In many countries across the globe, marriage is a significant risk factor for women contracting HIV. Married women are often unable to negotiate condom use with their husbands; marriage is assumed to give men unlimited sexual access to their wives’ bodies; and the stigma of male infidelity isn’t nearly as strong as the stigma of female infidelity — to the point where in may countries (especially those which use Sharia law), virtually all prosecutions for infidelity are leveled against women, as pregnancy is used as “evidence.”
Which is why the Bush administration’s policy of promoting abstinence and marriage, and de-emphasizing condom use, is deadly.
This is an impoverished, authoritarian, war-ravaged country, but it offers an important lesson for President Bush and American school boards: Don’t fear those lifesaving bits of latex known as condoms.
Cambodia has become one of the world’s few success stories in the struggle against AIDS, and it has achieved that success partly by vigorously promoting condoms. This strategy has saved thousands of lives.
Cambodia has cut the prevalence of H.I.V. in adults from 3 percent in 1997 to about 1.8 percent today. In rural Cambodian towns like this one, billboards and posters promote condoms, and clinics and brothels have buckets of them. Health centers don’t have X-ray machines or oxygen tanks, but they have phalluses to show visitors how to put on condoms.
Nearly having the HIV infection rate is incredible progress. And while pushing abstience and marriage is certainly admirable, it ignores the social realities that many women live:
Here in Poipet, I met a 27-year-old woman with AIDS, Tem Phok. She had been a prostitute in a brothel, so I assumed that that was how she contracted AIDS. “Oh, no,” she said. “I got AIDS later, from my husband,” who has already died.
“In the brothel, I always used condoms,” she said. “But when I was married, I didn’t use a condom. … A woman with a husband is in much more danger than a girl in a brothel.”
That’s an exaggeration, but she has a point: It doesn’t do much good for American officials to preach abstinence and fidelity in places where the big risk of contracting H.I.V. comes with marriage. In countries with a high prevalence of AIDS, just about the most dangerous thing a woman can do is to marry.
Of course, this isn’t just an international issue: The Bush administration is promoting its backwards policies here, too.
But the Bush program has also been undermined by a resistance to condoms. The administration has taken information about condoms off government Web sites, and its AIDS prevention efforts abroad, when aimed at young people, have emphasized abstinence to the exclusion of condoms.
Likewise, in much of the U.S., social conservatives with administration backing have instituted “abstinence only” sex education, so that teens are encouraged to take “virginity pledges” but aren’t given a backup plan.
Careful studies of “abstinence only” programs in the U.S. suggest that they do delay sexual intercourse, but that young people are then less likely to use condoms afterward. The evidence indicates that a balanced approach — encouraging abstinence but also promoting condoms — is far more effective at protecting young people in America or abroad from sexually transmitted infections, including H.I.V.
Religious conservatives have been behind the war on condoms, but it’s important to note that many of the religious people doing the hands-on work with HIV-infected communities agree that condoms are the best way to go. It’s the people who are the mouthpieces for religious groups, and who don’t actually have to dirty their hands with those dead and dying from their policies, who are happy to claim that abstinence-until-marriage programs are successful.
In the past, social conservatives routinely cited Uganda as proof that it’s best to focus just on abstinence. It’s true that Uganda cut H.I.V. rates significantly, partly by promoting abstinence and fidelity — but also by promoting condoms. More recently, Uganda has been backing away from condoms, with U.S. support, and its H.I.V. prevalence is rising again.
Despite the hostility to condoms in Washington (and at the Vatican), in the field, even conservative missionaries tend to endorse them.
“Why should we be afraid of latex, when we see that it can save lives,” a Catholic nun in Cameroon told me, adding that her clinic hands out large numbers of condoms. She explained: “I just don’t mention that in my reports to the bishop.”
Thanks to Matt for emailing me the article, since my cheap ass can’t access TimesSelect.
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