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Discussion in 'Pre-Medical - MD' started by alleyez, Apr 6, 2004.
I'm the bestest
Did you staple them to pamphlets? I read that somewhere on SDN.
Now you'll have to check for closets full of well protected bananas. When I was in grad school, I heard a story of a woman and her team that went to Africa to teach about safe sex. The team used bananas to show the proper use of condoms, and when they went back a few months later, they found closets full of bananas with condoms on them. Sad but true...
I am sure that was a joke
Actually it wasn't a joke. Essentially, these folks went in with the "one size fits all" mentality and standard health education measures that obviously don't always work (kinda like attaching condoms to a pamphlet that is not literacy or culturally appropriate). The female villagers that the team worked with only replicated what they were taught, showing an obvious misunderstanding of what they were really supposed to do with the condoms they received.
I am glad the colonialist mentality of helping out hapless indigents is alive and well. A study came out a few months ago that showed that the average American teen has a 50% chance of getting an STD. I'm sure whomever fancies going to the 3rd world as a way to bolster a med school application can be just as helpful spreading the word about STDs in the US, especially among children and teens.
It is very difficult to teach safe sex to many natives in Africa and other parts of the world. Many of them have very, very solid pre-conceived notions about sex and its importance in their culture. Having many children, for many of these people, is a very positive thing as they see it. It is part of their culture.
To go even further, I was reading about the polio vaccine drive in Nigeria. Many of the people there have begun to refuse to allow their children to be vaccinated because they think that the vaccine will cause infertility or other physical defects in their children. Many of the muslims in that country think that the US/UN led drive to erradicate polio is just a way to diminish their populations by causing this infertility (which obvioulsy is not caused by the polio vaccine).
I personally think the problem is part resources, but an even larger part information. As was mentioned here, handing out a pamphlet with a condom is not enough. You have to explain what the condom does, in the persons language. You have to answer their questions. It's just common sense. When you use any product here in the US or get any medical procedure performed, you ask questions. You don't just let people work on you without knowing what's going on. The same situation has to be applied to 3rd world countries.
...speaking of information, here is a resource for those who think condoms are the solution.
I don't think that anyone indicated this as a discussion on whether or not condoms are effective in preventing STDs/STIs (especially those transmitted via skin to skin contact). This is moreso a matter of the techniques being used to educate people. The abstinence issue is a debate that is right here, right now, in the United States. Encouraging condom use has historically been used in developing countries highly affected by HIV/AIDS, and apparently some of the techniques used have not been effectively communicated. No, condoms aren't the answer to everything, but can still help prevent the transmission of some STDs (but again, this is not 100%); this is highly debatable based on the evidence, as shown by some of the newletters on the website pillion referenced (which by the way is very much in support of the political agenda of our current administration).
I thought this was a thread to poke fun at SnS. Now it's become serious
I didn't know SnS passed out condoms in Africa
I wouldnt call it highly debatable. That site is somewhat misleading. Just because condoms dont reduce risk to an 'acceptable level' ie: NONE doesnt mean we should abandon them for some ridiculous and unrealistic abstinence pledge. Not to mention their 'newsletters' are half editorials, and i dont see actual objective studies (medical literature) anywhere on the site...
blah blah blah
The purpose of the Medical Institute is not strictly research oriented (although it contains many articles in the topical reference library). It is primarily pedagogical, hence the editorials and newsletters. As for the "ridiculous and unrealistic abstinance" education, somebody explain to me how it is not the most healthy choice a person can make. Promoting abstinance is no more unrealistic than telling an obese person that if he wants to avoid a heart attack, he should eat properly. Sometimes people listen and get healthier; sometimes they don't listen and they become ill. Blah, blah, blah...
No, its like telling an obese person that they should only eat 1500 calories a day when theyre obviously incapable of controlling their compusive eating A more realistic approach would be telling them the proper type of food to eat, or 'safe eating.'
The goal is public health. Promoting abstinence instead of condom/safe sex practices (or both together) is a wholly unrealistic suggestion that the ultraconservative political and religious leaders hold. I do support joint education of course, as anything that helps prevent the spread of disease should be encouraged (assuming both education types are statistically usefull, something which is in question).
The one thing I didn't say is that condoms were not effective. They are extremely effective in preventing pregnancy and "some" STDs when used properly. My apologies, since I should have clarified "highly debatable" to mean that condoms are not effective in preventing certain diseases, such as those transmitted via skin-to-skin contact (e.g., HPV).
As far as promoting abstinence is concerned, yes, to a certain degree, it is effective. But when considering the current audience of adolescents, just telling them not to have sex is not the most effective thing to do when a number of them are already sexually active. There does need to be some support for other preventive measures (e.g., condom usage). However, we won't really see this reflected at the national level based on the current administration's support of abstinence education (support that is reflected by the content on the Medical Institute's website).
blah, blah, blah...
Right on Childe
A major reason it seems unrealistic is because people are not expected to abstain. The mentality is simply: "Don't do it, but we know you will, so here's a condom." What does that tell somebody? When a person grabs a condom from the candy dish at school, does anybody tell that person that he/she is not protected against certain diseases (HPV, etc.)? No, the person believes he/she is being "safe." It seems more like a false sense of security.
I'll explain why proposing abstinance in Africa is a ridiculous idea, it will not happen. What makes you think that you can overhaul a societies cultural beliefs? As far as your obesity analogy, abstainance for obesity would correlate with a starvation diet, rather than switching over to healthy foods and increasing excercise. What the hell makes you think you know what is right and wrong for people of another culture anyway?
And condoms are very effective at stopping the spread of HIV, why even go any further to propose that something more intrusive--the actual cessation of normal sexual relationships altogether--would be a better solution, when you and I know it wouldn't happen?!
What if AIDS were transmitted by air? Would you recommend that people stop breathing or would you recomend respirators? Or would you recommend that people lock themselves in a room and watch people on the outside catch AIDS and say, "It's their fault for breathing?"
Seriously, are you going to say that people in Africa are heathens that deserve to burn in hell for having sex with eachother just as they always have, in loving relationships?? Cause that's what you imply--cultural shovanism--when you even suggest absinance as a plausible goal for HIV/AIDS prevention in Africa.
As far as AIDS in Africa, there are so many complex factors that have created the horrendous problem.
These etimates are from UNAIDS latest report and from the CDC that give numbers to the acutal severity of the problem in Africa, in case you were unaware:
Since the global outbreak of HIV/AIDS in the early 1980s, the pandemic has hit sub-Saharan Africa the hardest. By the end of 2004, it is projected that 32 million HIV infected individuals?68.4% of all HIV infected individuals world-wide?will live in Sub-Saharan Africa. (UNAIDS, updated) Current data from the Centers for Disease Control and Prevention (as cited in Stine, 2004) show that Southern Africa?the countries below Zaire and Tanzania?is being particularly devastated by HIV, with nine out of the eleven Southern African countries having infection rates of 15% to 40%.
In the U.S. we've experience a flat line for the rate of new infections: 50,000 per year.
What accounts for these differences?
More than you probably think!
Here are a few things some people probably don't know about:
Malnourshment due to poverty, malaria, and other tropical disease make the body more phyisologically susceptible to HIV.
Poverty also creates incredibly desperate situations for people. For example, gold miners in South Africa face death on a daily basis. When interviewed, they don't seem to care so much about getting AIDS.
Polygomy is acceptable in many areas (for example, Botswana) for men anyway. Women are seen as property in many cases due to bride price practices and such, no rights to have a bank account, run a bussiness.
Uh, I don't think so.
I'll teach you how to protect yourself from HIV if you convert to my religion
As someone who has in fact "passed out condoms in Africa" (well not really, I was designing HIV/AIDS education programs), I can add a little different perspective than the old condoms-abstiance debate.
First, I do not think the root of the problem in Africa (at least not in Tanzania where I was) is teenagers having all that horrible premarital sex
Many of the women being infected by HIV are being infected by their husbands. There is a huge inbalance of power between the sexes. Most of the women I spoke to did not have control over their own sexual experiences.
Of the young women having sex, the majority are having sex with older men for economic reasons. All of the young girls I spoke with talked about resisting "sugar daddies" (older men who give girls things like toiletries in exchange for a sexual relationship). There was very little talk of "boyfriends" in the way we conceive of them.
Of course, I met many women and girls who were exceptions to these generalizations, but they were definitly a small minority.
Also, like someone else mentioned, because of the high rates of other infections, women in Africa are much more suseptable to HIV infection. There are simply not health resources available, especially not for women.
So anyway, as far as condom distribution goes, it is successful only when it can get men afraid enough to use condoms in all of their sexual exploits. However, I personally don't think this is a very realistic expectation, just as it isn't a realistic expecation for any other group of people in the world.
There are no easy answers.
Also, as to the. "why don't you do some good by passing out condoms in the states...there are plenty of problems here?" The AIDS situation in the US and Africa are not even remotely comparable. Also, people do these types of programs for many different reasons... including broadening one's world view...imagine that!
You want a cockie for that?
I agree that it is probably unrealistic to hope that teaching abstinence will work. People don't care anymore what the safest alternative is. Just look at all the people who smoke regularly. Unless it causes instant death (and sometimes not even then) people just won't care. It's too bad, imagine a world where everyone had intercoarse only with their life partner, there would be no AIDS epidemic.
I really wish people would consider abstinence but I'm LDS so I've been taught the virtues of virtue my entire life. I doubt others see life the same way.
Hey Mr. Virue abstinance will never work for any human population. You claim to be an example so I will use LDS counter examples to prove my point. Believe me, "virtue" is all about circumstance.
A cultural obsession with abstinance before marriage did not prevent my Gen Chem partner from gettin' herself impregnated 5 weeks before class started freshman year. Her BF had to come back from his mission early for a little shot-gun wedding. Maybe if someone had handed those two some condoms in highschool she would be a doctor and I wouldn't have ended up with the worst lab partner in history of world.
Enter good little mormon girl #2. Roommate caught her humping (are we allowed to say humping?) a highschool boy (she met him at a mormon social event) on the couch in sophmore year while her BF was on his mission. She later married Mr Mission, or should I say Elder Mission. She admitted to the afformentioned roomie that she had never confessed her escapaid to new hubbie. Did she give him any fun diseases? The world may never know.
These are not rampant sluts. They were true believers in living by the code etc. until their moment of weakness came. I am just trying to illustrate the fact that human nature and human biology will will out over even the most persistant cultural conditioning. Holding up the ethics of "The Scarlett Letter" as an ideal is not a healthy alternitive to a little practical realism.
So... I cannot overhaul a societies cultural beliefs, but you can. What do you think the U.S. does when it goes to a country and starts trying to make everybody use condoms? You are also assuming that you know what is right and wrong for a people of another culture, so spare me the sermon. Perhaps we shouldn't be over there in the first place...
Obviosuly, abstinence will not solve every immediate problem, and yes, many will continue to get STDs. But the lower a culture lowers it's standards, the more it's problems will spirate out of control. It may take generations to see the benefits of cultural taboos against casual sex and multiple partners, but it will be better for a culture in the long run (I'll at least speak for my own culture).
Are you really as stupid as you sound or are you just trying to push my buttons? All I would like to change is for people to slap some latex on their dicks before having sex, and more importantly to give people correct conceptualizations about how STDs work (right now many African people think STDs are a bad karma sort of thing, it seems like this is what you think as well). You talk about African culture having "lower standards" in your next post! Not comparable. Education does not have to equal cultural overhaul, some successful programs have been developed that involve educating a group of traditional African healers, who in turn peer educate other African healers about the nature of HIV and condom use as a preventative measure. Imposing moral values and guilt trips for a culture's traditional sexual behaviours does in my mind equal cultural overhaul.
As I mentioned before (but you didn't get it through your thick skull) poverty is the biggest problem for the HIV/AIDS pandemic in Africa. I should clarify and say that most researchers now understand that the problem is not all due to people sleeping around. People sleep around in most areas of the world as evident by the prevalance of other STDs. Africa is in a horrible situation where they are incredibly vulnerable to a STD and they don't even know or believe in the biology behind the disease. And you have the nerve to say that we, who are knowledgeable about the disease, should not help the situation?!?!?!?!?! Wake up and show some compassion. I'm assuming you are christian? I'm not, but it goes to show how totally false some peoples religious beliefs are.
How did you miss the first sentance in my post? Are you confrontational or just stupid? I will repeat is slowly so you can understand my stance.
It is UN-REA-LIST-IC to hope that abstinence will work for any society.
I only wish that it could since our chances of finding a cure for the most troubling STD's don't seem to be large at the present. Also I don't claim that every LDS person actually lives our beliefs, I can only vouch for myself.
I forsee a future where this thread exists in that vile 24-hour argument that is the everyone forum.
..oh, that's all you would like to change? "What makes you think that you can overhaul a societies cultural beliefs? ... What the hell makes you think you know what is right and wrong for people of another culture anyway?" (what a cool-tempered person you are) What you presume to be a morally insignificant adjustment in the most intimate realm of personal relationships may be an outright assault on their beliefs and way of life. I'm not necessarily speaking of African culture, but any culture. For some peoples, life is sacred and contraception is perceived to be an assault against life (hence the word contra-conception). You accuse me of imposing morals when you yourself impose them. And who said anything about a guilt trip (your own conscience, maybe), abstinance is as much a part of preventative education as your belief in condom use.
By suggesting that the U.S. should not be in Africa, I am only drawing the conclusions of your own words... what makes us think we know what is best for them? I'm not at all against helping others, but we obviously have different ideas about what constitutes help. As for "lowering standards", I am not speaking of any particular culture, but cultures in general.
Not to get in the middle of the debate, but I went to a lecture a few years back on the female condom being more appropriate in developing nations, where males tend to be in control of the sexual experiences. Because the woman can insert the condom hours prior to having sex, the condom itself feels more "natural" for the man, etc. it was supposed to remove some of the barriers of use. Although there are certainly some drawbacks, such as problems with women reusing them, the advantages seem to be there. It hasn't caught on much in the US, but it seems like the promotion efforts overseas are going well.
By abstinance I'm assuming you mean monogomy between one man and one woman for life. I don't think any successful HIV/AIDS prevention programs are feasible by promoting abstinance in Africa, and I've never heard of any people doing work in Africa who say otherwise.
I'm not talking about contraception, having children IS a big part of status for men and women in Africa, this thread is about HIV/AIDS and trying to save lives. According to UNAIDS-- approximatly 2.3 million Sub-Saharan Africans died of AIDS in 2003.
About my concious and sleeping around... American culture ingrains into most people's minds (including mine) that practices of polygomy are immoral, so what. You seem to think that the HIV problem is caused by polygomy or sleeping around or whatever, when in reality it is caused by unsafe sex. Condoms are an effective barrier for the transmission of HIV, plain and simple.
I'm sorry if I get a bit heated over this issue, I wish you'd go back and read over the information I have presented in this thread and accept it, because it is legitamite. Some others who have acutally seen the problem first hand if Africa seem to agree. And my stand does remain that if your belief is that America should sit back and say that Africans are doing this to themselves and that we don't have any bussiness helping them other than telling them they shouldn't sleep around (when people in our own country sleep around all the time) than that is wrong and uncompationate.
I realize the issue is not about having children, but about preventing disease. My point is that, while condoms may be effective in preventing the transmission of some diseases, the nature of condoms is to prevent conception of life, which is unethical for some peoples in the world. So for us to walk in and assume that another culture should use a technique that we (or some of us) think is best for them is as presumptuous and "imposing" as any other alternative (such as abstinence). While promoting abstinence will not completely prevent the spread of STDs, neither will condoms. Condoms may prevent more cases of HIV/AIDS, but it does not protect against other viruses, such as HPV and herpes.
The more partners one has, the greater the chances of spreading a disease, so explain to me why monogomy is not the most healthy "choice." However, monogomy is not "ingrained" into our minds because it is the most healthy choice, but because it is rooted in the Judeo-Christian heritage of America (but that's another thread).
No, I don't think we should just sit back at watch other countries destroy themselves. But the question of how best to help them is not as obvious and simple as making their men "slap some latex on their dicks before having sex."
For point #1-- I hear what you are saying, that for people who think blocking conception is immoral, condoms would be an issue. Usually these people are religious, smaller or diffuse precentages of the larger population, and don't have problems with sleeping around anyway. Various researchers have found (through interviewing) that, in general, if Africans gain an understanding of HIV and learned to appreciate that it is a sexually transmitted disease, then they want to wear condoms with partners outside of their marraige relationships, in order to not bring diseases home to their family. I feel fine educating people about the nature of disease without thinking that I am imposing anything unethical. *I should add that the rate of HIV transmission (for healthy individuals, co-factors in Africa proably make these worse) is 1 in 1000 unprotected sexual encounters for female to male transmission, and 1 in 300 encounters for male to female transmissions. So if condoms were used in extramarital affairs alone, they would be expected to have a very benificial impact.
For #2 & #3-- I've already answered this question... but to summerize and condense: a) "teaching" monogomy isn't a viable part of an HIV/AIDS prevention plan. Also, if it were possible, then teaching monogomy would be a long-term endevour and wee need short term interventions becuase of the severity of the problem. If you could show me reports of successful research (that has been published in a reputable journal) on HIV/AIDS prevention programs that were based on teaching monogomy, I'd be interested. b) Teaching concepts about STD and condom use is vastly more important because of the vulnerability factors that Africans face, such as the various complexes invovled with poverty.
Therfore, from a + b you should be able to see that teaching monogomy is not an effective way to help Sub-Saharan Africans. Therefore it certainly is not healthy, realistically speaking.
And my "slap some latex..." line was not meant to suggest I think there is any easy answer to Sub-Saharan Africa's problems with HIV/AIDS. That should be obvious from the other information I've provided about the complexity of the problem. The real problems lie with poverty and desperation. But we can only do so much to turn the entire world into prosperous countries that can provide services and offer a health life to all of their citizens. What we need is a short-term intervention that curbs the spread of the disease, 3.2 million people became infected LAST YEAR (UNAIDS), that's almost the entire populations of Los Angeles!
Your solution of monogomy would indeed become apparent to Africans after they see, what, 60%, 75% of their loved ones die from AIDS, assuming they know how HIV/AIDS works by then. By that time their work force would be demolished, their economy in shambles, most of the remaining population would be orphaned children (very few teachers left to teach the kids about AIDS and monogomy at that point). This is what you implied earlier, that AIDS is teaching Africans a lesson to learn higher moral standards. I'm sorry, but this is the reality of the HIV/AIDS epidemic in Africa.
Bump! Only because i laughed out loud when i saw the subject line.
I really want to go to Africa.
Hey! I think you gave one to me!
But, after a couple years, I ran out. Can I have another?
www.hsph.harvard.edu/hcpds/documents/Senate Testimony rev2.pdf
Wow skiracer, that is a very interesting article. I have actaully read other studies done by Dr. Green. He was the person who worked to introduce HIV/AIDS education to traditional African healer "circles," which I referred to earlier.
I'd like to make a few points however.
One is that Uganda and Senegal are the only countries to have success with any HIV/AIDS prevention (according to UNAIDS, I see that Green lists Zambia as well).
Another is that this was a government supported program from the begining, it seemed to be accepted since the 1980s. "The distinctive Uganda ABC model of the earlier period, the one developed primarily by Ugandans for Ugandans, is the one that seems to have worked best, and is the one that has most to teach the rest of the world." There were religious groups coming in and offering aid, funded by the U.S. govt under the stipulation that they would not bash condom use, and they helped a lot I'm sure, but their efforts were congruent with the people's.
I would definately not oppose any program that is being asked for by the people of a country. I had not heard of any examples of any abstinance-based programs being effective, and this was a new finding. As Green states, these sorts of programs have been long thought to be ineffective.
I think that for us as pre-meds or medical students or as Americans wanting to help to make a difference, it would be much more helpful for us to go pass out condoms than it would be for us to go and try to preach abstinance.
As I mentioned before (but you didn't get it through your thick skull) poverty is the biggest problem for the HIV/AIDS pandemic in Africa. I should clarify and say that most researchers now understand that the problem is not all due to people sleeping around. People sleep around in most areas of the world as evident by the prevalance of other STDs. Africa is in a horrible situation where they are incredibly vulnerable to a STD and they don't even know or believe in the biology behind the disease. And you have the nerve to say that we, who are knowledgeable about the disease, should not help the situation?!?!?!?!?! Wake up and show some compassion. I'm assuming you are christian? I'm not, but it goes to show how totally false some peoples religious beliefs are. [/B][/QUOTE]
AIDS is not an "african" disease i.e it did not originate from there otherwise the traditional healers and the societal customs would have prevented this epidemic for example malaria has been prevalent in the region for centuries but it has not killed the whole population...yet
does that make sense
If you are including Herpes and Genital Warts which TONS of people have then yes, 50% sounds right.
Can DO's pass out condoms in Africa too or are MD's the only ones allowed to?
MDs only, but DOs can open the boxes the condoms come in and hand them to the MDs, as well as probably sign off the UPS slip that the shipment arrived. also, DOs can perform OMT on genitals of at risk populations.
I'm not commenting on the debate on this board, but just wanted to say that the first thing that came to my mind when I saw this thread was:
SQUAT N SQUEEZE, the INFAMOUS ONE THAT CLAIMED HE PASSED OUT CONDOMS IN AFRICA.
HIV did originate in Africa so far as we know, it is thought to have crossed over from monkeys to humans somewhere in West Africa. And AIDS and malaria are much different, I don't get your point.
I just wanted to comment on the whole abstinance versus condoms debate. First, the various churches have been trying to "teach" monogamy in Africa for last 80 years at least. You can guess how successful they have been...just about as successful as they have been everywhere else in the world! I don't think all of us can go and "teach" monogamy in any better fashion than the churches have done. This certainly won't work to the extent needed to curb the spread of the disease. It may help certain individuals who you are able to convince that this is their most healthy choice (that is if their one monogamous partner shares the same conviction!), but it will not help the very, very serious problem that exists right now. Everyone will be dead first.
Second, most groups in Africa are teaching prevention using the ABC model that someone previously mentioned. No groups that I met with were simply passing out condoms and very few groups were just preaching abstinance. Even the Catholic nuns I worked with were using the ABC model because it would only take about 2 minutes to figure out that the old abstinance is the way speach wasn't going to get anyone anywhere. Oh, for those who don't know the ABC model.
The letters stand for
B-Be faithful to one uninfected partner
This is the order of preferred prevention or most effective prevention to less effective.
In addition, people are attempting to increase access to health care to combat the problem that has been previously mentioned about infections increasing HIV transmission rates.
There are also people working to increase women's control over their sexuality.
There are people attempting to reach young men...to teach them how to make more healthy decisions and increase control over their own destinies...something poverty has taken from them. Like someone said...it is awfully difficult to care about a disease that will kill you 10 years from now when you are starving.
Once again...it is a COMPLICATED problem...don't insult and patronize the people who are dying from this disease everyday by trying to paint it in black and white.