Abstinence stigma

When Iona Nikitchenko, Joseph Stalin's hand-picked jurist for the Nuremberg tribunal, showed up for duty, he asked his fellow judges, "What is meant in the English by 'cross-examine'?" Not a good sign.

The biannual National STD Prevention Conference, which met last month in Jacksonville, Fla., was not much in the mood for cross-examination either. Leaders had packed the court with a pretty parcel of preening advocates of politically popular solutions for sexually transmitted diseases.

The politically unpopular solution is abstinence, of course. Its invitation to the ball was conspicuously overlooked, at least in the view of Rep. Mark Souder (R-Ind.), who chairs the House subcommittee on drug policy. He challenged the composition of a panel without a speaker supporting abstinence programs, and with all speakers set to deliver presentations against abstinence.

The Centers for Disease Control, main sponsor of the conference, heard the voice of one congressman crying in the wilderness and canned the kangaroo court by deleting one anti-abstinence spokesman (William Smith of the Sexuality Information and Education Council of the United States) and adding two for the pro-abstinence side, Patricia Sulak of Scott & White Memorial Hospital in Texas (and founder of a program called "Worth the Wait"), and Eric Walsh of Loma Linda University.

You can write the rest of this column yourself. A "shocked" Mr. Smith asked, "What does this say about the ability of politicians to influence what is going on in public health?" Rep. Henry Waxman (D-Calif.) called the switch "inexcusable." Joseph Zenilman, president of the co-sponsoring American Sexually Transmitted Diseases Association, was "surprised and astounded" at the way "the process of peer review" had been "subverted by pure politics." Bruce Trigg, conference organizer, condemned "this type of interference at a scientific meeting."

One would have thought a "scientific meeting" was a meeting at which all sides of a question are considered. One would have thought anti-abstinence ideology would be "cross-examined" under the circumstances. And these are the circumstances, as stated by the 2006 Conference itself: "STD rates remain unacceptably high in groups such as adolescents and men who have sex with men. Socio-cultural norms have not been conducive to understanding and addressing sexual risk behaviors."

Dovetailing the Jacksonville event, I spoke last week with a Ugandan named Martin Ssempa who knows something about abstinence programs and "socio-cultural norms." In April of 2005, he testified before the U.S. House Committee on International Relations: "The country [after Idi Amin's rule] was in chaos. . . . We had no funds to purchase condoms even if we wanted to. Therefore, the Musevenis [the new president and his born-again wife] spoke to their people . . . : 'Abstain and you will not get it, and be faithful to one uninfected partner and you will not get it.'" They called the message "zero grazing." A socio-cultural norm, you know.

Pastor Ssempa said, "President Museveni actually traveled from village to village with a bullhorn. . . . The first lady . . . was vocal about the program and all public and many private agencies were involved. . . . The health ministry, the local health agencies, the schools, the churches, and other faith-based organizations, the newspapers and the radio-all were involved. And the program worked. HIV/AIDS incidence rates fell in the late 1980s and the HIV/AIDS prevalence rate fell from 21 percent in 1992 to around 6 percent in 2002. I know of no other country which has cut its HIV/AIDS prevalence rate by two-thirds."

Pastor Ssempa lamented to the House committee a new enemy threatening to hijack his country's success story: "That enemy is the Western belief that condoms can end the HIV/AIDS epidemic." He said, "Condom social marketing, the primary HIV/AIDS prevention method promoted by . . . Western donors for the last 18 years, has not worked."

The church Mr. Ssempa pastors on the campus of Makerere University of Kampala, Uganda's largest school, is where his abstinence rally, called "Primetime," attracts 5,000 students weekly. These in turn fan out to their home districts carrying a healthy ideology. I asked him what he's done since April '05. He said he and his new Global Center have declared 2006 the year to fight abstinence stigma.

Abstinence stigma, hmm. He meant the cultural stigma in Africa, but also, I think, the one infecting scientific inquiry. I told him what I had seen in the papers that day about Jacksonville, and he wasn't a bit surprised.