India makes a billion condoms annually, to help prevent AIDS and other sexually-transmitted diseases, and to control population. Both are pressing issues there. But only a quarter of the condoms are actually used for their intended purposes; the rest are utilized in the manufacture of clothing (saris), slippers, toys, road-paving, and construction jobs. This news (minus the road-paving and construction angle) has made the rounds in the last few days, with a brief report, much like this one in the Seattle Post-Intelligencer, running in dozens of papers in the U.S. and other countries.

Interesting thing, tho: the story is actually eight months old. From last August:

Only about 25 percent of the condoms are used for sexual activity, despite an aggressive government campaign to combat the spread of AIDS. Most of the condoms produced in India are paid for by the government and meant for free distribution by social service agencies. But, few reach the people who need them.

The report, prepared by Professor Ramakant of King George's Medical University of Lucknow, says that businesses are buying up the condoms in bulk. Contractors use them mixed with concrete and tar to pave roads. The latex apparently helps make the roads smooth and resistant to cracks. Builders are using the condoms on the layer that lies beneath the cement plaster on roofs and as heat penetrates they expand to form a waterproof layer that prevents seepage.

Condoms are also used in large quantities by manufacturers of gold embroidered saris, the 11-yard garments worn by Indian women. Workers use the lubricated condoms to polish the gold embroidery, the report says. India has 5.1 million HIV-positive people, the world's second highest number of infections after South Africa, according to the United Nations.

Condoms are great as a feel-good AIDS prevention strategy for Big Government and NGO social engineers looking to salve their consciences. But in real life, from Bangalore to Seattle, there are a variety of barriers to their use, especially in India and some African nations, where individuals are often hesitant to even acknowledge AIDS risk because of strong social stigma.

The stigma, which also exists in Western nations, is borne of mainstream society's reaction to the behavorial aspects underlying many AIDS cases. The stigma will always be there. And it is the actual risk-inducing behaviors which should be targeted, rather than the reactions of mainstream society to the behaviors.

And instead of focusing public education on messages such as "use a condom, it's really OK," or "be accepting of people with HIV," the spotlight should be on the power of the individual to make smart decisions which minimize risk. Committed, monogamous relationships are key.

I cannot forsee a day - with AIDS on the upswing globally - when anyone should seek to pardon or excuse casual and unprotected homosexual sex, especially casual and unprotected anal sex; or heterosexual sex involving prostitutes; or injecting drug use, because of the risk of needle-sharing involving HIV-positive users. Yet we gravely risk that effect by focusing on condoms, which so often aren't used in such situations, despite all the a priori public exhortations.

That most condoms in India continue to be used for industrial and commercial manufacturing purposes, rather than disease prevention or birth control; and that there is an upsurge in STDs in many large American cities; tells us that the best prevention measures come from within, not without. The only thing resembling a magic bullet for AIDS prevention is the power of the individual.

It all comes back to family, and parents who model stable, caring and monogamous intimate relationships for their children to emulate as they themselves move toward, and into adulthood. Additionally, economic opportunity and education enhance family stability, influencing individual behavior and decisions. More and better jobs and schools, and national, regional and local governments which are committed to those objectives, are also part of the necessary response to AIDS in developing nations. That talk is talked, but is it really walked? Not well enough.

Measuring condom utilization, and encouraging condom use is way, way down the list. At best.

Posted by Matt Rosenberg at April 26, 2005 07:17 PM

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