A GNA Feature By Eunice Menka

Accra, July 26, GNA - The debate as to whether a science-led campaign involving condoms use or moral calls for abstinence and fidelity is the key to the effective HIV/AIDS control continues to take centre stage as experts say this unresolved issue is hampering prevention strategies within the communities.

Scientists and leading HIV/AIDS experts say public health principles should guide the fight against the disease and not ideology or issues of morality because messages on abstinence and faithfulness in marriages evaporate into thin air in environments where sex is virtually sold on the streets.

The science-led campaigners say the active promotion of condoms would do the trick and not mere messages of abstinence and faithfulness in relationships.

Religious Leaders, however, counter these arguments saying the "moral free" approach of a science-led combat would not win the fight but rather promote promiscuity and more HIV/AIDS cases and deaths in the communities.

The global debate on issues of morality and science continues to dominate discussions on the way forward in managing the epidemic. Even in Ghana, there have been recent calls from some quarters for the legalisation of prostitution and the adoption of a more liberal stance in dealing with commercial sex workers to ensure that they are brought on board to help to stem the spread of HIV.

The battle lines have been drawn between these two groups with religious leaders and scientists taking very entrenched positions on condom use.

The international press recently carried a report of a leading Catholic Priest in Nairobi teaming up with some Muslims to burn up condoms at Uhuru Park in Kenya.

Dr Nii Akwei Addo, The Programmes Manager of the National AIDS Control Programme, in an interview with the Ghana News Agency in Accra, said there is the need to preach both abstinence and the use of condoms because of the different needs of various segments of the population. He said while an abstinence-only message might be right for children and some adolescents, for others who were sexually active, there was the need for health specialists to protect them since as Ghanaians they were entitled to protection.

"The philosophical debate on condoms has very little relevance on the ground," Madam Jennifer Cooke, the Deputy Director in charge of Africa Programme for the Centre for Strategic and International Studies (CSIS) in the US, said in recent interviews with some African Journalists on a State Department sponsored HIV/AIDS Reporting tour of the US.

According to her, there was the need to find common grounds between public health experts and faith-based organisations engaged in the fight against the disease.

She touched on United States policy, which kicked against prostitution and sex trafficking, and said there was the need for Congress to see commercial sex workers as women with needs to be taken care of.

Madam Cooke said HIV/AIDS funding had brought on board faith-based organisations in the fight but there was the need for sensitivity on both sides.

According to her, prevention, care and treatment were taking place at the community level and so public health specialists needed to learn from religious leaders while religious leaders also took into account public health principles when dealing with HIV/AIDS within the communities.

The battle is not only between scientists and religious leaders but countries such as the United States, commended for their generosity in doling out monies to assist developing countries to manage the epidemic, had in recent times come under harsh criticism for their ideological stance which pitted abstinence against condoms.

The CSIS in its May 2005, HIV/AIDS Task Force Report said: "Many observers have expressed concern that the thrust of President Bush's emergency plan for AIDS prevention programme for women focuses on abstinence only debate, despite the reality that women all too often do not have the option to practice abstinence.

"While some considered it to be an example of US imposing a certain moral agenda, others criticised it on the grounds that it was simply an ineffective strategy," the report said.

Last year the international media carried a story citing Brazil as having refused to accept funding from the United States for its HIV/AIDS prevention activities until Washington dropped a demand that Brazil condemned prostitution.

Brazil turned down 40 million dollars last year from the US Agency for International Development (USAID) because of what it saw as conditions that were not based on scientific evidence in fighting the disease.

"Biblical principles is their guide, not science," Dr Pedro Chequer, Director of Brazil's National HIV/AIDS Programme told Reuters. "This premise is inadequate because it hurts our autonomous national policy," Mr Chequer said.

According to Brazilian officials, the condemnation of prostitution would hurt their programme, seen as a model for developing nations in fighting HIV/AIDS.

Just this May, in an article published in the Wall Street Journal, Dr Chequer said: "We can't control HIV/AIDS with principles that are theological and fundamentalist."

The United States has been accused both within and outside US that it has a soft spot for faith-based organisations and has been too much under the influence of these religious bodies on issues bordering on HIV/AIDS.

The scientists argue that for HIV/AIDS prevention activities to succeed, people should be told what to do and then given the skills to negotiate or make informed choices.

They say religious leaders should not presume to tell people which choices to make. They should also stop denigrating condoms and be guided by public health principles.

Indeed the HIV-prevention model for changing behaviour known as "ABC", that is: Abstain, Be Faithful and Use Condoms, has generated enormous controversy.

While most public health experts see the A, B and C as choices to be made based on an individual's situation in life, religious leaders say HIV/AIDS prevention activities should focus on A and B and C should not be considered at all as an option.

Until recently, issues about sex and sexuality were never addressed in the pulpit. It is not considered spiritual. Talking about sex and sexuality from the pulpit has been challenging indeed to the churches. According to Dr Addo, the churches should be concerned about morality in the fight against HIV/AIDS, but they also need to acknowledge that issues such as human physiology and the hormone drive in young people, sometimes leads them to engage in sex. He said: "The abstinence message alone would not work. Both condom and abstinence messages should be promoted."

Dr Addo said they were working with some religious groups in this direction, adding that although for instance, facilities such as the St. Martins Hospital in Agormanya in the Eastern Region was a Catholic Church facility, public health professionals were free to talk about condoms at these premises whenever they went there for various programmes.

Madam Barbara Smith of the Catholic Medical Mission Board, based in the United States, said they did not promote condoms but focused on abstinence in line with the principles of the Catholic Church. "We emphasis on Catholic Church doctrines but we counsel clients on their options," she said.

But which is working? Is it abstinence or condoms? Has there been any scientific study to see which is working on the ground? Quite recently, some South African Priests condemned the promotion of condoms within their country, saying it failed to curb the spread of the disease and rather increased promiscuity.

Reuters quoted Cardinal Wilfred Napier as saying: "there is no evidence that condom promotion works to prevent HIV transmission and that as a contraceptive, condoms have a failure rate.

"Can you show me one example where condoms have stopped the spread of AIDS?" He asked.

"If you look at South Africa, millions have been spent promoting condoms, and we have one of the highest rates in the world. By promoting condoms, we are promoting immoral behaviour," Napier said. Although, there are other modes of HIV infections, the epidemic is basically all about managing one's sexuality and some argue that the individual should be left with the choice of deciding which way to go. HIV/AIDS would continue to be a challenge since hopes of a vaccine appears to be in the distant future, however, curbing the spread of the disease appears to lie, to a large extent, in the hands of individuals and the lifestyles they choose to pursue.