Rethinking Aids Prevention

This is not another book about how AIDS is out of control in Africa and Third World nations, or one complaining about the inadequacy of secured funds to fight the pandemic. The author looks objectively at countries that have succeeded in reducing HIV infection rates...along with a worrisome flip side to the progress. The largely medical solutions funded by major donors have had little impact in Africa, the continent hardest hit by AIDS. Instead, relatively simple, low-cost behavioral change programs—stressing increased monogamy and delayed sexual activity for young people—have made the greatest headway in fighting or preventing the disease's spread. Ugandans pioneered these simple, sustainable interventions and achieved significant results. As National Review journalist Rod Dreher put it, Rather than pay for clinics, gadgets and medical procedures—especially in the important earlier years of its response to the epidemic—Uganda mobilized human resources. In a New York Times interview, Green cited evidence that partner reduction, promoted as mutual faithfulness, is the single most effective way of reducing the spread of AIDS. That deceptively simple solution is not merely about medical advances or condom use. It is about the ABC model: Abstain, Be faithful, and use Condoms if A and B are impossible. Yet deeply rooted Western biases have obstructed the effectiveness of AIDS prevention. Many Western scientists have attacked the ABC approach as impossible and moralistic. Some Western activists and HIV carriers have been outraged, thinking the approach passes moral judgment on their behaviors. But there is also a troubling suspicion among a growing number of scientists who support the ABC model that certain opponents may simply be AIDS profiteers, more interested in protecting their incomes than battling the disease. This book is a bellwether in the escalating controversy, offering persuasive evidence in support of the ABC approach and exposing the fallacies and motivations of its opponents.

This is not another book about how AIDS is out of control in Africa and Third World nations, or one complaining about the inadequacy of secured funds to fight the pandemic. The author looks objectively at countries that have succeeded in reducing HIV infection rates...along with a worrisome flip side to the progress. The largely medical solutions funded by major donors have had little impact in Africa, the continent hardest hit by AIDS. Instead, relatively simple, low-cost behavioral change programs—stressing increased monogamy and delayed sexual activity for young people—have made the greatest headway in fighting or preventing the disease's spread. Ugandans pioneered these simple, sustainable interventions and achieved significant results. As National Review journalist Rod Dreher put it, Rather than pay for clinics, gadgets and medical procedures—especially in the important earlier years of its response to the epidemic—Uganda mobilized human resources. In a New York Times interview, Green cited evidence that partner reduction, promoted as mutual faithfulness, is the single most effective way of reducing the spread of AIDS. That deceptively simple solution is not merely about medical advances or condom use. It is about the ABC model: Abstain, Be faithful, and use Condoms if A and B are impossible. Yet deeply rooted Western biases have obstructed the effectiveness of AIDS prevention. Many Western scientists have attacked the ABC approach as impossible and moralistic. Some Western activists and HIV carriers have been outraged, thinking the approach passes moral judgment on their behaviors. But there is also a troubling suspicion among a growing number of scientists who support the ABC model that certain opponents may simply be AIDS profiteers, more interested in protecting their incomes than battling the disease. This book is a bellwether in the escalating controversy, offering persuasive evidence in support of the ABC approach and exposing the fallacies and motivations of its opponents.

Ideological blinders have led to millions of preventable AIDS deaths in Africa. Dr. Edward C. Green, former director of the Harvard AIDS Prevention Project, describes how Western AIDS “experts” stubbornly pursued ineffective remedies and sabotaged the most successful AIDS prevention program on that ravaged continent. Drawing on 30 years of conducting research in Africa, Southeast Asia, and other parts of the world in international health, Green offers a set of evidence-based and experience-rich solutions to the AIDS crisis. He calls for new emphasis on promoting sexual fidelity, the only strategy shown by research to work. Controversial but important findings for health researchers, international development specialists, and policy makers.

This is not another book about how AIDS is out of control in Africa and Third World nations, or one complaining about the inadequacy of secured funds to fight the pandemic. The author looks objectively at countries that have succeeded in reducing HIV infection rates...along with a worrisome flip side to the progress. The largely medical solutions funded by major donors have had little impact in Africa, the continent hardest hit by AIDS. Instead, relatively simple, low-cost behavioral change programs—stressing increased monogamy and delayed sexual activity for young people—have made the greatest headway in fighting or preventing the disease's spread. Ugandans pioneered these simple, sustainable interventions and achieved significant results. As National Review journalist Rod Dreher put it, Rather than pay for clinics, gadgets and medical procedures—especially in the important earlier years of its response to the epidemic—Uganda mobilized human resources. In a New York Times interview, Green cited evidence that partner reduction, promoted as mutual faithfulness, is the single most effective way of reducing the spread of AIDS. That deceptively simple solution is not merely about medical advances or condom use. It is about the ABC model: Abstain, Be faithful, and use Condoms if A and B are impossible. Yet deeply rooted Western biases have obstructed the effectiveness of AIDS prevention. Many Western scientists have attacked the ABC approach as impossible and moralistic. Some Western activists and HIV carriers have been outraged, thinking the approach passes moral judgment on their behaviors. But there is also a troubling suspicion among a growing number of scientists who support the ABC model that certain opponents may simply be AIDS profiteers, more interested in protecting their incomes than battling the disease. This book is a bellwether in the escalating controversy, offering persuasive evidence in support of the ABC approach and exposing the fallacies and motivations of its opponents.

The author reviews the entire existing corpus of AIDS research, strongly challenging the HIV hypothesis. Deconstructing the conventional wisdom about AIDS, he then presents alternative "multifactorial" models, which view the disease as resulting from numerous synergistic - but controllable - insults to the immune system - HIV, but also drug use, anal exposure to semen, malnutrition, microbial infections - and autoimmune models, in which these insults initiate a civil war within the immune system itself.

As the HIV epidemic moves into its fourth decade, it is clear that the global response has failed to adequately address the needs of a wide range of vulnerable populations and groups. Chief among these are gay, bisexual and other men who have sex with men, and transgender persons, who globally face the disproportional burden of HIV infection. This volume rethinks HIV prevention and health promotion for sexual and gender minorities – in both the industrialised societies of the West, as well as in the developing nations of the Global South. The chapters it contains offer a critical analysis of past and present HIV research employing categories to designate gay and other men who have sex with men, transgender persons, and/or other persons and communities with diverse gender and sexual identities. Contributors question the politics of many of the existing classifications and categories in HIV research and argue for a more sophisticated analysis of gender and sexual diversity in order to tackle the social and political barriers that impede the design of successful HIV prevention and health promotion approaches. This book was originally published as a special issue of Global Public Health.