Tuesday, May 31, 2011

Vatican and UNAIDS Agree to Appear to Disagree

It seems that UNAIDS and the Vatican are sort of agreeing about condoms. UNAIDS haven't managed to persuade very many people to use them frequently and consistently enough to reduce sexually transmitted infection rates (STI) or unplanned pregnancies.

And the Vatican doesn't care whether STI rates or unplanned pregnancy rates are reduced as long as no 'sins' are seen to be committed in the process. But in most Catholic countries, especially rich ones, people take little enough notice of the preachings of the church.

The two institutions have a lot in common. They are both massively wealthy, unelected and virtually unaccountable, packed with some of the most educated people in their field, slow to change and often utterly oblivious to what goes on in the outside world.

The invitation of Dr Michel Sidibe, executive director of UNAIDS, to speak at a conference at the Vatican is seen as significant because the Vatican "usually only invites like-minded outsiders to its conferences and UNAIDS has not been like-minded on this issue at all".

I think that's an exaggeration. Sidibe may have come down on the side of condoms and stressed abstinence and marital fidelity a little less, while the Vatican has stressed abstinence and marital infidelity more and appeared to rail against condoms.

But both parties wish to influence the sexual behavior of poor people and seem hell bent on doing so. Both Sidibe and the pope know that talk about abstinence and marital fidelity are just talk. So far, UNAIDS have made do with putting a brave face on the results of their 'prevention' programs and the Catholic church has long had to put up with keeping the lid on reality.

Let's face it, neither institution has really aimed to reduce HIV transmission very convincingly. Both have done everything in their power to protect their own interests, although those interests are not always completely clear.

In truth, condoms are about all we have to reduce sexually transmitted HIV. There is a lot of talk about other measures, microbicides, pre-exposure prophylaxis, treatment as prevention, circumcision and probably a few others. But all of these are recommended in conjunction with the consistent and correct use of condoms.

Catholics have long ignored the pope's pronouncements about certain things, including contraception, abortion, homosexuality, pre-marital sex and much else. Even many of the popes own leaders have been shown to enjoy a varied sex life, even if their ways of expressing their sexuality might not be so popular among their followers.

If the technocrats and multinationals are even close to being right in claiming that one or several of their offerings will one day significantly reduce HIV transmission, at least in certain contexts, the two mammoths may even be able to publicly agree on things, about condoms, health, even sex.

That would be interesting because neither party would end up being able to control people's sexual behavior in the ways they might wish. If any of these technological solutions can reduce HIV transmission, any incentive to use condoms or adopt any of the other strictures of 'safe sex', imagined or otherwise, will disappear.

I don't think anyone seriously believes HIV will just be wiped out in the forseeable future. Sadly, HIV transmission is going to continue to be high enough to infect huge numbers of people, but mainly in developing countries.

There is a lot of enthusiasm for something that looks like a solution, preferably just one single measure, rather than a combination of measures. Sidibe calls 'treatment as prevention' a game-changer, but it might also result in the almost total irrelevance of these two vast institutions.

Now is not the time to start backtracking on condoms. HIV is a matter of health, something neither of these institutions know anything about. We badly need an institution that can represent the health related interests of people, especially poor people living in developing countries. We don't need any more vested interests stealing the health agenda. So let's kiss the Vatican and UNAIDS goodbye and start working on HIV.


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