perennial public health the struggle between therapy and prevention. In this case, an ounce of prevention is worth a great deal more than a pound of cure.

Of course, research for a cure to AIDS must go forward apace, but a larger portion of the resources in the global struggle against AIDS should be devoted to prevention. Is it not more humane to prevent AIDS than to treat its ravages? Obviously, both endeavors deserve our commitment.

Ernest W. Lefever is senior fellow at the Ethics and Public Policy Center.