AS
A
NEW
member
of
the
Presidential
Advisory
Council
on
HIV/AIDS,
I
want
to
respond
to
some
comments
fellow
anthropologist
Doug
Feldman
made
about
me
in
this
publication.
(“Critics
say
Bush
choice
for
PACHA
advocates
abstinence,”
news,
Aug.
22).
I
have
been
engaged
in
a
public
debate
with
Feldman
about
AIDS
for
months.
He
recently
contacted
the
Washington
Blade
to
make
the
claim
that
I
support
“fidelity
only”
programs
and
that
I
dismiss
condom
promotion
as
“a
waste
of
time
and
money.”
I
have
never
said
anything
like
this.
My
research
findings
from
Africa
have
been
very
unpopular
among
American
condoms-only
advocates.
What
I
found
in
Uganda,
for
example,
is
that
HIV-infection
rates
were
already
declining
before
American-supported
programs
of
condom
social
marketing
and
treatment
of
STDs
had
begun.
That
means
something
other
than
the
standard
package
of
interventions
was
probably
responsible
for
declining
infection
rates.
Those
who
work
in
the
AIDS
prevention
industry
did
not
want
to
hear
this.
And
because
there
is
a
highly
political
debate
in
America
over
condoms
vs.
abstinence,
Feldman
thought
he
could
do
damage
if
he
accused
me
of
pushing
“abstinence
only,”
even
though
I
never
promoted
this
nor
have
most
Ugandans
been
abstaining.
In
fact,
anticipating
the
wrath
of
colleagues,
I
almost
kept
silent
about
Uganda.
But
then
HIV-prevalence
rates
kept
rising
in
most
countries,
while
they
continued
to
fall
in
Uganda.
WHAT
WAS
GOING
on
there?
What
I
and
a
few
other
researchers
willing
to
speak
out
found
is
that
Ugandans
were
having
fewer
sexual
partners,
and
teenagers
were
waiting
until
they
were
a
bit
older
to
initiate
sex.
Indeed,
the
early
national
response
to
AIDS
in
Uganda
emphasized,
“Stick
to
one
partner,”
and
“Love
faithfully.”
Yet
Americans
and
other
foreign
experts
had
begun
advising
Africans
that
condoms
were
the
“only
proven
intervention.”
Reacting
to
Western
advice,
Ugandan
President
Museveni
said
in
1990,
“We
are
being
told
that
only
a
thin
piece
of
rubber
stands
between
us
and
the
death
of
our
continent.
I
feel
that
condoms
have
a
role
to
play
as
a
means
of
protection,
especially
in
couples
who
are
HIV-positive,
but
they
cannot
become
the
main
means
of
stemming
the
tide
of
AIDS.”
Condom
use
in
Uganda’s
general
population
today
is
about
as
low
as
it
is
throughout
Africa,
but
condom
user
rates
are
quite
high
(59
percent)
among
those
men
who
still
report
having
causal
sex.
Let
me
emphasize
that
I
am
simply
reporting
what
occurred
in
Uganda.
Before
I
first
went
to
Uganda,
I
also
shared
the
view
of
most
my
colleagues
that
a
strategy
based
on
reduction
in
numbers
of
sexual
partners
was
unrealistic
in
poor
countries
where
women
have
little
power,
there
is
a
transactional
dimension
to
sex,
and
polygamy
abounds.
Yet
when
people
are
facing
the
possibility
of
dying,
they
can
do
remarkable
things.
“Love
faithfully”
was
the
main
message
and
the
main
behavioral
response
in
Uganda,
and
HIV
prevalence
fell
by
66
percent,
whether
or
not
Americans
approve
of
the
way
this
came
about.
NOW
WHAT
DOES
this
have
to
do
with
America
and
with
gay
men?
I
am
not
sure,
to
tell
the
truth.
It
appears
from
recent
surveys
and
op-ed
articles
by
gay
journalists
and
scientists
that
there
is
quite
a
bit
of
casual
sex
and
barebacking
these
days,
more
than
there
was
in
the
latter
1980s.
Infection
rates
seem
to
be
rising
again.
What
to
do?
Urge
more
condom
use?
This
cannot
be
the
whole
solution.
We
now
know
condoms
are
not
as
protective
as
we
once
thought
they
were.
A
recent
meta-analysis
of
many
studies
found
that
HIV
seroconversion
occurred
in
approximately
20
percent
of
couples
who
used
condoms
consistently
in
vaginal
sex.
And
if
anything,
“condom
integrity”
is
more
challenged
during
anal
sex.
Whatever
we
say
about
condoms,
it
is
safer
to
have
fewer
sexual
partners.
There
are
many
monogamous
gay
couples.
I
think
we
all
know
from
common
sense
and
from
personal
experience
that
those
people,
gay
or
straight,
who
have
less
casual
sex
are
less
likely
to
become
HIV
infected.
This
should
not
be
about
moralizing
or
curtailing
anyone’s
sexual
or
political
freedom.
This
is
just
the
epidemiology
of
an
infectious
disease.
I
believe
in
giving
people
all
the
facts,
and
then
letting
them
decide
what
to
do.
Edward
Green,
a
D.C.
native,
is
a
senior
researcher
at
the
Harvard
School
of
Public
Health
and
was
recently
appointed
to
the
President’s
Advisory
Committee
on
HIV/AIDS
(PACHA).
He
can
be
reached
through
this
publication.
