Drop condoms, change behaviour

I feel compelled to respond to the several outraged readers who opposed my view that promoting condom use in Africa was not the most effective way to deal with AIDS. Many felt I had no idea what life is like in Africa.

I feel compelled to respond to the several outraged readers who opposed my view that promoting condom use in Africa was not the most effective way to deal with AIDS.

Many felt I had no idea what life is like in Africa.

They are right. I am a white Canadian woman who grew up in the days of women’s liberation and the pill. However, I would like to do a simple distribution and cost-benefit analysis.

The average income for Africans is $1 a day.

Condoms, at the international price, cost 25 cents or less, but this cost does not include mass distribution.

Likewise, the existence of a condom does not guarantee its safe use. That requires education — and in a culturally diverse continent like Africa, it requires overcoming cultural norms.

For instance, there is no women’s liberation as we know it in Africa.

A woman cannot insist that her husband wear a condom.

One reader noted that condoms in Africa are intended for married women, to protect them from HIV/AIDS infected partners, and this is good in theory, but if the man will not comply, it’s all talk. And if the man will not abstain from multiple partners, the woman will be at very high risk.

Abstinence behaviour modification has been proven to work in Uganda where a widespread, aggressive campaign to encourage men to “zip up” and young people to wait for the right one has been very effective.

“Among women aged 15 and above, the number reporting multiple sexual partners fell from 18.4 per cent in 1989 to 8.1 per cent in 1995 to 2.5 per cent in 2000,” according to Harvard study anthropologist E.C. Green. Smaller but similar declines in male promiscuity were reported as well.

At the same time, while the average Ugandan girl becomes sexually active at the age of 17 — about one year older than was the case a decade ago — the rate of marriage among girls aged 15 to 19 is 76 per cent, compared with 37 per cent in neighbouring Kenya.

Most startling is the fact that the prevalence of AIDS in Uganda dropped from 15 per cent in 1991 to just over five per cent in 2001.

This was accomplished only by advertising/education campaigns to modify behaviour.

And what a great investment! Successful behaviour modification will last a lifetime where condoms are only good for one insertion. Talk about cost-benefit!

Anthropologist E.C. Green noted on this issue that “Condoms are marketed (for Africa) as if they are 100 per cent safe; but there is leakage, breakage, slippage, improper usage. . . . If condoms fail or aren’t used correctly or consistently just 20 percent of the time, if you don’t change your behaviour and keep running around, it may be just a matter of time before you’ll get infected.”

Likewise, let’s think about access.

Aside from the fact that many women in rural Africa have never even heard of condoms, there’s just no Wal-Mart where you can buy them by the box.

According to a 2001 paper in the British Medical Journal there is a significant “condom gap” in terms of provision.

Something like 724 million condoms are distributed annually in sub-Saharan Africa, providing 4.6 condoms for every man between the ages of 15 and 59. Wow, 4.6 good times a year. Some countries get a higher proportion — up to 17 condoms a year per man.To bridge the gap and bring every country up to the 17 condoms/per man ratio, the world needs to ramp up Africa’s condom supply to 265 billion at a cost of $1.9 billion a year. That would still only take care of 17 encounters. Talk about drought!

Behaviour modification can last forever. Condoms don’t even last the night.

Michelle Stirling-Anosh is a Ponoka freelance columnist.

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