Bill Gates, the man who brought you a new and improved “third world” toilet and microwaves to treat malaria, is now, through his Grand Exploration Challenges program, offering up to $100,000 for a new and improved condom.
The Bill and Melinda Gates Foundation is concerned that many men do not use condoms consistently because they see them as interfering with the spontaneity and pleasure of sex, and so it is calling for condoms in new shapes, packaging and materials that will “significantly preserve or enhance pleasure, in order to improve uptake and regular use.”
The problem with this contest (from a public health standpoint) is that it is unlikely to lead to the desired end of a decrease in sexually transmitted infection (STI) rates. After all, most other condom manufacturers have already put hundreds of thousands of hours of research into making condoms that are more reliable and have other features that are meant to increase use, yet we still see high rates of HIV/AIDS and other diseases where condoms are readily available and promoted.
Of course, the intent of project is to fund innovative ideas and concepts that the experts have not yet considered. And who knows, perhaps some budding genius will indeed come up with an idea using some miracle substance to make an “unbreakable” condom.
But the primary problem regarding the AIDS epidemic is not unsafe condoms – though it is important to note the high failure rate of condoms – it is unsafe behavior. The only African nation that significantly brought down its adult HIV infection rate is Uganda, and it did this in the early 1990s by stressing faithfulness and monogamy, not condom use. Sadly, beginning in 2002 the condom promoters made their way back into Uganda, and its AIDS rate is again on the rise. It was ranked 10th in the world in AIDS prevalence rate in 2009.
It is worth noting that the African nations with the most Catholics and Muslims (religions which strongly preach against risky sexual behavior) have the lowest adult HIV infection rates on the continent. For example, the nations of Northern Africa, which have large Muslim populations, have an adult infection rate of less than one in a thousand. The nations that have less than 30 percent Muslims and Catholics ― Swaziland, Namibia, Zimbabwe, Liberia and South Africa ― have an average of a one in six adult HIV infection rate.
Even more telling than the African situation is the story behind the wildly different adult HIV infection rates of Thailand and the Philippines—nations with somewhat comparable populations in the same part of the world. When the AIDS epidemic first reared its ugly head back in the 1980s, Thailand immediately embarked on a state program to saturate the country with condoms. The latest records show that Thailand has well over half a million adults living with HIV/AIDS and an adult infection rate of 1.3 percent, giving it the highest HIV rate in Southeast Asia. At the onset of the epidemic, the government of the Philippines took an approach almost exactly the opposite of Thailand, informing its people of the high failure rate of condoms and strongly discouraging their use. The Philippines currently has fewer than 9,000 adults living with HIV/AIDS, and an adult infection rate of only one in 1,000. In other words, condom-saturated Thailand has an adult infection rate thirteen times higher than the Philippines. Sadly, with the passage of the condom-promoting “RH Bill” in December of last year, we can expect to see an increase in AIDS rates in the Philippines, as we did in Uganda, where the development “experts” have managed to turn a success story into a growing tragedy.
This makes sense when we consider the fact that 22 major studies of more than 40,000 condoms used during heterosexual intercourse showed that the condoms broke or tore an average of 4.6 percent of the time and slipped off an average of 2.5 percent of the time, for a total failure rate of 7.1 percent, or one in every fourteen uses. Defenders of the “condom first” method of AIDS prevention place the blame on insufficient promotion of condoms, ignoring both the history of hundreds of millions spent on condom promotion and the behavior-oriented approach of neighboring countries with much lower rates.
With a failure rate like this, it is no wonder that HIV remains as widespread as it is, given that condoms have been the focus of prevention efforts in so many countries. Indeed, statistics suggest that the Gates Foundation would serve its ultimate objective of reducing infections better by seeking an imaginative and original human solution, not a technical one.
The primary danger here is that promotion of a “new and improved” condom is just going to lead to more of the same results we have already seen. As the saying goes, “If you keep on doing what you’ve always done, you’ll keep on getting what you’ve always got.” And the last thing Africa needs now is more AIDS.
Perhaps Mr. Gates would better understand the problem in computer parlance: Despite untold millions of dollars spent on research, there is still no such thing as a “bug-free” condom. And if you get a “bug” while using a condom, the consequences are far more serious than those solved by simply rebooting or taking your laptop to the local computer repair shop for diagnosis.
Some writers have already exploited the many easy and humorous analogies available to the informed critic of Mr. Gates’ project, but in truth, this is a deadly serious matter. The fact that behavior modification focused on partner reduction – the only type of effort that has ever led to a significant decrease in HIV/AIDS transmission rates – is not even a part of the picture is revealing.
However noble his aims may be, the banality of Mr. Gates’ proposed solution belies the lack of imagination that is common to the international “development” industry, a movement that sees the poor in developing nations as a problem to be solved, rather than as a resource to be honored and helped to flourish.