HSPH Prof. Arouses Condom Controversy

Faithful partnerships provide answer to AIDS crisis in Africa, Prof. and Pope say

Edward Green, the director of the Harvard AIDS Prevention Research Project and senior research scientist at the Harvard School of Public Health, drew attention last week when he agreed with Pope Benedict XVI’s statement that the answer to the African AIDS crisis lies in the promotion of faithful partnerships rather than increasing the availability of condoms.

“I knew that if I agreed with anything the Pope said it would cause a fire-storm,” said Green. “I took the opportunity to cause an uproar and focus on the evidence.”

Citing several studies published in peer-reviewed journals since 2004, Green said that empirical data does not support the idea that condoms are successful in decreasing the spread of HIV.

“The Pope may be right,” Green said. “The marketing and distribution of condoms won’t solve the problem. Partner fidelity has a much better chance.”

“Risk compensation” or the idea that people are more likely to engage in riskier sex and have multiple partners if they use condoms at least some of the time, is cited as one reason for the failure of condoms to slow the AID epidemic in Africa.

With brand names like “Shield” and “Trust,” Green said that the condoms marketed and distributed in Africa provide a false sense of security.

While Nick Danforth, a resident scholar at the Women’s Studies Research Center at Brandeis and affiliate of the Harvard AIDS Prevention Research Project, acknowledges an association between inconsistent condom use and higher HIV infection rates, he believes risk compensation is only one of several possible explanations.

In addition, people who know or suspect they are HIV positive are more likely to use condoms and people that would have more partners anyway are more likely to use condoms and become infected, said Danforth.

Later this week, a group of scientists including the several global AIDS experts, the United Nations, World Health Organization and World Bank will release a consensus statement stating that male circumcision and discouraging multiple and concurrent partnerships are the most important strategies for curbing the spread of HIV in Africa, though condoms distribution should be used as a secondary strategy.

Green identifies as agnostic but does advocate for the involvement of faith-based organizations in Africa both because many clinics and schools in Africa are affiliated with churches and because many religious scriptures promote faithful relationships.

Green pointed to a homegrown program in Uganda to combat AIDS, which emphasized fidelity and mutual monogamy. According to Green, fewer people had more than one partner in the previous year and the prevalence of HIV has decreased.

Swaziland and Botswana, the two countries that have the highest infection rates are now instituting similar programs.

But a number of Green’s colleagues do not completely agree with his conclusions.

“Right now condoms are the most effective means we have available for preventing the spread of HIV,” said Abdoulaye Dieng Sarr, a senior research scientist at the Harvard School of Public Health.

But Sarr added that AIDS workers in Africa should continue to do everything they can to slow the spread of HIV—both distributing condoms and promoting faithful partnerships.

Green insisted that he is not against condom use. “I am against saying that we are doing all that we can because we have exported so many cartons of condoms,” he said.