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Of elephants and AIDS

Page 2 of 2 -- In an interview last week, Bush's AIDS coordinator, Randall Tobias, said, "We're trying to use every tool that's available." He meant there is a role for all elements of the "ABC approach" to AIDS prevention first popularized in Uganda: abstinence, being faithful, and condoms.

Abstinence is not a realistic option for a young woman in sub-Saharan Africa who has been married off to an older man who engages in risky sex practices. But UN Secretary General Kofi Annan in his opening-day address used the word abstain in calling on men to be more responsible in their sexual behavior and to free themselves of cultural stereotypes and expectations about female subordination in the home.

Dr. Ernest Darkoh, manager of Botswana's AIDS program, also talked about the failure of health officials to take on men's role in transmitting the virus. "I don't hear people saying, 'Do something about the men,' " he said.

More freedom for women
Even the ABC approach is too limited for a virus as frustratingly invulnerable to a vaccine as HIV has proven itself. The word vaccine was not even mentioned during the official opening speeches. Scientists are said to be five to seven years away from developing a vaginal microbicide that women could use to protect themselves from men who don't heed the message of sexual responsibility and refuse to use condoms. Beyond that line of defense, women -- and society at large -- would benefit if more resources were invested in their education. This would free them from the economic imperative of early marriage to older, prosperous men or prostitution, with the great risk that it carries of HIV infection.

During the conference, these and other issues were debated against a backdrop of the parading elephants, young Thai women modeling dresses made of condoms, and Nelson Mandela speaking eloquently of the TB that afflicted him in prison. He called for more funds for treatment of TB, an opportunistic infection that flourishes when HIV patients' immune systems are weakened. In the same exhibition hall where drug maker Roche touted the virtues of its $16,000-to-$20,000 per year Fuzeon treatment for failing AIDS patients who have run out of options, a 16-foot motorized condom blimp floated overhead, advertising an HIV prevention measure that costs pennies to manufacture.

There is talk of ending or scaling down the biennial AIDS conferences. This would be a mistake. World leaders long ignored this deeply stigmatized disease, which in its initial stages lies so quietly that many are unaware they carry the virus and could be infecting others. There is much to be gained from so many victims and fighters of AIDS meeting in loud, and sometimes rude, circus-like gatherings to confront a disease that owes much of its lethality to silence.


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