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Do sexual abstinence and marital fidelity help in the global fight to prevent the spread of HIV? Public health expert Edward C. Green, a senior research scientist at Harvard University and author of Rethinking AIDS Prevention, has studied the spread of HIV and AIDS in southern African since the late 1980s. His analysis of the now-famous A-B-C strategy (abstain, be faithful, or use a condom) suggests a strong, causal link between this prevention strategy and the major reduction of HIV cases in Uganda.

But new research from Columbia University researchers found no evidence that abstinence and fidelity caused the overall decline of HIV in Uganda between 1994 and 2002. The study reported that increased use of condoms and the death of AIDS patients resulted in fewer HIV cases. Green rejected those new findings during an interview with Tim Morgan, Christianity Today's deputy managing editor. (An edited transcript.)

What's your reaction to new field research casting doubt on the role of abstinence and fidelity in lowering HIV in Uganda?

Every two or three years, somebody does a study comparing behavior in Uganda between the mid-1990s and now. And it's the same old stuff. Most behavioral change in Uganda was in the latter 1980s and early 1990s.

So benefits to public health from fewer people with HIV in that earlier period carried beyond the mid-1990s?

The first thing that happens is the rate of new infections goes down quickly when you're changing your behavior. And that's called the incidence rate. So the incidence rate started going down in the later 1980s and early 1990s and then it's the dynamics of epidemics that even if you don't really do anything after that, prevalence continues to go down for a number of years after the major fundamental behavioral changes of that sort.

Somehow the headlines coming out of regarding this report are: Abstinence doesn't work, but increased use of condoms does work.

It's bouncing all over the internet, those very headlines. All over the world is the headline: "Condoms work, abstinence doesn't." It's nonsense.

We know that the Bush administration has put big money into abstinence and fidelity programs throughout Africa. Do you suppose this kind of flawed news coverage is going weaken that resolve?

Yes, it may weaken the resolve. The spinmeisters make two claims about the study. One, since condoms went up and prevalence continued to go down, condoms made prevalence go down. We know that's not true because condoms went up in every country in Africa and in several countries condom user levels went higher than Uganda and infection rates didn't come down, they went up. We know the statement that condoms worked is not true.

Then there's another claim: When people die off, prevalence goes down because of death. That's also not true because infection rates and levels of death, however you want to measure them, have gone up higher in other African countries and prevalence hasn't come down.

Within Uganda in some parts, prevalence went up to 30 percent. In other parts, it only went to 4 percent and then it went down. It went down uniformly throughout Uganda. Uganda is actually a constellation of different mini-epidemics, all of which had sort of different dynamics. Some went up to 30 percent; others went up to 4 percent, and they all came down.

Does that mean another factor caused the HIV decline? You point to abstinence and fidelity.

I said it in my 2003 book that the single most important behavioral change was fidelity, and most of that is marital fidelity. It wasn't actually abstinence. Most Ugandans are between the ages of 15 and 49, and that's where we measure disease and behavior; most Africans, including Ugandans 15 to 49, are not abstaining. Most of them are, in fact, married and sexually active. But the difference is they've become monogamous and faithful. That's the big change. The second change is the proportion of youth engaging in sex, that went down in a big way between the latter 1980s and the mid-1990s.

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March (Web-only) 2005, Vol. 49