HIV/AIDS EPIDEMIC: by Dr Kerrie AllenNews Weekly
Using common sense, not condom sense
, October 8, 2005
Sister Dr Miriam Duggan
has succeeded where the United Nations and international aid agencies have failed in combating Africa's HIV/ AIDS epidemic. She recently toured Australia as a guest of the Australian Family Association and spoke to Dr Kerrie Allen.I remember the conversation well. I was at university working on HIV/AIDS in the Caribbean. One of my public health colleagues and I were discussing prostitution in Third World countries with, of all people, a Catholic priest.
The priest was arguing that prostitution should be eliminated, and my shocked colleague was arguing that that couldn't happen because these impoverished women depended upon prostitution for their income. "But is it good for the women?" asked the priest. "Is it what's best for them?"
I always believed that, even if prostitution did provide incomes in poor countries often for whole families, it did immeasurable harm to the prostituted women.
However, the priest's comment made me question why Western nations thought only of handing out condoms to these prostitutes as the sole way of protecting them from HIV/AIDS.
I wondered how many Westerners really considered the consequences of keeping women in an occupation which endangers their lives.
How often have Westerners reacted to the tragic HIV/AIDS epidemic in Africa and unthinkingly jumped on the bandwagon of condom distribution?
How often have we seen the thousands of AIDS orphans and been solemnly lectured that stricken African countries needs more condoms?
Earlier this year, VicHealth's CEO, Rob Moody, savaged Melbourne's Herald Sun
columnist Andrew Bolt for arguing that the Catholic Church's teachings on sexual abstinence outside marriage and faithfulness within marriage had actually saved African lives (whereas condoms, which have a 15 per cent failure rate, just killed).
Moody's outburst is not surprising. Non-Christians generally assume that the Catholic Church asks the impossible; that freedom without restraint is the highest good; and that sexual self-control is impossible.
Here is where we can learn from the experience of a remarkable medical doctor, Sister Miriam Duggan, who has worked in Africa for many years fighting the spread of HIV/AIDS.
She recently toured this country, as a guest of the Australian Family Association, and spoke on the topic, "Abstinence and Faithfulness - the Ugandan Experience of HIV/AIDS prevention".
Dr Duggan, as well as being a qualified gynaecologist, is congregational leader of the Franciscan Missionary Sisters for Africa. She was medical superintendent of the main hospital in Uganda's capital, Kampala, in 1987, just at the time when the HIV/AIDS virus had infected 24 per cent of Uganda's population.
After four years of failed United Nations and USAID condom programs, HIV/AIDS infection soared to 30 per cent of the population.
The chief means of transmission was heterosexual promiscuity, owing to multiple partnering and adultery.
As the crisis deepened, Dr Duggan could see that the distribution of condoms only encouraged promiscuous behaviour and put more lives at risk.
With backing from the Ugandan Government, she began developing abstinence and fidelity programs, which focussed on changing attitudes and behaviours. She was confident that people were capable of changing if they were shown how to do so.
Her programs seek, first, to convince people that they need to change; but, more than that, that they have the capacity to change and that they can call on spiritual power to help them.Allegation
Dr Duggan dismisses the oft-repeated allegation that the Catholic Church has supposedly killed millions in Africa owing to its strict teachings prohibiting condoms. She responds: "Africa is only 7 per cent Catholic; so if you want to have sex with many or commit adultery, the Church isn't going to sway your mind at all."
The Ugandan program is founded neither on some out-of-touch church dogma nor on unrealistic ideas. Its success depends on convincing people of their own self-worth and the value of their brothers and sisters; their ability to change their behaviour and not give in to peer pressures; and the consequences of "freedoms" and choices.
Dr Duggan refers to psychologists' observations that people only fail to change their behaviour when they are not offered alternatives.
Since her program has been implemented, HIV/AIDS infections rates have declined dramatically - from 30 per cent of the population in 1990 to 15 per cent in 1997, 7 per cent in 2000, and 6 per cent in 2005.
In 1989, 25 per cent of men aged 15-49 reported engaging in commercial sex. In 2000, only 1.6 per cent of men in this age group paid for sex. The number of partners people have had also dramatically declined.
How did people realise they could change their lives and retain their virginity until marriage? Some of the issues which Dr Duggan's special workshops take people through include the following questions:
- What pressures are put on you and by whom?
- What do you understand as freedom and are you really free?
- What are the falsehoods and contradictions in your life?
- What are your values?
- Can a girl say "no" to sex? What will it cost her?
- Why do you have sex before marriage?
- What do you understand as "safe sex"?
- Where do you stand with your religion?
- What are your weaknesses and what are your strengths. How will you move to your goal? What do you need to put into place to help yourself?
People are thus taught that values, attitudes and behaviours are all dependent upon one another. Schoolchildren have reported that it is the media which promotes loose morals and promiscuity. And who is ultimately responsible for this? They tell Dr Duggan, "It's the adults who put it on, Sister."
Young people are also shown the statistics of HIV/AIDS, and are asked to draw pictures based on questions, such as "If we continue [in Uganda] with our present behaviour, what will be the situation for us in two or 10 years' time?"
Dr Duggan reports that their drawings often include orphans or morgues overflowing with bodies. She then confronts them with the question: "Are you in that picture, given your present reality now?"
The program then gets young people to consider what their friends may say if they change their lifestyles or choose to be virgins until marriage. What will this cost them?
They are especially encouraged to think about their own life as a precious gift from their parents for the procreation of their own children.
The program has also helped many prostitutes to discover their own dignity and value. Given the desperate poverty experienced by so many Ugandans, the program also teaches skills and trades which uphold the dignity of the women.
Thus the program not only focuses on behavioural change, but also addresses people's everyday economic needs too.
Much thought and work are also devoted to AIDS orphans and children grieving the loss of their parents.
Many African countries, which for years have seen condoms as the sole answer to HIV/AIDS, are at last seeing that they are losing the battle. They are increasingly turning to Dr Duggan's Ugandan program, seeing it as the only sustainable way to help their people.
But they face powerful opposition, as much United Nations and UNICEF funding is tied up with condom companies which stand to make more money if they can convince international aid agencies that condom-only measures should be the frontline weapon in Africa's battle against HIV/AIDS.
Dr Duggan describes how Uganda has fought against these agencies, which are unduly manipulated by condom companies. The UN's special envoy for HIV/AIDS obstinately refuses to acknowledge the evidence of Dr Duggan's successful abstinence and fidelity programs and is outraged by US President George W. Bush's support for these programs and his cut in funding condoms.
Australia itself can learn much from the Ugandan experience.
HIV/AIDS in Australia is largely found among homosexual men. Heterosexual people, however, have increasingly put themselves at risk, especially from sexually-transmitted diseases (STDs) like chlamydia, as they engage in promiscuous sexual activity from an earlier age.
Condoms are not the answer to these STDs, either in Australia or Uganda; they simply delude people into thinking that they can engage in risk-free sex with more people more often.
Some individuals in the UN have acknowledged the importance of discouraging multiple partnering and casual sex in order to combat the spread of STDs. One UN official recently attacked some of his colleagues' refusal to face facts:
"What has been most avoided is what is most needed ... Fidelity in marriage and abstinence outside of marriage must be the key elements in our response."
It is these areas in which the Australian government, churches and international aid agencies should concentrate their funds, so that people can be enabled to live healthy and dignified lives.
Dr Miriam Duggan especially recommends:
Dr Kerrie Allen is research officer for the Australian Family Association.
- Delayed onset of sexual activity until marriage.
- Marital faithfulness instead of adultery and multiple partnering.
- Sound values-based sex education.
- Leadership that promotes sound values.
- Role models that promote life.
- Fuller participation in the life of one's community.