Time to Re-enlist Science (and Condoms) in the Fight against AIDS

My favorite part of Barack Obama’s inauguration speech was "We will restore science to its rightful place and wield technology's wonders to raise health care's quality and lower its costs." Science and the scientific method – the process of making decisions based on observable, empirical and measurable evidence – have profoundly changed the way much of the human race (and even some of the luckier animals) live in this world.

Nowhere has the marginalization of science been more evident than in global HIV/AIDS policy. The AIDS virus has been lucky enough (or impressively crafty in its evolutionary development) to have a principle mode of transition that many people are afraid to talk about. The fact that controlling the spread of the HIV virus means talking about sex has been critical in the world’s general inability to aggressively and effectively fight the disease.

When I was in graduate school, I interviewed with a large Catholic international NGO for a fellowship to work on global HIV/AIDS projects. It seemed like a good opportunity and I seemed a good match. That is until I was told I would be expected to respect certain policies of the faith-based organization – basically that abstinence would be the key intervention, with no promotion of condoms included. Unfortunately I don’t respect that policy and obviously didn’t get the fellowship.

Nowhere are the results of turning our backs on science more telling than in Uganda, where a comprehensive and aggressive campaign of ABC (Abstain, Be faithful, use Condoms) helped dramatically slow the spread of AIDS in the country and made Uganda a model for AIDS control in Africa. Then, under pressure to emphasize abstinence and fidelity and deemphasize condom use, the “C” began to disappear from ABC. After reducing HIV prevalence rates from a peak of around 15% of adults infected in 1991 to around 5% in 2001, the rate has again begun to increase.

Two excellent PBS Frontline documentaries detail the evolution of global HIV/AIDS and the condom debate in Uganda.

While the reasons for Uganda’s successes and failures in controlling HIV/AIDS are not completely understood, it is clear that policy should be based on evidence rather than ideology. It is indeed time to restore science to its rightful place.