Journal Backs Condoms for HIV/AIDS Fight

Limitations on their use will cost lives, a Lancet editorial says

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By Steven Reinberg
HealthDay Reporter

THURSDAY, April 13(HealthDay News) -- The prestigious British medical journal The Lancet is calling for the widespread use of condoms as an effective way of preventing the spread of HIV/AIDS and as the best method to save lives.

The editorial, in the April 15 issue, also had harsh words for the Bush administration's abstinence-focused approach to battling the spread of HIV/AIDS.

"Health workers who have seen their patients, friends, and family die from this disease should not have to tip-toe around this ill-informed and ideologically driven policy," the editorial said.

In January 2003, President George W. Bush launched the President's Emergency Plan for AIDS Relief (PEPFAR), designed to generate $15 billion between 2004 and 2008 to fight HIV/AIDS in some of the poorest parts of the world.

One goal of the plan is to prevent 7 million new HIV infections by 2010. The cornerstone of this strategy is the so-called "ABC approach" -- Abstain, Be faithful, use Condoms, with the emphasis on A and B, over C.

PEPFAR requires that one-third of the money dedicated to HIV prevention must be spent on programs that promote abstinence and faithfulness and cannot be spent on promoting condoms.

Last week, the U.S. Government Accountability Office (GAO) concluded in a report that this strategy is causing problems for health workers trying to deliver care.

The Office of the Global AIDS Coordinator, which oversees PEPFAR, has developed guidelines for health-care teams to help meet the legal requirements. However, these guidelines are often ambiguous and some of those implementing the programs are confused about which population groups can be targeted with information about condoms.

This ambiguity has made health-care workers unsure whether they will lose funding if they answer young peoples' questions about condom use, the editorial states.

"PEPFAR is supposed to be an 'emergency' plan," the editorialists wrote. "It should be executed as such."

"The GAO report should prompt Congress to ask whether the $600 million ear-marked for prevention programs based on abstinence and faithfulness is an effective use of U.S. taxpayers' money. Many more lives will be saved if condom use is heavily promoted alongside messages to abstain and be faithful," the editorial concluded.

One expert agreed with the editorial.

"When good medicine and common sense are forced to take a back seat to rigid ideology, people suffer, as the GAO report clearly demonstrates," said Dr. Michael Horberg, the director of HIV/AIDS policy at the Kaiser Permanente Health Plan.

Another expert echoed Horberg's opinion.

"There is nothing new about turning science into politics. This has been going on for some time in this administration," said Dr. Joel Gallant, an associate professor and associate director of the AIDS Service at Johns Hopkins University School of Medicine.

"We should prevent HIV infection any way we can and that has been shown to work," Gallant said. "Condoms work extremely well. People are going to be sexually active and to talk only about abstinence is to ignore that fact. We have seen data that abstinence programs actually increase the risk that sex, when it does occur, will be unsafe."

But one outspoken supporter of an abstinence-first campaign disagreed with that notion.

"Don't trust the GAO report," said Wendy Wright, president of the Washington, D.C.-based conservative group Concerned Women for America. "You have to look at who they interviewed. The people they interviewed are people more wedded to an ideology of pushing condoms than to actually saving lives."

Wright doesn't think that condom distribution prevents the spread of HIV. She cited a failed condom program in South Africa and a successful abstinence program in Uganda.

"There is not only a lack of success for condoms," Wright said. "It's worse than that -- they are utter failures."

But Gallant said restrictions on condom promotion and use have already hurt HIV-prevention efforts.

"This idea that we should restrict condom use is absurd. Condoms work. To claim otherwise is to ignore scientific data over political and religious ideology," he said.

More information

For more on HIV/AIDS, head to the U.S. Center for Disease Control and Prevention.

SOURCES: Joel Gallant, M.D., M.P.H., associate professor and associate director, AIDS Service, Johns Hopkins University School of Medicine, Baltimore; Michael Horberg, M.D., director, HIV/AIDS policy, Kaiser Permanente Health Plan, Santa Clara, Calif; Wendy Wright, president, Concerned Women for America, Washington, D.C.; April 15, 2006, The Lancet

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