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Discord over 'ABC' at Aids conference
The Guardian (UK)
July 04, 2004

http://www.guardian.co.uk/aids/story/0,7369,1259417,00.html

The debates over the effectiveness of condoms in cutting infection rates and the impact of free trade agreements on low-cost generic drugs dominated proceedings today at an international Aids conference in Thailand.

Ugandan president Yoweri Museveni, whose country has seen a substantial recent decrease in Aids infection rates, told delegates that the promotion of abstinence and faithful relationships should come before condom use. Mr Museveni said loving relationships based on trust are crucial, and that "the principle of condoms is not the ultimate solution".

His comments angered many Aids campaigners, who feel condom use is the key to cutting infection rates, particularly in societies where men frequent prostitutes.

An epidemiologist tracking Asia's emerging epidemics told conference delegates that countries including China and Bangladesh face HIV problems largely driven by prostitution, and that promoting condoms is the best strategy to block further spread.

"I disagree with [Mr Museveni] ... Condoms are greatly shortchanged in Africa as a prevention method," said Tim Brown, of the Hawaii-based think tank East West Center. "If you increase condom use by 50%, I guarantee you that HIV will go down by 50%."

Barbara Lee, a US Democratic congresswoman, told delegates: "In an age where 5 million people are newly infected each year and women and girls too often do not have the choice to abstain, an abstinence-until-marriage programme is not only irresponsible, it's really inhumane."

Condoms have been promoted as a frontline defence against Aids by countries such as Thailand, where a campaign to get sex workers to insist on condoms yielded a more-than-sevenfold reduction in HIV rates in 13 years. But US president George Bush has required that one-third of the US funds allotted for HIV prevention support abstinence-until-marriage programmes, prioritising them over condoms.

Uganda, where the battle against the spread of HIV provides a rare success story for sub-Saharan Africa, pioneered a strategy that later became known as "ABC" or "abstinence, being faithful and condoms" - in that order, a policy backed by Mr Bush. The country has brought its infection rate down from more than 30% of the country's 25 million people in the early 1990s to about 6% last year, though some experts say it is unclear how that success has been achieved.

"In some cultures, sexual intercourse is so elaborate that condoms are a hindrance," Mr Museveni told a conference plenary session. "Let the condom be used by people who cannot abstain, cannot be faithful, or are estranged."

However, Mr Museveni's approach was not entirely what Christian pro-abstinence campaigners in the US would want to hear. He told delegates that marriage should be flexible, and that sticking with someone when a relationship turns sour might mean that an unfaithful partner brings home an infection. Ideological monogamy is also part of the problem," he said.

Also today, medical charity Médecins Sans Frontières warned that the HIV generic drug industry in developing countries is being threatened by free trade agreements, such as the one Thailand is currently negotiating with the United States.

The group urged Thailand to stand firm in the negotiations and not concede any of its rights to produce cheap generic drugs.

In a bid to protect its giant pharmaceutical companies, the US will try to impose US patent laws in the free trade agreement, as it already has in the deal it signed with Singapore last year, said Paul Cawthorne of Médecins Sans Frontières.

"If the Thais sign such an agreement, they will have to close down their generic drug production," Mr Cawthorne told a news conference.

Proponents say low-cost generic copies of the main Aids drugs are crucial in making the medicine affordable in poor countries. Big pharmaceutical companies say it is unfair that, having spent billions of dollars developing these medicines, they should not see any profit from them.

According to the World Health Organisation, 6 million people in poor countries need antiretroviral treatment, but only 5% of them are getting it.

World Trade Organisation rules allow countries to ignore foreign patents and produce copies of expensive drugs in times of health crises, but there is nothing to prevent bilateral trade agreements from imposing patent restrictions. Brazil, one of the biggest producers of generic drugs, has refused to sign a free trade agreement with the US because of this issue.

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