Unfortunately the multinational company that I work for sponsors HIV/AIDS programs that give out condoms. I knew I had to write to the program co-ordinator, but I agonized over and over what point to make, knowing that it was likely my email would be ignored. Wise or not, the following is the fight I chose to fight. Maybe it will empower you to find out if your company is sponsoring, and write a similar letter (for example Global Business Coalition, gbcimpact.org/)).
World AIDS day came and went recently, and seeing Company XYZ’s involvement in this troubling epidemic, my interest in the topic was peaked. I started reading several of the links provided on the Company XYZ’s site. I’m very glad to see that Company XYZ is interested in helping to stem the HIV/AIDS epidemic in Africa (and elsewhere).
I am writing this email concerning a important pillar in most (and all of Company XYZ’s ) HIV/AIDS programs, the distribution of condoms. On the surface, the strategy should work, given the behavior of infected individuals does not change (except for proper condom use) and given condoms having any degree of protection against infection. However, while looking at Company XYZ’s resources, and outside resources, I could not find one sociological study claiming that increased condom availability resulted in fewer new HIV infections. While my search is not comprehensive, I am finding claims that new infections are on the rise where condom availability is increased. Needless to say, this is not what one would expect.
It seems that there is a problem with the way condoms are integrated into these programs, and this problem is widespread, not just in the initiatives Company XYZ supports. Because this is the status quo (and as I will suggest the common paradigm) I ask you to consider the merits of my point without any previous stereotypes.
Issue 1: Dangerously Ambiguous Message About Condom Effectiveness
When I read about the education these programs give out, in every case, unless one goes and reads the scientific studies on condom effectiveness (in preventing HIV infection), you are left with the impression that condoms are 100% effective. Using the reputable studies that Company XYZ provides, condoms when used perfectly, prevent HIV infection 90-95% of the time. In reality, with imperfect use (i.e. the current common application of condoms), studies say the number is around 80%! Given these facts, is it not negligent for Company XYZ to have condom dispensers without any warnings, or education programs without these facts? To sum up, it seems to me (please verify) that programs essentially say “condoms are effective in preventing HIV infection”. This is true, they are effective in the strict sense. Without a qualifier in the education programs, effective implies perfect (or close to perfect). To say condoms are effective is dangerously ambiguous when the current average effectiveness lies around 80%.
Issue 2: Condom Availability Not Showing HIV/AIDS Incidence Decline
My impression from the Company XYZ resources, is that every program mentions that condom availability is paramount to an effective HIV program. However, time and time again, no reference is given of a sociological study that shows HIV incidence going down with an increase in condom availability. Despite the lack of reference, time and time again, condom availability is touted as essential to any effective HIV/AIDS program. When one looks outside of the Company XYZ resources, the opposite seems to be the case. For whatever reason, the statistically expected result, that increasing condom availability/use would decrease the number of new infections (for the same time period), does not seem to be the case. Rather, abstinence/monogamy encouraging programs without condoms seem to be working (ex. Uganda).
Proposed Solution to Issue 1
Simply put, condom users must know the 20% chance of infection they are taking. This must be in the education program, and it must be on condom dispensing machines.
Proposed Solutions to Issue 2
It is unclear why condom availability isn’t working (please correct me if this conclusion is wrong). It is Company XYZ’s responsibility to step back and re-assess if this is infact true. If it is true, then radical changes to the manner condoms are integrated into programs need to be considered.
Perhaps the solution to Issue 1 will act as a solution to Issue 2 as well. In other words, with a true knowledge of condom effectiveness (and ineffectiveness), individuals will take less actual risks (that they previously did not perceive).
A more radical solution may be to withdraw condoms from HIV/AIDS programs altogether. The rationale behind this proposition, is that by distributing condoms, the irresponsible behavior is not challenged at its root (i.e. putting your partner at risk, when you know you have HIV), but rather the irresponsible behavior is in effect, encouraged.
These two solutions have different sociological reasons as their assumption; dangerous misinformation about condoms, or condoms encouraging irresponsible behavior. The real sociological reason for condom availability failing to reverse HIV/AIDS infection trends, may be a combination of the two sociological reasons.
Please contact me by phone or email to discuss this important topic. If my definition of the issues/problems has incorrect assumptions, please advise. Given that my research has led me to those conclusions, and that I am proposing a solution which could save millions of lives, I am compelled to follow through on these solutions; I cannot let them rest silent until I am convinced they will not help.