Thursday, February 10, 2005

The Rebuilding of Montserrat, 5:
A Social HIV Vaccination

GEM 05:02:09a

The December 3, 2004 Montserrat Reporter led with a chilling headline: "Survey Reports 70% of MSS Girls Sexually Active." Now, while this headline is a bit sensationalist -- the body of the story simply says that the Ministry’s survey actually showed that the 70 % relates to the students as a whole -- we have to reckon with the implications of such statistics in an era of rampant HIV/AIDS.

For, if the statistics are even approximately true, we could easily lose a generation of promising young people to AIDS within a decade, the time AIDS can take to incubate.

Why? Because condoms are significantly less than 100% effective (if and when they are actually used), so habitual risky sexual behaviour tied to a false sense of security can actually worsen one’s chance of exposure to HIV infection. For instance: UN and other studies concede that these thin rubber sheaths fail in use, for one reason or another, some 10% of the time. [Cf. Hearst, Norman et al, "Condoms," in AIDS Policy and Law, Vol. 18 No. 13, (July 22, 2003); also, cf. Weller and Davis, "Condom effectiveness in Reducing Heterosexual HIV Transmission," Cochrane Review, No. 1 (2003).] So, basic probability theory tells us that if such condoms are used ten times, the chance of one being protected all ten times is actually only 35%: 90% of 90% of 90%, ten times over. (That chance is more or less the same as that for a really high-risk version of Russian Roulette: loading four rounds into the chambers of a six-shot revolver, spinning, cocking the hammer and pulling the trigger; while hoping to hear "click." Would you willingly make such a gamble with your life?)

Thus, it is no surprise to see that the only really remarkable AIDS success story, Uganda, is based on the ABC strategy: (1) abstinence till marriage, (2) being faithful to one’s spouse, and only after those, (3) condoms. As someone sums up, big-A, big-B, small-c. As a recent Heritage Foundation report on Uganda’s success story sums up:

"President Yoweri Museveni came to office in 1986 and quickly launched a frank and sobering education campaign about the deadliness of the disease and the hazards of irresponsible sex. It offered three clear options for avoiding death from AIDS: The emphasis for the majority population was on monogamy. The emphasis for youth was on abstinence. Condoms were offered as a last resort, mostly for high-risk groups. The message was delivered from middle-school classrooms to churches to community seminars and in radio, print, and television broadcasts . . . The effect was to create what researchers call a "social vaccine" against HIV: a set of cultural values that encouraged more responsible sexual attitudes and behaviors . . . . What happened in Uganda is that a lot of forces at one time were promoting more responsible sexual behavior, so you get to a social norm, a tipping point kind of thing. At some point all these messages, plus seeing more people dying, get people to change their sexual behavior." [ Loconte, J. ]

Let’s pause: the Ugandan ABC strategy has shown how to get a great many people to become more sexually responsible. In their case, that has reduced their -- catastrophic -- AIDS infection rates from 15% in 1991 to a current rate of 6% and falling. Nor is that just a matter of dying-off of victims: the successes include achieving significantly higher abstinence rates and delayed sexual initiation among the crucial 15 -19 year old secondary school age group. So, then, why is it that so many of the AIDS prevention efforts in the Caribbean so often seem to be "C-heavy" or even "C-only"? Will it take a sharply mounting death rate from AIDS to wake us up in Montserrat and the wider Caribbean?

Moreover, the Uganda case highlights that collaboration between the health authorities and the church can make a big difference to success in AIDS prevention, so the finger-pointing that sometimes pops up between AIDS activists and church leaders in our region is clearly counter-productive.

Finally, it is time to be frank: the MSS student statistics are also a challenge to our churches and our SDP Vision Statement’s claim that we are a God-fearing society. For, while over eighty percent of our population identifies with the churches, which teach us to "flee fornication" and to "honour marriage," the high incidences of early sexual activity and of out of wedlock births tells us that the Biblical teaching on family life and morality simply has not hit home in our own community – and, indeed, all across the Caribbean. Why is that so, and why in the teeth of twenty years of knowing that promiscuity is a major risk factor for deadly HIV infection – for which there is simply no cure?

Plainly, it is time for us to think again, to repent, and to find a better way to deal with AIDS, and also with sexual ethics, family life and Christian discipleship. The lives and souls of a whole generation are at stake.

So, now, let’s talk . . . AMEN

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