Ugandan doctor links African AIDS epidemic to Western sexual values

Kampala, Uganda, Apr 1, 2009 / 12:48 pm

Each day more scientists, researchers and doctors are voicing their support for Pope Benedict XVI’s statement that condoms are not decreasing the spread of AIDS in Africa. Dr. Filippo Ciantia, a Ugandan doctor who specializes in tropical medicine, told CNA that, “In every African country where there has been HIV prevalence decline, this has been preceded by decline in casual and multi-partner sex.”

Ciantia worked in Northern Uganda from 1980-1989, the critical years where an unidentified virus, now known to be AIDS, began to spread. He described in a 2006 paper, “The Victory of Reason,” what he had documented.

“I began to notice some young adults … [who] were severely wasted, with chronic diarrhea, skin rashes and fever. Others were affected by disseminated tuberculosis. I still recall that I hardly believed the results of the biopsy…we were faced with a new disease.” The name given to this disease in Uganda was “Slim Disease,” but after it was identified as HIV/AIDS, Dr. Ciantia related that “it was clear that there was no cure.”

The Ugandan Government eventually realized that this new deadly disease could quickly “wipe away our country,” he recalled.  In order to prevent its spread early on, the government produced the booklet, “Guidelines on Control of AIDS,” which stressed the need for behavioral change instead of marketing condoms.

Regarding condoms, Ciantia clarified that he has found “limited or no direct evidence” that the societal promotion of condoms has contributed to “the reduction or slowing down of HIV in generalized epidemics.”

In 1991, Ugandan President Yoweri Kaguta Museveni rejected “condom social marketing” and instead emphasized a behavioral change approach at an AIDS conference in Florence, Italy. He said, “…I have been emphasizing a return to our time-tested cultural practices, which emphasized fidelity and condemnation of pre-marital or extra-marital sex. Young people must be taught the virtues of abstinence, self control and postponement of pleasure and sometimes sacrifice...”

Museveni and others in the medical and social work community in Uganda urged this approach, which “led to an impressive mobilization of the entire society, single persons, groups, the Church and other religious organizations and associations,” said Dr. Ciantia.

The “epic of the people of Uganda,” as Ciantia called it, awakened “people to discover the full dignity and value of human life and love.” Though difficult at times, it was through the virtue of hope and the support of friends and family that behavioral change was able to occur, he said.

The three behavioral changes encouraged by the Ugandan plan--known as the ABC behaviors--are: abstinence, faithfulness and lastly, condom use by casual partners. Out of these three changes, Ciantia reported that the behavioral change that made the greatest impact appears to be “faithfulness or partner reduction behaviors by Ugandan men and women, whose reported casual sex encounters declined by well over 50 percent between 1989 and 1995.”

Overall, the result of this approach has been the dramatic reduction of HIV/AIDS in the adult population from about 18% in the late 1980s to 6.4 % in 2005.

Dr. Ciantia explained that there are three major lessons we can learn from Uganda.  First of all, we see that development occurs when the people are the subject of change.  It cannot be accomplished by just handing over “technical or scientific tools,” there needs to be a real involvement of the persons and communities.

We can also learn that fighting HIV/AIDS needs to be based on evidence and proper verification of facts. The evidence shows that the “Ugandan experience provides, in the time of the evidence-based medicine, an African lesson to the whole world,” the tropical medicine specialist said.

Finally, we see that the solution must focus on the human person and her/his responsibility and not just a general addressing the “masses” approach, Dr. Ciantia emphasized.

The opposition to these lessons “is really ideological,” he charged, pointing out that “we are facing smoking and alcoholism with strong primary behavior campaign[s] and seriously limiting personal choices (for a public and personal health benefit). But sexual behavior cannot be touched! This is real Western taboo.”

He closed by noting that the Holy Father “has been realistic, reasonable and evidence-based. All criticize him, but actual empirical [data] support his position.”

Dr. Ciantia has also published a letter along with several African colleagues further detailing the evidence for their postion. It can be read at http://www.catholicnewsagency.com/document.php?n=810