"There is always a philosophy for lack of courage."—Albert Camus

Monday, April 30, 2007

Dang. Abstinence Fails Yet Again...

Vice paid its tribute to virtue again the other day, or however the saying goes, when Bush’s chief of the $15 billion African AIDS initiative, which pushes abstinence, got outed as a consumer of professional sex services.

Although it must be, um, liberating to have little in the way of standards, I wouldn't deny anyone their schadenfreude at someone else violating theirs. It's only human, both the failing and the schadenfreude.

But let's not pretend that the "reasonable" people have any genuine enthusiasm whatsoever for the concept of abstinence. If they did, they'd be disappointed, not gleeful, that Randall Tobias failed his duty:

It’s denied by no one that only abstinence can prevent AIDS. The ideal, the 100% solution.

The agreed-upon protocol for AIDS prevention, and generally held across the ideological spectrum to have effectiveness , has been ABC: Abstinence (for the single), Be faithful (for the married partnered), and, of course, Condoms.

However, since the American education establishment might fairly be regarded as “progressive,” as is the western social science community, which includes those NGOs (Non-Governmental Organizations, better understood as secular do-gooders as opposed to religious do-gooders) who prowl Africa, you have to wonder about the "progressive" commitment to abstinence as a desirable thing. This is the 21st century after all, not the 19th, and tradititional sexual moralities are so, I dunno, bourgeois.

I expect the average progressive ABC program goes something like this:

"Be careful about who you have sex with. Don't just sleep with any old body. The more careful you are, the more you know about your partners, and the less casual your sex, the safer you are.*"

Now that we’ve got that out of the way,

“…people are going to have sex whether or not they're taught about abstinence, as studies show. So teaching people how to have sex in the safest manner possible is therefore better than teaching them nothing about how to more safely have sex.*”

So here’s how to use a condom…

There’s been a spate of sociology lately indicating that abstinence programs are ineffective, and that should not be dismissed out of hand. However, the objections to abstinence were a dogma of their own and started well before any survey results started trickling in. People are going to have sex anyway.

But the hole in the condom, if you will, is that they aren't 100% effective, and 90% is pretty much as generous as estimates get (and 5-10% less in male-to-male relations).

It might be true that Africa could be educated more deeply on proper use and into a better percentage, but the fact remains that in the media- and sex education-saturated US, the failure rate of condoms is pretty much the same. By the light of reality-based metrics, how much improvement we can reasonably expect is questionable.

Further, even if the use of condoms could be successfully be framed as safer (although still not safe) sex, the failure rate in the face of a fatal disease is unacceptable by any standard we use for safety in any other hazardous situation, like crossing the street or climbing a ladder.

If my understanding of the math is correct, condom failure rates are annualized: If you have sex even with a condom in Botswana---where 35% of the population is already infected---your risk of exposure over 10 years is 35%. Not good. In fact, since condom failure rates are calculated by the resulting pregnancies, not by actual failure and trickle-down theories, "exposure" might not fully describe the awful truth.

Which brings up an imaginary dialogue with me playing both parts (since lefties aren’t as game as Socrates’ foil Thrasymachus in Plato’s Republic):

If you had a pill that could make smoking safe for 90% of people, but would leave the others at grave risk, would you still dispense it?


Would you stop urging people to quit smoking?

---That’s ridiculous.

Would you be afraid that dispensing the pill might make people less apt to quit?

---Human nature being what it is, I'd have to say that's possible, if not likely.

That people might actually be less afraid to take up smoking?

---Again, human nature being what it is...

If anyone could tell me with a straight face that some progressive person or NGO could teach abstinence in the US or Africa with the same passion as they could an anti-smoking class, perhaps I'd change my mind. But most would admit that’s a laughable mental image.

Turns out that the right isn't the only side capable of cultural imperialism. And if I felt they'd done the math on the true risk of sex in Africa even with condom use, and had a true appreciation of just how many deaths a 10% failure rate amounts to, I wouldn't be writing on this, and neither would Harvard researcher Edward C. Green. This is his opinion/account of Africa being used as a proxy battlefield in the West’s own culture war (do read the whole thing):

Condoms have been regarded as the first line of defense for everyone, everywhere, and anyone who disagrees with this orthodoxy has been dismissed as a religious fanatic with ‘an agenda...'

...reality is very different from the Western experts' perception. Surveys today suggest that more than half of African males and females between the ages of 15 and 19 are abstaining from premarital sex, and increasing proportions of adults are having sex with only one partner. Yet few who work in AIDS prevention have called attention to these important trends, perhaps because they contradict the image of the hypersexed African that Western AIDS experts have been selling since the beginning of the AIDS pandemic. They depict Africans as "polygamous by nature," and supposedly so driven by hormones and poverty that commercial and transactional sex, and the inability to make responsible decisions about sex, are simply part of what it means to be African. If you accept this condescending view, condoms seem to be the only realistic solution to AIDS.

The trouble with the image of the hypersexed African is that it was never true for most Africans. Meanwhile, sexual behavior in Africa has changed. Not only in Uganda, but also perhaps in Senegal, Kenya, and elsewhere, abstinence and faithfulness have worked better than condoms. I document the evidence for Uganda and Senegal in detail in my 2003 book Rethinking AIDS Prevention. I also show that in about 1999, Kenya switched to a Uganda-style approach. In the past four to five years, casual sex on the part of Kenyan men and women has declined by about 50 percent, and HIV infection rates have fallen...

For the record, I don't necessarily accept Green's proposition that A and B are even occasionally more effective than C. But it issues a serious challenge to abstinence being a lost cause, that people can't or won't adopt new behaviors. Indeed, C, trying to get people to use condoms, stakes many lives on the belief that people will.

The New Papacy, of modernism, of sociology, of statistics, must be content to work from worst to best on hopes of a better average. But that approach never gets anywhere near its destination, because what is not easily and universally achievable, the best course, must be discarded. We’re realists, after all, and there’s no time for idealism.

Fair enough, but we cannot surrender the conduct of human events over to (by definition) mediocrity, or more etymologically correct, the meanness of the social sciences. No society can survive by aiming toward the lowest, by being happy just to bail water.

As a matter of little-known fact, the Bush Africa AIDS program is not "A only"---it just guarantees a certain level of funding for abstinence programs because nobody else in the world will. It's been made out as “A only” by proponents of “C only” because they want abstinence to fail; I must suspect that they are doing everything possible to make sure it does. If they were solely, and properly, concerned with African lives, they’d bite the anti-bullet and tolerate even religion being enlisted into the cause. But if abstinence saves just one life…

(No, I don’t think that riff will work. Oh, well.)

I myself don’t know anyone on the right who’s opposed to the distribution and instruction in the use of condoms. (Such folks exist, of course, and likely believe Elvis is still alive too. No offense.) But the rest of us wouldn’t stop passing out Kevlar vests to our troops, although if it led to overestimating their effectiveness and therefore to unnecessary risks, concern for their lives would require that we emphasize their failure rate over and over.

And, of course, if there were a 100% guaranteed way of not getting shot, we would make that the primary focus of their education.

But those who favor the Kama Sutra and disdain the Bible don’t feel that way. They don’t want bourgeois sexual morality to prove out, for abstinence to succeed, and God forbid that the Bible regain any traction, even tangentially.

In this reality-based age, where every bean can be counted and the social sciences are both king and queen, such a thing would be intolerable. But the Golden Age of Sexuality that today's progressives and their ideological spawn revere---the Fifties to the Eighties of the past century---of liberation, of contraception and penicillin, where all sex was consequence-free, is gone. Dead and gone.

It all seemed so sweet at the time, but its taste now is of ashes.

*actual quotes

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