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Back to AIDS basics

FOR ALL the recent gains in making lower-cost AIDS drugs more available in the developing world, treatment efforts will be overwhelmed unless countries do a better job of prevention. It is encouraging that both President Bush and major nonprofit health organizations are sending the same message on the ABCs of prevention: abstinence, being faithful in marriage, and condom use when appropriate.

The president endorsed this approach at a recent appearance before a charitable arm of a predominantly black church in Philadelphia. It is not the first time Bush has endorsed condom use -- he did so last July while in Uganda, where health workers popularized the ABC approach to prevent the spread of the HIV infection that causes AIDS.

Still, for an administration that often seems to advance abstinence to the exclusion of other means in preventing both AIDS and unintended pregnancies, the president's words are a recognition that there is no single approach to slowing the worldwide spread of a disease that may have already infected as many as 40 million people. The challenge for the administration is to make sure that US policies down the line reflect the practical approach Bush defined.

US policy calls for one-third of AIDS prevention money in the president's AIDS initiative to go toward abstinence efforts in the African, Caribbean, and Asian countries that are targeted by the initiative. If such efforts include a large element of education about sexually transmitted diseases -- ignorance of the causes of AIDS is widesread in sub-Saharan Africa -- they might provide a benefit. But abstinence is not an option for married women in those countries, a high-risk group because of the unsafe sex practices of their husbands. Effective prevention for them means use of male or female condoms and, in the future, development of virus-killing microbicides.

To its credit, the US Agency for International Development will distribute 550 million condoms in the developing world this year, more than any other donor and a substantial increase over the rate during the Clinton administration. But, according to a calculation by Population Action International, low- and middle-income countries need 9 billion condoms a year and have just 2.5 billion. In sub-Saharan Africa, just 19 percent of males report using condoms with their "non-cohabiting" partners. In Southeast Asia, the figure is 13 percent.

Beyond the ABCs of AIDS prevention, US policy should encourage greater efforts in universal education, reproductive and general health, and economic development. Studies have found that in societies that invest in these areas, especially the education of women, rates of HIV infection are substantially lower. The ABCs are just first steps in fighting this disease. 

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