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Hope for change with Obama’s Global AIDS Coordinator appointment?

29 April 2009

US President Obama has named Eric Goosby as Global AIDS Coordinator, making him the administrator of the President’s Emergency Fund for AIDS Relief (PEPFAR). Blogger Texas in Africa has hope that the new appointment and the reign of Obama will bring about some change, in particular, a better dose of prevention. Yes, prevention is important, and more importantly, it’s going to be cheaper in the long run than treatment — if it works. The problem is, we don’t have much in the way of systematic or objective data collection to know what works. and to be honest, I don’t really think condoms were all that powerful an approach (neither does this guy).

You see, HIV is a virus that has a low transmissibility rate. That means, it’s less typically the single sex act interactions where you will see transmission. Rather, it will likely be longer term relationships in which someone will become infected. It’s much more difficult to convince someone in such a relationship to use condoms. Sure, it’s OK to use them with “bar girls” but not your girlfriend; that would say you don’t trust her, and if you don’t trust her, you don’t love her.

There’s a very recent article that talks about “Condom Semiotics” in the American Sociological Review written by some colleagues that goes more in-depth about what using a condom can say about a relationship. [ungated version here.]

It’s probably not very fashionable to ally oneself with the Pope and President Bush, and I don’t know that we would be in the same group for ideological reasons — but, for me, it’s all about the evidence. I’ve not been convinced that the promotion of condoms has had much impact on reducing HIV transmission. They have made a lot of money for folks in the “AIDS” industry (like PSI), and I’ve seen some great soccer balls in the villages made from the Chisango brand in Malawi. But, I’d be very surprised if “infection rates will finally start to go down” as a result of “substantial condom distribution and education programs.”

Whatever we want to say about President Bush, PEPFAR was a serious, unparalleled commitment. I am all for a critical view of policy, but not the kind that is politically motivated or unsubstantiated by evidence. If the goal really is to reduce HIV transmission, then we should gather objective data on a variety of prevention programs to study prevention interventions. Then there needs to be a come-to-Jesus conversation about what works where and whether it can be transformed to work in other settings.

2 Comments leave one →
  1. 30 April 2009 9:58 pm

    Thanks for the feedback. I definitely agree that programs that are focused only on condom use don’t work; getting people to use condoms has been problematic in sub-Saharan Africa. What I’m arguing for, though, is a return to the ABC approach, where condoms are part of a comprehensive approach. PEPFAR is a success in terms of ARV treatment for the infected, but the Bush administration’s prevention efforts were not. We know from places like Uganda that ABC is much more effective than just focusing on one or two of the elements of the program. So I’m hopeful that the Obama administration will do all three.

  2. 1 May 2009 7:02 am

    What we know about Uganda is that the “zero grazing” campaign was very effective. I don’t know that we can say the ABC approach was necessarily effective. A friend is doing some analysis of newspaper articles on the “C” part of the “ABC” campaign in Uganda… and I think the major takeaway was that the decline in infection rates happened at a time when “C” was scarcely talked about in the press.

    I guess what I’m trying to say is that maybe there’s a “D” that works really well or maybe “A” is a terrible idea. Rather than promote a strategy whose effectiveness we have not systematically measured, let’s look at what we’ve done to see what /actually/ works. “ABC” is a clever marketing campaign, and the “C” part has lots of interested parties (not just ones who are interested in money, but ones who are interested in “rights”), so perhaps the mere notion that we should rethink it is too radical an idea.

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