AIDS Policy Lethal Mix of Ideology? Interview with Author Matthew Hanley By Carrie Gress
SAN FRANCISCO, California, DEC. 9, 2010 (Zenit.org).- When it comes to fighting AIDS, the western model of risk reduction hasn't curbed the deadly epidemic.
In this interview with ZENIT, Matthew Hanley, author of "Affirming Love, Avoiding AIDS: What Africa Can Teach the West," written with Dr. Jokin Irala, discusses the science behind preventing AIDS and what truly is effective as outlined in his book recently published by The National Catholic Bioethics Center.
Q: Your book highlights the evidenced-based science behind what is actually curtailing the spread of AIDS in parts of Africa, especially Uganda. What has been effective in fighting the disease in countries with such high infection rates?
Hanley: Quite simply, each of Africa's declines in AIDS rates are most attributable to changes in sexual behavior -- specifically fidelity or what the public health community sometimes calls "partner reduction."
On the one hand, this should not be surprising, since HIV is driven by multiple and often concurrent sexual partnerships. But it is even more striking considering that the trifecta of "technical fixes" heavily promoted by the AIDS establishment have simply failed to reverse these epidemics.
The condom is of course the most well known, but is important to note that the AIDS establishment also relied on testing services and the treatment of other sexually transmitted infections as a means of preventing HIV transmission. For a long time it was assumed that each of these measures would turn the tide – but they didn't.
Uganda was indeed a major success story; but what many people don't realize is that their AIDS rates are going back up now, as a result of a shift in emphasis away from fidelity and abstinence (which gave them such dramatic success in the first place), and towards the condom, and the entire western "risk reduction" model.
Q: Many suggest that it is just the poverty of Africa or the ignorance of its people that spreads the disease, and therefore the answer is just more free condoms. Does the evidence bear this out in areas where condoms have been made widely available?
Hanley: The first thing one might observe is that some of the poorest countries in Africa have the lowest AIDS rates, while some of the wealthiest countries have some of the highest AIDS rates.
Even within high HIV prevalence countries such as Kenya or Tanzania, it surprises many people to learn that AIDS rates tend to be higher among the well off than among the poorer classes; perhaps even more surprisingly, AIDS rates tend to be higher among the more educated than among the less educated.
More broadly, however, depicting AIDS as a disease of poverty suggests that the solution is economic rather than behavioral; it assumes that people have no human agency – that as long as people are materially poor, some matters will remain beyond their control.
In that sense, it blends in with the broader worldview which undergirds the western "risk reduction" model: the AIDS establishment has been much more willing to promote anything -- from condoms to testing to economic development -- over behavior change.
Q: Looking at the science behind condoms, aside from the moral problems they pose, do condoms fail to stop the spread of AIDS because intrinsic flaws, for example, holes in the latex, or because people with the virus use them unreliably? Or both?
Hanley: Well, there is still a failure rate, even if they are used perfectly and consistently; this should not be forgotten.
But the science tells us that condoms can provide a measure of protection – even if not as high as many have long claimed. This is what might be called theoretical protection. Inconsistent use does not confer that protection.
Despite persistent efforts by the AIDS establishment, they have not been consistently used by large segments of the population. So in practice, at the population level, they have not reversed African epidemics despite their theoretical effectiveness at the individual level.
Q: You point out that with other public health issues behavior change is encouraged instead of merely limiting risk, for example, smoking. No cigarette package is labeled "please use a filter." Instead, the message is to promote quitting. And yet condom use is seen to be the preventative measure against AIDS instead of abstinence. What do you think motivates this discrepancy in policy when it comes to the deadly virus?
Hanley: Yes, it is surely noteworthy that public health authorities have, on the one hand, taken aggressive, even authoritarian action by banning certain foods or mandating city-wide bans on smoking, which many feel are excessive restrictions.
The fact that they are mostly silent about sexual behavior -- which accounts for a host of other major epidemics in addition to AIDS -- indicates quite clearly that other things take precedence over their regard for the optimal health of the population.
When the good of health conflicts with the now decades-old project of absolute sexual freedom, we have seen quite clearly that there really is no contest. In fact, to suggest that people should limit their sexual behavior is to cross the cultural Rubicon; even officials to whom the public health is entrusted dare not contradict the prevailing ideological orthodoxy of modern western culture.
The power of that which is ungrounded in moral truth yet nonetheless nearly universally deemed to be the only acceptable thought today is what Benedict XVI has in mind when refers to the "dictatorship of relativism."
No one dares point out the obvious about AIDS prevention because that would be an act of gross insubordination – and one that does not go unpunished.
Q: Pope Benedict XVI has made the headlines recently with his remarks on the use of condoms. Many in the media and public health seem to believe that the Holy Father holds a dangerous position on condom use that only spreads the disease further. How would you respond to someone who says the Catholic Church is part of the problem not the solution to the end of the AIDS epidemic?
Hanely: First, the glaring inconsistency: are we really to suppose that great numbers of people do not use condoms because they heard somewhere that's not allowed, but nonetheless engage in the kinds of sexual activity proscribed by the Church in the first place?
Adopting the behaviors that the Church as well as other religions and traditional cultures recommend all but ensures a life free from AIDS; that certainly sounds more like a solution than a problem. Common sense behavioral adaptation to the lethal threat of AIDS has saved millions of lives.
Those who think the Church is an obstacle to AIDS prevention would be hard pressed to explain the failures of the secularized public health authorities.
Even a former UNAIDS employee recently provided a detailed account of the disingenuous and corrupt inner working of the agency; UNAIDS has an abysmal track record of manipulating data, suppressing inconvenient findings, and resisting sensible behavior change measures.
Their favored approaches have not reduced AIDS in Africa. Even in the Unites States, where "high risk" groups are very knowledgeable about "protection," HIV incidence has been constant for over a decade; this can hardly be counted as a success.
But the Church remains "a problem" not because of epidemiological trends, but because many reject its moral stance to begin with.
I would try to convey to a skeptic that the Church actually holds the human person in higher regard, and that what it proposes is humane, possible, and fulfilling.
It is important to recognize that the lines of demarcation here are moral and philosophical, not scientific; the debate over HIV prevention is not so much about what works or might work (though it is usually cast in this light), but rather over what is allowed, what is good for the human person – and what is not. These are questions that science does not address.
I would further try to convey that the policies the AIDS Establishment has pursued are in fact based upon a prevailing worldview – upon particular strains of thought.
We intentionally spent a fair amount of time in our book identifying and discussing the lethal mix of utilitarianism, relativism, and radical individualism -- not "science" -- which ultimately drives our HIV prevention policy.
Rigid adherence to these modes of reasoning has not served us well. We contrast them with the Christian view of the human person and approach to sexuality, which is often misrepresented or poorly understood.
We have tried to present the evidence alongside a critique of culture. If we come to a greater appreciation that our public health leaders are, much like other arteries of our culture, advancing particular ethical modes of thought rather than emphasizing common sense recommendations consistent with its discipline's own principles, then perhaps we can begin to make constructive adjustments.