Abstain, Be faithful, use a Condom — the well-worn ABC approach to HIV prevention. Pity the letter B, rarely noticed between letters capable of picking fights wherever they go. On the face of things, who could object to B's nice-guy message?  Be faithful: it seems to belong in a league with ‘Don't slouch' and ‘Say please'.

But in fact, a compelling theory holds that if B had been explained fully and pursued more responsibly years ago by the international organizations and UN agencies most associated with HIV prevention messages, masses of deaths and immeasurable amounts of human suffering might have been averted.

The theory, set out most recently in two books reviewed by AIDS-Free World for the journal Nature, holds that patterns of sexual mixing (in this instance, the common practice of maintaining two or more concurrent partnerships over the longterm) in east and southern Africa have a great deal to do with the sky-high prevalence rates in that region. Author Helen Epstein, focusing in particular on Uganda, contends that when international organizations took over the AIDS response in that country, they dismissed indigenous understanding of the epidemic’s course, ignoring evidence that local responses — while based on logic, not science — were already proving enormously successful in curbing the spread of the virus. The homegrown Ugandan prevention message, “zero grazing!”, was revised and downplayed into obscurity by the foreign aid establishment, eventually to be replaced by “Be faithful” — a vague, moral-sounding admonition, stripped of all its original clarity and urgency.   James Chin introduces epidemiology to corroborate the theory that if scientific reason had prevailed, the focused would have been trained largely on concurrent sexual partnerships. He asserts that long before the first cases of AIDS were reported in the region, World Health Organization data on Sexually Transmitted Infections demonstrated a dangerous pattern of concurrent sexual partnerships. But he says that the UN was so clutched about offending Africans that, instead of reading the forecast and acting accordingly, WHO and UNAIDS silenced those who sounded the alarm. Safer to be politically correct, he says they decided, than to state scientific facts that might be misconstrued as racist. Epstein also offers evidence that UNAIDS and others knew that a focus on concurrency could save countless lives, but offers no rationale for their inaction; she's just baffled by the efforts to suppress or ignore hard evidence.

These are not easy accusations to swallow, and so it shouldn’t surprise us that UNAIDS feels defensive. But it should surprise us — and outrage us — if the questions that experts have raised do not lead to a fresh examination of the concurrency theory and to appropriate action — action focused on protecting the lives of Africans, not the track records of international civil servants.

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