Fight against Aids: How UNAids perpetuated the myth of condom effectiveness in Africa in the face of all the evidence

“It is true that the way that UNAIDS dealt with my report says a lot about the culture of UNAIDS and how they operate -- and that much of what it says is not very good,” laments Dr. Hearst. “On the other hand, I have refrained until now from trying to make this a bigger issue than it should be. And I don't have a great desire to participate in any unnecessary UNAIDS bashing.

Prior to the commissioning of the UNAIDS condom review study, Norman Hearst had actively participated in the organization’s affairs spanning the course of several years.

But since that time he feels that he has been blacklisted by UNAIDS.

“I have never been asked to consult for them, be on any of their committees, participate in any UNAIDS meetings, etc., despite having done all of these things previously.” says Hearst.

In fact, some UNAIDS officials are said to have denied they had ever funded the study. “I don't know if these individuals were misinformed or deliberately lying.”

But the Hearst-Chen episode is not the only instance where the unexpected results a commissioned report on the ineffectiveness of condoms in stopping the spread of HIV in generalized epidemics in sub-Saharan Africa has been hidden from the general public or simply blatantly ignored.

The findings of other independent consultants have also reported to UNAIDS that partner reduction, and not condoms, abstinence and the like have been the key in turning back the HIV/AIDS juggernaut-as what happened in Uganda during the early years of the plague.

Another illustration of UNAIDS early intransigence (as well as that of its predecessor, the WHO’s Global Program on AIDS) about the effectiveness of behaviour change, is the case of the landmark study led by Dr. Maxine Ankrah, an African-American sociologist, who was at the time the head of the department of Social Work and Social Administration at Makerere University, Kampala. Ankrah’s pioneering study on sexual behaviour in Uganda in 1989 (part of a WHO Global Program on AIDS study on the types of sexual behaviours that promotes the spread of HIV/AIDS) led to the publication of “AIDS IN UGANDA: analysis of the social dimensions of the epidemic, National Survey, September-December 1989”.

Maxine Ankrah’s study was one of a pair showing that partner reduction, not condoms, was the main reason for Uganda's HIV decline.

A second study of sexual behaviour in Uganda was carried out in 1995, by which time the HIV rate in the country had fallen significantly.

When Ankrah’s findings were compared to the 1995 follow-up, it was clear that the HIV decline correlated strongly with a decline in multiple sexual partnerships.

However, for years various UNAIDS reports maintained that condoms, not partner reduction had been the major reason for Uganda’s success against AIDS.

Ankrah’s study, showing much higher rates of casual sex in 1989 compared to 1995 was never made public or referred to in UNAIDS or WHO documents.

Other studies suggesting partner reduction had been more important than condoms in reducing Uganda’s HIV infection rate were also shelved; these include Tom Barton’s unpublished report, which was also commissioned by UNAIDS and also never made public, “Epidemics and Behaviours”; Making condoms work for HIV prevention,” which is part of UNAIDS’ unpublished Best Practice Collection as well as a Uganda Ministry of Health’s reports on he 1995 Demographic and Health Survey.

Subsequently, other researchers showed that patterns of sexual partnerships in Uganda were complex, as they would turn out to be in other East and Southern African countries.