Archbishop of Sydney

Africa and AIDS

By + Cardinal George Pell
Archbishop of Sydney
24 July 2005

It is hard to comprehend the scale of the catastrophe of AIDS and the enormous human suffering it has brought.  In the two decades to 2000 20 million were killed by the disease.  Africa has borne the brunt.  The United Nations predicts that 10 per cent of Africa’s population might die from AIDS by 2025. 

Some countries in Africa are hit worse than others.  In Swaziland today 40 per cent of all adults are HIV-positive.  In South Africa former President Mandela has claimed that half of the country’s young people will die of AIDS, with  200 HIV-infected children being born there each day in 2002; a total of 73,000 babies a year.

High-risk groups for HIV-infection continue to be men who have sex with men, intravenous drug users and sex workers and their clients.  In Asia, for example, the AIDS epidemic is concentrated among these groups.

In Africa, however, the epidemic is spread throughout the general population and is largely transmitted through heterosexual sex.  Success in preventing HIV-infection varies from country to country, with Senegal and Uganda being the stand-out success stories.  They have also been successful in having lower levels of stigma attached to AIDS sufferers.

Since 1991 HIV infection rates in Uganda fell from 21 to 6 per cent, owing to the “ABC strategy”.  This strategy, which was strongly promoted by President Museveni and his wife, encourages people to Abstain from sex until marriage, to Be faithful in marriage, and if either of these steps is not possible, to use Condoms.

The World Health Organisation reported a decline in pre-marital sex among young men from 60 per cent in 1989 to 23 per cent in 1995 following this program.  For young women, the decline was from 53 per cent to 16 per cent.  Expert analysis suggests a strong causal link between ABC and the major reduction of HIV in Uganda, which continues to flow on from the change in behaviour adopted in the late 1980s and mid 1990s. 

This success is probably due more to a reduction in casual partners and increased fidelity than abstinence.  A strong element of ABC in Uganda was the promotion of “zero grazing”, which reduced the proportion of men using casual partners by 60 per cent. 

Despite African traditions favouring a number of long-term concurrent partners,  the big change in behaviour was in the shift to increased levels of monogamy and fidelity.  Fidelity to one partner seems to have been the main response to the epidemic in Uganda, in addition to a decrease in the number of sexual partners generally.

Behavioural change through abstinence and being faithful is critical to stemming the AIDS epidemic. Condom promotion is well resourced, achieves some success especially among high risk groups, but encourages promiscuity and an unwarranted sense of safety.  The Church focuses her activity on caring for the sufferers and changing behaviour.