337. "How to thwart AIDS in Africa" USA Today (September 20, 2000), page 17A.
When millions are condemned to die a horrible death, it is a sin to mince words. Muted words, not to mention staying mum, make one an accomplice.
The only way to stop the AIDS epidemic in Africa is for African men to change their behavior. If they stop resorting to prostitutes, abstain from intercourse when young and remain monogamous later, the epidemic will die down in a hurry.
Indeed, in a few African countries in which the local equivalent of political correctness has not stopped public leaders from strongly advocating behavior changes, infection rates have dropped drastically. In Uganda, infection rates dropped from 14% in the early 1990s to 8% in 1998. In Senegal, rates are below 2%.
As a sociologist, I am painfully aware of how difficult it is to change culture, habits and especially what is considered macho. But nothing less will do. Providing medical aid and cheaper drugs to those infected is decent and humane. But all the billions to be so spent will not stop one new infection.
Even at the lower costs some African leaders demand, anti-viral drugs consume a large amount of resources. They also must be taken properly or they will lead to drug-resistant mutations of HIV. At best, it will take years before vaccines are developed, tested, mass-produced and distributed. Behavioral changes can save lives now, at very low cost.
We must tell African leaders, intellectuals, clergy and other opinion makers in no uncertain terms that their demands for cheaper drugs are fully understandable, but they must stop acting as if the heart of the problem is that the West has not so far provided such drugs on a large scale. Blaming the West deflects attention from what must be the first priority: keeping people from being infected in the first place.
When I say we should "tell the Africans" what to do, I can practically hear political-correctness objections. As the Rev. Eugene Rivers put it, "We've sort of danced around the edges, because what we're addressing is, in many cases, black male sexual behavior, and that is, in politically correct and liberal circles, a taboo topic."
We are told that one culture is not to judge another. They engage in female circumcision? We practice male circumcision. They force girls to marry old men? We are not respectful of our elders. And so it goes. I will leave it for later to sort out the ethical issues this position raises. All that needs to be said in this context is that when we can help save millions from a terrible disease and death, we are obligated to speak up.
We underestimate how much other cultures look up to us, despite their potshots. Speaking up should include sending Africa a large number of our public health officials, a much-increased Peace Corps contingent and community leaders to help develop the messages and social action that will lead to needed behavioral changes.
Change sexual conduct
As with other social problems, we have medicalized HIV rather than treating it firstly as a behavioral problem. Most people who study HIV, attend conferences, consult about it, are medical researchers; few are social scientists. Medical researchers naturally are interested in the development of drugs and vaccines. They do not consider finding better ways to change sexual conduct their prime business. They ought to.
As a refugee from Nazi Germany, I generally am opposed to characterizing another event as a Holocaust, because I consider it an evil in a class by itself. But as millions die such unnecessary and horrible deaths, keeping mum now is akin to being silent when the first news of concentration camps reached the West. The main difference now is that we know much better what is happening and what must be done. Those who allow the interest in drugs to deflect attention from fostering behavioral change should consider themselves accomplices in the HIV epidemic.
Amitai Etzioni, who teaches at George Washington University, is a member of USA TODAY's board of contributors. His books include The Spirit of Community.