The HIV vaccine that no one wants

Posted: Dec 06, 2002 12:00 AM
World AIDS Day (Dec. 1) came and went with barely any notice of the fact that a kind of vaccine against HIV has been researched, tested and is available to save countless lives in Africa. It was first developed during the late 1980s in Uganda, where it has created the biggest drop in HIV prevalence in the world. It hasn't yet been patented or advertised, but it has a name: abstinence and marital fidelity. According to a U.S. Agency for International Development study, in Uganda "national HIV prevalence peaked at around 15 percent in 1991, and had fallen to five percent as of 2001. This dramatic decline in prevalence is unique worldwide." In the mid-1980s, when it became clear that AIDS was on the rise in Uganda, President Yoweri Museveni adopted a program that, as Arthur Allen has written in The New Republic, "would become known as ABC, for Abstain, Be faithful or wear a Condom -- very much in order of emphasis." Museveni essentially led a crusade against having sex outside of marriage. You can almost hear the clucking of "progressives" in the West: How quaint. How prudish. How unrealistic. Try, instead: How wondrously effective. According to a study of one Ugandan district, almost 60 percent of youths age 13-16 reported engaging in sexual activity in 1994, but by 2001, the number had plummeted to less than 5 percent. The USAID study reports that compared with men in other sub-Saharan African countries, Uganda males are "less likely to have ever had sex (in the 15-19-year-old range), more likely to be married and keep sex within marriage, and less likely to have multiple partners." The effect on HIV rates has been nearly miraculous. Researcher Rand Stoneburner estimates that Uganda's approach has been almost as effective as an HIV vaccine. So, where's the shouting from the rooftops? The silence about Uganda has to do with the fact that the condom, that sacred totem of the AIDS establishment, didn't initially play much of a role in ABC's success. As late as 1995 -- by which time HIV was already firmly on the decline -- only 16 percent in Ugandan males reported ever using one. In contrast, as Allen reports, Botswana and Zimbabwe, the two countries in the world with the highest rates of HIV prevalence, are both relatively condom-friendly. In a 1999 study, more than 70 percent of Zimbabwean males reported using a condom in their most recent high-risk sex act. AIDS activists aren't picketing international organizations, demanding that they spread the Uganda model, because they have a blind spot. For them, urging people not to have sex almost constitutes a human-rights violation. The researchers who have simply followed the Uganda data to its logical conclusion find themselves isolated in the AIDS world. "A lot of my colleagues get very wary at the sound of language urging behavioral changes," says one lonely expert, Harvard researcher Edward C Green. "It sounds judgmental, moralistic. But it's hard to argue with success." Difficult or no -- there is still an ongoing effort to argue with success. The Washington Post recently reported on "the war" on AIDS in Botswana: "Bill Gates is bankrolling the assault. A top pharmaceutical firm is supplying ammunition. And Harvard University researchers are developing new weapons." Given the devastation in Botswana, where life expectancy is down from age 65 to less than 40, it is understandable to want to "try anything." But it's unforgivable not to try what has proven to work. Money, pills and experts all might help, but are besides the point absent a new ethic of sexual responsibility. Now, Uganda shouldn't be mistaken for a chapter of the Christian Coalition. Condom use among high-risk groups has consolidated Uganda's gains, and social acceptance of HIV-positive people is quite high. But the AIDS establishment will never act on Uganda's central lesson until it gives up its total devotion to the idea of judgment-free sexual self-expression. In the meantime, Africa dies.