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