Wednesday, July 14, 2004

Bush And Sex

     The world health establishment is currently gathered in Bangkok for the 15th annual International Conference on AIDS. There, the United States and its key ally Uganda stand virtually alone in touting abstinence as an efficient, effective counter to the rapid spread of HIV, the virus that causes AIDS.
     To give credit where it is due, Uganda has, over the course of the past decade, reduced its infection rate from thirty percent to six percent. Despite the fact that the program succeeded largely because of a heavy emphasis on condom usage, Ugandan President Yoweri Museveni opened the conference by challenging the role condoms in the spread of AIDS, and instead once again pushing for abstinence as the primary means of controlling this epidemic. The Bush Administration has touted a similar plan, as over one-third of the money earmarked for combating AIDS is dedicated to faith-based groups providing abstinence education.
     Unfortunately, this is an unsound plan for making significant in-roads against the spread of AIDS. AIDS is caused by the HIV virus, a retrovirus with no known cure or vaccine. It is not caused by welfare queens, the collapse of the modern family, or surprisingly enough, gay marriage. In short, this virus does not discriminate on the basis of political affiliation, ideology, or quality of worldview. It is rather, quite happy to commandeer the immune system of any human person, cannibalize that person's T-lymphocytes for the purposes of its own replication, and slowly eat its host to death.
     There are, however, a suite of behaviors that lower the risk of being infected with the HIV virus. And certainly, abstinence, like the use of condoms, is one of them. But a measure of rationality must be applied here; will people really just stop having sex? Can people really stop having sex? The sex drive represents one of the most primal and animal forces that govern the behavior of humanity. Because it was evolutionarily beneficial to have a strong desire to procreate, the sex drive has been selected for and integrated into the human psyche at a very basic level. The blood-brain barrier is permeable to non-polar molecules, leaving the brain vulnerable to the influence of steroid hormones. People are going to have sex. It is difficult to be more blunt.
     Teaching people about the proper use of condoms and other STI prevention methods will not cause otherwise pure and chaste children to have wild, promiscuous sex. No more than seatbelts cause people to drive more recklessly due to a false illusion of safety. No more than physician-prescribed programs of diet and exercise cause patients to pursue hard drugs because they now have health to spare.
     The entire concept of abstinence being an effective counter to AIDS is predicated largely upon two notions. Firstly, the institution of consensual sex. Do all partners in the world have right of refusal for sexual relations? Do all partners have an equal share of power or leverage in a relationship? Is it fair to assume that every event of possible disease transmission is composed of two people that are the same age, ethnicity, employment status, socio-economic class, level of maturity, ad nauseum? The answer to the somewhat nauseating questions listed above is a resounding "no." Clearly, these conditions are not met. Clearly, there are people who have no choice in their sex lives. And the key point upon which abstinence hinges is choice.
     Secondly, the belief in island immunity in favor of herd immunity. The idea of island immunity is a relic from a simpler time, when the United States was largely isolated by land and sea from the rest of the world. Crop blights and influenza outbreaks did not transfer from Europe as readily, if at all. With globalization, the resevoir of infectious disease is now the entirety of humanity. The "herd" is now the population of the world. The spread of infectious disease relies upon so many interactions between so many agents that it is very difficult, even with the most advanced computer, to accurately model such events. However, events in other regions of the world are not fundamentally disconnected from the United States. Rather, they are inexorably linked. An AIDS crisis in Africa means an AIDS crisis in the world means an AIDS crisis in the United States. Thus, an unwillingness to fight AIDS in other countries with the safe and effective method of condom usage negatively impacts the public health of the United States.
      These two premises form a dangerous combination, one that threatens to leave our generation to face a world even more fearful of and less equipped to deal with the spectre of AIDS. To ignore the plight of others even at direct detriment to one's self is ridiculous. To leave global health up the choice of those who often have none is irresponsible in the extreme.


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