A ‘choice platform’ on AIDS

Choices, not just condoms, are what women at risk of HIV need to protect themselves.

Erica Gollub, a professor of epidemiology who has worked as a consultant to the Female Health Company, wonders why the global AIDS prevention community has yet to get behind the policy, adopted by the New York State AIDS Institute in 1992, of a "hierarchical counseling approach." Gollub describes "quality hierarchical counseling" as urging women to use condoms whenever possible, with discussion of possible strategies (to get their male partners to use them). Information is then given, in order, about the other options, which include female condoms, microbicides, coitus interruptus (or withdrawal), fewer sexual partners, and even abstinence.

In the article "Choice is Empowering: Getting Strategic about Preventing HIV Infection in Women," published in the December 2006 issue of International Family Planning Perspectives, Gollub stresses that "a key ingredient is information in plain language about how HIV infects women­i.e., why condoms are the best protection. The beauty of such an approach is that it expedites information-sharing with the women who need it, and that new evidence can change the list itself, the order (of importance or efficacy) of methods and the counseling scripts."

Disturbing to Gollub is how much of the resistance to "hierarchical counseling," or to the less than 100-percent support for male condom use, is rooted in distrust of women -- or at least in their ability to make clear-headed decisions.

Critics of giving women a whole menu of prevention options believe that "providing women with information on a menu of prevention methods assumes that they will not use male condoms. For example, a common argument against the promotion of the highly effective female condom is that it is appropriate for, or acceptable to, a very small percentage of the world's population and thus a far cry from ideal."

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By Rina Jimenez-David's column, At Large. Philippine Daily Inquirer March 16, 2007