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Record My Mind: Banal Records of a Pedestrian Life

Suffering and evil overwhelm me and I stew in my own juice. 

Friday, February 25, 2005

2/25/2005 01:56:00 am - Lessons from Uganda

Like Uganda, Singapore adopts the A (Abstinence), B (Being faithful), C (Condom) approach in dealing with AIDS. The futility of emphasizing A in this three-pronged approach is apparent in these two news article here (registration required) and here.

I believe the emphasis should be on C since those who are most likely to spread the epidemic are those least likely to abstain from sex. That group that must be a first priority target of the health authorities.

Reducing promiscuity is a laudable effort but the odds are stacked against the government since this amounts to overcoming a person's DNA, especially those who are inclined towards promiscuity. There will always be promiscuous people and some of them will be connectors who give birth to the tipping point (Malcolm Gladwell popularised this phrase in his book The Tipping Point. Summary here.) in any epidemic.

It is far harder for promiscuous people to fight against their DNA than for them to use a condom. If our objective is to control the epidemic and not let HIV infections go out of hand, this seems to be the path of least resistance. If our objective is to reduce promiscuity because it's morally repulsive, then we need to decide which is more important, the moral issue or the public health issue.

Although reducing your promiscuity means that you reduce your exposure to HIV, it does not mean that someone who is not promiscuous will not be infected and that all promiscuous people will be infected. It really depends on the protective measures being taken. It's not what you do, but how you do it.

Even more unfortunate and disagreeable is that the emphasis given to reducing promiscuity will result in the stigmatization of those rare, unfortunate souls who got infected with HIV but are not promiscuous. When the general judgement towards an AIDS patient is "That person is promiscuous that's why he/she has AIDS", ignorance is perpetuated. The outcome is unfounded prejudice against all AIDS patients.

Digression: How do we control a public health issue without blaming its victims is an important though neglected question that is discussed here. How often do we clearly isolate the political, the moral and public health issues when dealing with AIDS and human sexuality?

The counter argument against emphasizing C is to prevent a false sense of security. The Senior Minister of State for Health, Dr Balaji Sadasivan says here that "Condom use reduces the health risk significantly but it does not reduce the risk to zero. This is why the Ministry does not support a stand-alone condom use message for the general public."

Another concern is that young and impressionable people could get the wrong message, and promiscuity would become endemic in society, fuelling the spread of AIDS. I will only buy this argument if there is strong empirical support for it.

Also in the news last week: Fears of a mutant superkiller HIV strain that results in AIDS within three months of infection.

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