Monday, July 12, 2004
To me, the question of the best methods of HIV prevention seems to be one about "elimination" versus "management". The ABC approach has the advantage of honesty and effectiveness: abstinence is a much more solid first line of defense than a condom. But, of course, not everyone is going to do it. And that's where CNN comes in.
But I have a problem with the CNN approach: it doesn't really seek to modify the risky behaviour, only to mess with the probabilities. Condoms aren't 100% effective, and you're not going to have a needle exchange on every street corner (I really don't know what the last N, "negotiation," actually mean). For a disease that depends so much on what people do to propagate, a management game plan like this seems to lull in a false sense of security.Take, for example, this line from Congresswoman Barbara Lee:
"Abstaining from sex is oftentimes not a choice, and therefore their only hope in preventing HIV infection is the use of condoms," she added.Honestly, I find the decision of abstinence seems to be the more easily controllable one: either party can refuse to have sex, but putting on the wrapper seems to be the at the whim of the one with something to wrap.
But then, I'm not stupid enough to think that a heroin-injecting prostitute is going to be receptive to the ABC approach.
Cultural differences will play a role in deciding what methods are best in what regions. I imagine that the more Christianized sub-Saharan Africa would be in a better position to accept ABC, while CNN may be the best one can hope for in southeast Asia (please do not flame me for cultural insensitivity: it's called a generalization). But demonizing one method or another is ridiculous.I think this bit pretty much says it best.
Helene Gayle, head of AIDS programs for the Bill and Melinda Gates Foundation, said one approach was not better than the other. "The debate is more distracting than it needs to be because we need to get on to the business of saving lives."