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Now, abstinence and fidelity are down nationwide in Uganda.

Oh yeah. We know it's countrywide. We outside experts, we donors, we world health organizations, all the funding organizations from the West, we've tried to steer Uganda away from the original program and tried to force them to conform to what we think is the way to prevent AIDS, which is condoms, drugs, and testing. So Uganda's national program has moved away from the focus on faithfulness and abstinence in recent years.

Will that program shift set in motion more HIV?

I think it will. That study we're talking about showed there were lower levels of abstinence and faithfulness in recent years. That's not good news. I know it's because the official program used to be to promote abstinence and faithfulness. If you read current documents, which are heavily influenced by outside groups that fund the programs, there's no abstinence and no faithfulness in the documents anymore.

In Uganda, are more people engaging high-risk sexual behaviors because they can get anti-HIV drugs?

The availability of drugs is quite a recent thing in the last two years. In America and Europe when the drugs became available, there was a move back towards riskier sex. That could be happening in Uganda. But even more than that, the focus on condoms as the first line of defense sells a false sense of security. People feel they can do what they want, use a condom, and it will be okay. That was not the message of the government in the early years.

What about this idea that condoms have to be provided everywhere alcohol and sex are sold? Do you agree or disagree with that?

That means bars and brothels. I'd go along with that. I think at bars and brothels you do need condoms. That's where there's a legitimate role for condoms. But what Western experts have gone into the developing world promoting condoms as the only proven method of preventing AIDS. So we take that approach with primary school children and rural village people, married people. It hasn't worked. People in the general population won't use condoms. There's a role for condoms in bars and brothels. Coming to primary schools with primarily a condom message or even high schools? No.

What's your view regarding President Bush's comment: "Abstinence is the only certain way to avoid contracting HIV; it works every time"?

That's true. And if you and your wife are tested and you're both HIV negative, then that's also 100 percent safe. Having sex within marriage and both partners are tested. And I'm sure if you asked President Bush that, he'd say, "Oh yeah, that's the other one."

What's the best role for abstinence advocacy in Africa as well as America?

In America, it's the abstinence people on one side and the condom people on the other side. Frankly, if we get away from morality and religion and just speak, epidemiologically, the virus doesn't know whether two partners are married or living in sin.

In Uganda the average of marriage for females is like 17.5 and I think it's around 19.5 or 20 for men. From a public health standpoint, that 'B' [be faithful] message is really, really important. It's not even in the debate now. You have the abstinence people versus the condoms people. We need the 'B' message.

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March (Web-only) 2005, Vol. 49