AIDS Delegates Differ On Condoms

Ugandan President Yoweri Musaveni addresses the morning session of the 15th International AIDS Conference in Bangkok, Thailand, Monday, July 12, 2004. Musaveni, credited with slashing HIV rates in his country, insisted Monday that condoms are not the ultimate solution to fighting the AIDS scourge, saying abstinence and loving relationships in marriage are even more crucial
AIDS conference delegates were deeply split over condoms Monday, with Uganda's leader drawing criticism for insisting they are less effective for HIV prevention than campaigns to promote abstinence and loving relationships.

President Yoweri Museveni's comments on the second day of the International AIDS Conference were in line with the policy of President Bush but at odds with a majority of researchers and AIDS activists at the meeting.

The conference opened Sunday with U.N. chief Kofi Annan challenging world leaders to do more to combat the raging global epidemic and warning that women are increasingly the unwitting victims of the disease.

Three years after world leaders pledged at the United Nations to defeat the epidemic, there has been progress on many fronts, Annan said in a speech to nearly 20,000 policy makers, scientists, activists and celebrities.

"And yet, we are not doing nearly well enough," he said, in the first appearance by the U.N. secretary-general at an International AIDS Conference.

"We need leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame. There must be no more sticking heads in the sand ... no more hiding behind a veil of apathy."

Several celebrities were in Bangkok in connection with the conference: American actress Ashley Judd, Hong Kong pop singer Coco Lee, and the new Miss Universe from Australia, Jennifer Hoggins. All three visited and met with AIDS victims and care providers.

"The $200-300 billion spent in Iraq probably could have eradicated this illness," actor Richard Gere — one of several celebrities at the meeting — told a panel discussion.

Condoms have been promoted as a frontline defense against AIDS by countries such as Thailand where a campaign to get sex workers to insist on condoms yielded a more-than-sevenfold reduction in HIV rates in 13 years.

An epidemiologist tracking Asia's emerging epidemics told conference delegates that additional countries — including China and Bangladesh — face HIV problems largely driven by prostitution, and that promoting condoms is best to block further spread.

"I disagree with (Museveni) ... Condoms are greatly shortchanged in Africa as a prevention method," said Tim Brown, of the Hawaii-based think tank East West Center. "If you increase condom use by 50 percent, I guarantee you that HIV will go down by 50 percent."

Uganda has waged a successful battle against the spread of HIV in a rare success story for sub-Saharan Africa — though some experts say it's unclear how that success has been achieved.

Museveni said loving relationships based on trust are crucial, and that "the principle of condoms is not the ultimate solution."

"In some cultures sexual intercourse is so elaborate that condoms are a hindrance," he told a conference plenary session. "Let the condom be used by people who cannot abstain, cannot be faithful, or are estranged."

Museveni — in a departure from many Western proponents of abstinence before wedlock — said marriage should be flexible, and that sticking with a relationship that has turned sour might mean that an unfaithful spouse brings home an infection.

"Ideological monogamy is also part of the problem," he said.

Uganda pioneered a strategy that later became known as "ABC" or "Abstinence, Being faithful, and Condoms" — in that order — a policy backed by Mr. Bush. Critics have said promoting condoms should come first.

Uganda has brought its infection rate down from more than 30 percent in the early 1990s to about 6 percent of the country's 25 million people last year.

Many conference delegates criticized the Bush administration's AIDS-funding initiatives for requiring that one-third of the money allotted for HIV prevention support abstinence-until-marriage programs.

"In an age where 5 million people are newly infected each year and women and girls too often do not have the choice to abstain, an abstinence-until-marriage program is not only irresponsible, it's really inhumane," U.S. Congresswoman Barbara Lee said, presenting a report by family planning group Population Action International.

Lee, a California Democrat, and other delegates urged the world's rich countries to spend more on condoms and other HIV-fighting programs for the developing world. Activists at a "Youth Speaks Out" session shouted "We want, We want Protection!"

Conference organizers set up a members-only lounge where HIV-infected people could relax and converse privately, while outside the venue, they set up colorful attractions such elephant rides and a replica of a typical Thai go-go bar — complete with female hostesses.

But events turned grim Monday when police said a man was trampled and gored to death by an elephant.

Some 25 million of the 38 million infected with HIV worldwide are in sub-Saharan Africa, but the virus is taking root increasingly in Asia, where 7.6 million are infected.

In Asia, the sex trade has been the main engine behind infections in countries such as Thailand and Cambodia, where epidemics exploded by the late 1980s — sparking aggressive responses including campaigns to boost condom use, said Brown, the epidemiologist.

Brown said countries including China and Bangladesh could face growing problems because their rate of condom use remains only about 10 percent.

Another key conference theme is getting more generic copies of the main AIDS drugs to the developing world.

The Belgium-based Medecins Sans Frontieres group warned that free trade agreements such as the one Thailand is negotiating with the United States could threaten that goal by imposing patent rules that block production of those copies.