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March 18, 2009

Catholics and condoms

On his first trip to Africa, Pope Benedict XVI has waded into the debate over condoms and HIV/AIDS, reiterating the Catholic Church’s traditional stance that abstinence and marital fidelity are the answers, not condoms. AIDS activist groups, like the Treatment Action Campaign in South Africa, immediately attacked his comments, asserting the primacy of condoms in the AIDS battle.

The Pope’s stance on condoms is criminal — and lacks any nuance that shows he understands the human element of the epidemic. Does he honestly expect the millions of people infected by HIV to abstain from sex for the rest of their lives? What does he suggest married couples do, when one is infected and one not? Is the use of a condom really a greater sin than passing on a deadly virus? I was raised Catholic and I understand the theological basis for his stance — according to Catholic doctrine, the only acceptable purpose for sex is procreation, or at least the possibility of procreation. But emphasis matters as much as content. If the Catholic Church had, over the years, spent as much time and energy condemning the behaviors that spread the virus (or encouraging more healthy sexual behavior) as it had forbidding condoms, it might have made a positive contribution to the AIDS fight.

But as I wrote in my book, the Catholic Church is Africa has always been squeamish about talking about sex. In part this may reflect a certain aversion to the topic all-together — after all, this is a religion based on a virgin birth and whose representatives on earth are supposed to be abstinent. But there are specific cultural reasons in Africa that have made many Catholic priests and nuns on the continent wary of tackling issues of sexual behavior too directly — it upsets the pragmatic compromise christianity has struck with African converts, most of whom came from polygamous societies. Missionaries came to African and told converts they could only have one spouse, but generally looked the other way when people (initially men, though increasingly women too) took other, unofficial partners. So a kind of informal polygamy developed that operates in the shadows. Everybody knows it happens, but no one talks about it. And unfortunately, this system of multiple, overlapping sexual partnerships is one in which HIV thrives — as Helen Epstein’s excellent book The Invisible Cure shows.

Many of the priests and nuns I met, even those actively involved in AIDS issues, feared alienating their congregations by talking about issues of fidelity, especially in a climate where the Church already feels under threat from younger, more dynamic evangelical churches which are growing in strength. I remember once interviewing the Archbishop of Lesotho and asking him why the church wasn’t talking more about fidelity and he said the church had decided to devote its energy towards helping those already affected — he didn’t want to talk about the issue at all. To be fair, many of the priests and nuns I spoke to were also deeply uncomfortable with the Church’s stance on condoms. Some went so far as to pass out condoms despite papal disapproval, but most simply avoided talking about the issues. They didn’t support condom use, but they didn’t go out of their way to forbid it either.

So the Pope is wrong, but so are AIDS activists. Condoms are an important tool, but they’re not the whole solution. We’ve got to start tackling the sexual behavior behind the epidemic. It’s far from easy, but if Pope Benedict XVI really wants to make a difference in Africa, he’ll stop talking about condoms and start talking about sex. And I don’t mean talking about abstinence, because that’s not really an answer either. But how to have sex, responsibly and healthily — or as the Church might want to frame it, morally — in the era of AIDS.

March 17, 2009

Dula Sentle to reopen

I just received news that Dula Sentle, the orphan organization in Otse, Botswana that first introduced me to Seeletso and Thabang, the family I profiled in the last section of No Place Left, will be reopened by an American non-profit. Dula Sentle, founded by Gill and Brenda Fonteyn, was closed by the Botswanan government under a cloud of suspicion shortly before my book was published. Since I was not in the region at the time, it was never entirely clear to me what happened — whether the charges against the couple (which ranged from abuse to failure to register the organization properly) were true or if they had fallen afoul of someone powerful in the government. I can say that I spent quite a lot of time at Dula Sentle and that the children in the village loved going there. As a result, the more serious allegations seemed to me unlikely to be true. 

The organization working to reopen Dula Sentle is The Healing Homes Project based in Long Beach, CA. In an email sent out to previous supporters of Dula Sentle, the founder of Healing Homes, said Dula Sentle’s once beautiful property was in a state of substantial disrepair. The windows are broken and most of its movable property has been stolen. It’s sad how quickly the work of years can be undone. I’m happy to hear that permission has been granted to reopen the center and wish the new organization the best of luck. 

February 23, 2009

Missing the forest for the trees

I’m still receiving emails and calls from AIDS denialists. One guy called me from Canada on my cellphone after midnight last Saturday, to tell me he was “disturbed” by some of the things I said about AIDS myths and conspiracy theories — and their devastating costs. I was more polite than he probably deserved and told him that if he wanted to discuss this, he should have the courtesy of calling during business hours. He called back at 8:45 Sunday morning. I think it’s probably the same guy who has sent me about a dozen links to wacky articles and posts denying the existence of AIDS. I’m hoping these people will forget about me, but I may have to reconsider having my contact details on this site. It’s never been a problem before and I hope I won’t have to resort to that as I think it’s important as a journalist to be accessible.

The whole situation has made me think more about how conspiracy theorists think and what makes them tick. All of the people who have contacted me are westerners, with little or no contact with Africa. I suppose it’s easier to deny the existence of the epidemic when you don’t see, on a daily basis, the overflowing hospitals and graveyards. Or the dramatic drops in death rates in places where ARVs have become available. Or the near-miraculous recovery of someone receiving ARV treatment.

Many of the people who have contacted me have extrapolated widely from their own experiences: they or someone they know and care for has responded badly to ARVs, so therefore they have decided that the treatment doesn’t work for anyone. As with all medical treatments, some people respond better to ARVs than others. There is a tragic desperation to many of the emails I’ve received — they’re grasping at straws, at the possibility that the disease itself doesn’t exist. The nature of HIV/AIDS makes this kind of self-delusion easier. Someone with AIDS can be seemingly healthy, even while their body’s defenses have been ravaged. But as I’ve seen too many times, all it takes is a single opportunistic infection to bring death swiftly.

The single unifying characteristic of the many people who have contacted me in recent weeks is their inability to see the forest for the trees. They focus on one mistake that was made in the scientific quest to understand AIDS (and certainly there were many) or one question we haven’t yet fully untangled. It’s as if we’re all looking at a giant jigsaw puzzle with some pieces still missing. We now know enough about AIDS to see the broader picture, but the conspiracy theorists are still focusing on the missing pieces. Despite the overwhelming evidence showing that HIV causes AIDS and that antiretroviral drugs are an effective therapy, they continue to insist that the epidemic doesn’t exist.

I remember when I was in college, a famous Yale mathematics profession named Serge Lange decided that AIDS was a statistical impossibility. He wasn’t an epidemiologist or a virologist or a doctor. To my knowledge, he’d never been to Africa. But from his office in New Haven, he decided that HIV couldn’t possibly cause AIDS or be transmitted sexually. He used to write long manifestos and leave copies of them outside our campus dining halls. But his theories ignored the very real evidence that a deadly epidemic was underway.

The funny thing is that that the video that prompted this backlash wasn’t really about the western AIDS denialists who have been flooding my inbox. I was speaking as much about the cost of denial and HIV/AIDS-related myths on the ground in Africa, among people who don’t know about retroviruses or t-cells: the rumors that AIDS is a bioweapon developed by America or the apartheid government, that condoms transmit AIDS, that people can protect or cure themselves with traditional medicine or by sleeping with a virgin.

There should be plenty of room for legitimate debate about HIV/AIDS. The early estimates about the number of infected, especially in Africa, were inflated, as even UNAIDS now admits. Western models for dealing with the epidemic were unthinkingly applied to Africa, even when they made no sense there. Our emphasis on privacy and consent, in particular, helped cast a veil of silence over the epidemic in Africa and fuel AIDS denial. But there’s a big difference between taking a critical examination of the epidemic and the willful refusal to accept the truth even in the face of overwhelming evidence. Okay, enough about AIDS denialists.

This is my last post on the issue. It’s a distraction from the real issues. 

February 6, 2009

AIDS denialists

My appearance in two brief mini-documentaries for the web, funded by the U.S. state department which I posted below, has earned me the ire of AIDS dissidents who continue to argue that HIV does not cause AIDS and that antiretroviral drugs are toxic. I woke up this morning to find my email inbox full of messages from members of various dissident groups, a few of which are reproduced below. Apparently the video has been posted to some AIDS denialist website.I hesitate to even engage in debates with these people or to give any publicity to their cause, which has resulted in the deaths of hundreds of thousands in South Africa alone. A recent study by researchers at Harvard University blames Thabo Mbeki’s refusal to acknowledge that HIV causes AIDS — and to therefore implement a comprehensive treatment policy — for the premature deaths of 365,000 people. Now that Mbeki is no longer president, they’ve lost an important ally. But AIDS denial still exists and is still a powerful force. The confusing messages coming from these so-called experts who still pepper the web with their debunked theories just make it harder for us to tackle the problem.


I saw the two videos you appeared in recently, bought and paid for by the US State Department.


I’m surprised you associated yourself with such blatant propaganda. The websites that you cited (duesberg.com, rethinkingaids.com, virusmyth.net) have never had any time for the theory that HIV was a government bioweapon. That theory requires you to believe that HIV is the cause of AIDS, it’s diametrically opposed to the beliefs of scientists who question the evidence that HIV is the cause of AIDS (and the accuracy of HIV tests, safety of AIDS drugs, reality of sexual transmission etc.). I’m sure that you know this, but the cause of propaganda is not well served by being truthful.

Your claim that 20 years has been lost in preventing HIV transmission and AIDS because so many people believed in “denialism” is quite incredible. People questioning the HIV=AIDS dogma have always been pushed to the margins. Pushed out of their jobs, their ability to publish, their ability to get grants, even their ability to express their opinions. I suppose that we should be flattered to believe that the lack of progress by the AIDS establishment is due to our efforts. The lack of a vaccine, the lack of drugs without fatal side effects, the continuing presence of false positive test results. It is ironic that after 25 years with all the funding allocated to one side of the argument, you are now complaining that the marginalized, ridiculed, heavily punished heretics were actually the ones stopping your side from scoring. That notion is breathtaking in its absurdity.

Since you are currently living in Greece, I encourage you to contact Maria [last name and email removed] and discuss her first hand experiences being an HIV-positive woman, being on the drugs for many years, and now having stopped them. You might learn something about the realities of the belief in HIV and how the belief is destroying people’s lives.

I am happy to debate what AIDS is, what HIV is, whether HIV is sexually transmitted, and whether the safety/toxicity tradeoff of drugs is positive with you any time, as long as the debate is made publicly available. You were so very poised and confident in a video where you can appear without fear of rebuttal, it will be interesting to see how you handle the debate when it actually gets down into science and facts.


David Crowe

President, Rethinking AIDS


Oh, God, David, why bother?  This woman made a video so awful it ended up on “AIDStruth.”  And who the hell sits around viewing State Department videos during Oscar season?  AIDStruth is a bunch of people so desperate that they think they need to spy on little old me.  If I were a conspiracy theorist, I think I could dream up a better bunch of villains than these “truthiness” nerds.  They’re an embarrassment to their universities and institutions.

I’m pleased that we have scared the U.S. Government so much that it has to commission a video supposedly about us.  (And it doesn’t describe us at all, for that matter.)  I call that progress.

Until AIDS researchers come up with a vaccine that works, they should stop blaming their failures on the people who predicted they would fail because a vaccine would make everyone “HIV positive.”  That’s how antibodies in vaccines work; they make you positive for antibodies — and Gallo says we don’t understand the biology.  Rethinking AIDS requested that his original Science papers be withdrawn because he actually crossed out the concluding sentence and substituted another one.  Maybe that’s how biology works.

Rather ironic that she talks about “racism” the very week the VERA Institute of Justice came out with its sham investigation of black and Hispanic kids being kidnapped from their families in New York and enrolled in HIV drug trials.  Trials so painful I can’t imagine anyone surviving, and yet “only” 80 kids died.

Nicole is not going to talk to Maria [initial removed] or anybody else who challenges her. That would take humility, intelligence, and integrity — qualities noticeably missing from the other side.  Compassion, too.  She would actually have to care about those kids in Harlem, and that would be too much to bear.

And yeah, I know I’m sending this directly to her.  Is she an actress?  A reporter would have actually researched the damn thing.

Elizabeth Ely

Adeline at the European Union

It’s been far too long since I updated this page, especially since I have happy news to report. Adeline, who is now working as a book keeper for the European Commission mission in Lesotho, gave a copy of No Place Left to her boss, the mission head. He asked her to talk about her experiences to local staff. The speech was so moving that they asked her to come to Brussels to speak on World AIDS Day (see the picture below). I was able to join her there for her speech, which left very few eyes in the audience dry.  Adeline at the European Union 

At home in Lesotho, she and her son Bongy are both responding well to ARV treatment. Bongy is growing fast and Adeline has nearly finished building a house. I also had the chance to visit South Africa for quick trip in November to do a little bit of reporting for Scientific American about the U.S. government’s global AIDS program, the President’s Emergency Fund for AIDS Relief (PEPFAR) which has been far more successful than anyone expected, especially in helping to expand treatment. You can read the article here. 

Despite a general overall positive feeling about the program, there were however still concerns about its emphasis on abstinence-only prevention and U.S. policy that bans organizations that “promote” prostitution from receiving American aid. One of President Obama’s first acts was to end this rule, to the delight of many AIDS and family planning organizations. 

Concern about PEPFAR’s prevention earmarks for abstinence wasn’t as pronounced as I had expected it to be, in large part because a major shift in thinking about prevention seemed to be underway. While there’s still little support among most AIDS professionals for abstinence-based programs, which have little evidence to support their efficacy, there is a growing consensus in South Africa more should be done to promote fidelity and partner-reduction. A whole host of innovative new programs, like South Africa’s One Love campaign, are trying to change attitudes about multiple partnerships. PEPFAR is funding many of these — and spending money earmarked for abstinence programming for these types of programs under a more liberal interpretation of the rule. See an article I wrote for The Christian Science Monitor on this issue. Most still hope, though, that the Obama administration will end the earmarks and allow policy on this to be dictated by research, not politics.  

November 18, 2008

Mini-documentaries on AIDS conspiracy theories

I recently appeared in two short web documentaries about the threat of HIV/AIDS conspiracy theories. Dr. Robert Gallo, the co-discoverer of HIV, also appeared in the videos. They were funded by the U.S. State Department, but produced by an independent production house called crossborders.

I can’t figure out how to embed the videos, but here are the links on youtube. I’m in the second one much more than the first one:

Debunking HIV/AIDS Myths

Consequences of HIV/AIDS Myths 

October 1, 2008

Finally new rules for HIV-positive visitors to the US

After more than 20 years of being barred because of their health status, HIV-positive people will soon be able to acquire visas to enter the United States under the same rules as other visitors. The discriminatory rule dates to 1987 and the height of AIDS-related fear-mongering. But although health officials have long accepted that the logic behind the rule was flawed, but the wheels of change move slowly. HIV/AIDS was removed from the list of diseases considered “of public health significance” for immigration as part of the act that renewed funding for the President’s Emergency Plan for AIDS Relief (PEPFAR).  

September 30, 2008

A new health minister for South Africa

Well, new South African President Kgalema Motlanthe’s first moves in regards to AIDS give reason for optimism. Health Minister Manto Tshabalala-Msimang was removed from her position — though not axed from cabinet entirely — and replaced by Barbara Hogan, a struggle veteran who has long been one of the most outspoken ANC members of parliament on HIV/AIDS issues. The move was immediately hailed by the Treatment Action Campaign (TAC) and other AIDS organizations. On the night of her appointment, the new minister was even serenaded outside her apartment by joyful AIDS activists.Nozizwe Madlala-Routledge,  the former deputy minister of health, who was fired after clashing with Manto on AIDS policy (though technically she was axed for traveling to Spain for HIV/AIDS meeting without permission) is also back on the scene. Mbeki and Manto not only fired her — they also demanded that she pay back the costs of her trip and tried to get her expelled from the ANC. Last week, she was appointed deputy speaker of parliament. Both moves  are positive signs that the new administration will forge a new direction on AIDS — which TAC says killed at least 2 million South Africans while Manto was health minister and Mbeki president.

September 24, 2008

Will Manto finally go?

I’m still stunned and shocked by the sudden ousting of Thabo Mbeki as president of South Africa, and particularly by the manner of his departure. There have been plenty of reasons to remove Mbeki in recent years — his refusal to acknowledge the AIDS crisis top among them. But Mbeki didn’t fall because of his policies, which would have been a victory for democracy, but rather through political infighting. What this means for the AIDS fight, and for South Africa’s future, remains uncertain.One looming question is what will happen to Manto Tshabalala-Msimang, Mbeki’s errant health minister and the proud proponent of garlic, olive oil and beetroot as a cure for AIDS. Her name hasn’t appeared on the lists of ministers who have resigned in solidarity with Mbeki.  It’s conspicuously absent from these lists of Mbeki loyalists (although some of the ministers who have resigned say they are willing to join the new government).Mbeki hasn’t mentioned AIDS in years and although he stopped openly opposing efforts to combat the epidemic, neither has he offered any leadership. Jacob Zuma — South Africa’s president-in-waiting — has made the right noises about AIDS, at least on a policy level (his personal behavior is a different thing, see my earlier post on this). But Manto’s fate will be a strong indication of his true colors.

July 21, 2008

Are Africans more genetically susceptible to AIDS?

I posited in my book that one day we might find that certain people, or groups of people, were genetically more susceptible to being infected by HIV. It seemed to me that social and behavioral differences just weren’t enough to explain the patterns of infection. Why, I wondered, did people of African descent, scattered around the world and with very different cultures, often have among the highest infection rates in the world? Think Haiti, which was one of the first countries hard-hit by the epidemic. Or the United States today, where black women are the fastest growing population of people with AIDS. 

Even within Africa, the patterns didn’t seem to make sense. Why did the epidemic peak at a much lower level in West Africa, despite widespread war and conflict and high rates of migration, both of which are believed to contribute to the spread of AIDS? Even within hard-hit communities, I sometimes found that one family would be completely devastated, while the neighboring one was relatively untouched.

Well, now we may have the beginnings of an answer. The New York Times reported earlier this week that a recent study found that a genetic variation found in some people of African decent may make them more vulnerable to infection. The variation once protected people from a now-extinct form of malaria. The authors, in London and Louisiana, suggest that it could explain 11 percent of AIDS infections in Africa.

Interestingly, the study was conducted on African-Americans, who also carry the genetic variation but at lower rates than Africans. If confirmed by future research, this may help explain why people of African descent around the world have been hit so hard by AIDS.

I fully expect that we will hear more news of this nature in the near future. 

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