Monday, March 15, 2010

Winning a fight

Before anything else, I would like to congratulate Manny Pacquiao, again. And to Joshua Clottey: you can't win without fighting for it. I mean, really fighting.

Now here's an
ongoing fight - on condoms, again. In her Inquirer column this weekend, Solita Monsod joins the fray.

The endless ‘condom dilemma’

Ma'm Monsod usually writes in her no-nonsense, hard-nosed, lets-get-the-facts-straight style that is very engaging and doubly difficult to contradict, but let me try to quibble a little bit.

She starts by exclaiming:
"OH NO, HERE WE GO AGAIN, DEBATING ON an issue that has been medically resolved. I am of course talking about condoms.". The issue at hand in her own words, is on "how serious is the HIV/AIDS problem in the Philippines and what medical studies say about the effectiveness of condoms.".

On the seriousness of AIDS, Monsod writes:

And while our official data show that the total cumulative number of reported HIV/AIDS cases was 4,567, another set of estimates puts it at a much higher number. This alternative data set can be found in “The Epidemiological Fact Sheet on HIV and AIDS—Philippines, 2008 Update,” published by the World Health Organization, UNAIDS (UN Joint Program on HIV/AIDS). What are their estimates for the Philippines? Not 4,567, but an average of 8,300—with a low estimate of 6,000 and a high estimate of 11,000. And this was as of 2007, mind you, while our official estimates were for up to 2010. In other words, the Philippine official estimates are very conservative (or much more op
timistic) than the international estimates.

On the effectiveness of condoms for AIDS, Monsod writes:

"Now let’s go to the condom effectiveness issue. Are they effective in preventing HIV/AIDS? The answer is “Yes,” if we listen to the WHO circa 2000 and the Johns Hopkins School of Public Health circa 1999...Johns Hopkins is more of the same (and probably one source of the WHO fact sheet): “Condoms provide highly effective protection against HIV infection when used correctly with every act of intercourse. All 10 cohort studies conducted through 1995 that evaluated condom use among heterosexual couples showed that consistent condom use protected against HIV."

It is hard to contest the figures and it's just as hard to contest the findings of a
reputable research organization, although it surely must be a case of glass-half-empty, glass-half-full sort of thing. The facts may also give us something like the what-do-you-see-an-old-lady-or-young-lady sort of illusion (see picture at left). The thing is, the facts tell us something either way. Let us take for example the "high estimate" of 11,000 cases in a nation of 90M. The facts also say it is still a far, far cry from the end-2007 estimated 610,000 cases in Thailand with a population of 65M; or 240,000 in Burma with a population of 47.7M; or 290,000 in Vietnam with a population of 86M. In all three countries, condom usage is rising and its use is aggressively promoted. The particular case of Thailand, where the 100% condom program was launched way, way back in the early 90's, is deeply troubling. How come despite its massive condom funding for nearly two decades, its HIV cases are more than 550 times than that in the Philippines? So I see, condoms have been proven to be scientifically effective as protection against HIV? Depends on what they mean by 'effective', certainly they cannot mean 100%. Are we now supposed to mimic Thailand and spend $80M++ annually on condoms? On the other hand, isn't Thailand supposed to learn from us? Could the sudden spike in the Philippines HIV cases be attributable to low condom prevalence, or are there some other more significant factors at work? In the Philippines, does the statistics on the recent rise in HIV infections state what are the attributes of the rising cases? How about infections through intravenous drug abuse? Just assuming that the new cases stem largely from promiscuous sex, do we then give out free condoms because condoms are inaccessible and unaffordable to many of these existing cases who have been infected through promiscuous sex, including MSM? Which study says these people couldn't access nor afford condoms, which are legally and openly sold as it is? If we have been neglecting condoms for sooo long, why is our HIV statistics not in the 6-digit figure? Where does AIDS education come into the picture? Monsod's statistics and research references raise more questions than answers.

And indeed, Monsod concludes her article with a question:

"The question therefore is: Will the beneficial social, economic and health aspects outweigh the disadvantageous moral/religious aspects, or will it be vice versa?"

Even as the word 'beneficial' may be argued, the above question of course is only relevant to a secularist with a relativist worldview on what is right. Weigh things against each other, and the weightier side should prevail? But from whose viewpoint? The problem is again, there will be widespread disagreement on whether one sees an old lady or a young lady. But ask a bishop, and of course he will tell you that apart from disparate perspectives, you can't weigh things against moral absolutes: any intrinsic evil cannot be justified by a relative good that could supposedly come out of it. Thus from a Catholic viewpoint, there should be no dilemma in the first place, and you can't simply weigh things
amorally to evaluate which is right. Finally, AIDS is not the worst consequence there is, for one thing, it only lasts a lifetime.

Back to Joshua Clottey: The bottom line is you tried to escape punishment with a good defensive tactic while employing a lousy fight plan.
But first, you must understand what 'winning' means, and what it takes.


aeisiel said...

Ma'm Monsod should get her facts straightened first...

"Condoms have a substantial failure rate for AIDS transmission. The risk of fatal infection is quantifiably significant. Among heterosexual couples studied using condoms in which one partner was infected, 30 percent became infected within the year" (M. Fischl, "Evaluation of Heterosexual Partners, Children, and Household Contacts of Adults with AIDS," Journal of the American Medical Association 257 [1987]: 447–449).

"Condom use was not significantly associated with protection against infection" (Padian, Windlestein, et al, "Male-to-Female Transmission of Human Immunodeficiency Virus," Journal of the American Medical Association 257 (1987): 788).

"There are no clinical (human) data supporting the value of condoms in preventing the spread of a range of diseases including . . . human immunodeficiency virus (HIV), the precursor of AIDS" (Lawrence J. McNamee, M.D., Brian F. McNamee, M.D., AIDS: The Nation’s First Politically Protected Disease. National Medical Legal Publishing House, 1988, 102–113).

"Sayings such as ‘the way to get AIDS is from unprotected sex’ should be avoided since they imply that ‘protected’ sex is safe. It is not" (W. Shepherd Smith, Jr. "Another Point of View: AIDS, HIV and Sex Education," AIDS/HIV News, January/February 1992, 12).

The idea that condom use protects us is not only deceptive; it encourages a lifestyle that leads to sorrow and perhaps even death. I still say that the best prevention against such horrific diseases is to be chaste. Sexual activity outside of marriage is FLAT-OUT WRONG!

WillyJ said...

Thanks for those references.

Remember when there was an uproar among liberals a year ago when the Pope commented that condom distribution programs would worsen the AIDS epidemic in Africa?

Well, there was this senior Harvard research scientist who spoke out:
A senior Harvard research scientist confirmed that Pope Benedict XVI, who endured heavy criticism for declaring that condom distribution programs worsen the AIDS epidemic in Africa, was actually correct.

Dr. Edward C. Green, director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies, told National Review Online last week that despite AIDS activists and media outlets pounding the pope for downplaying the effectiveness of condoms, the science actually supports the Catholic leader's claim.

"The pope is correct," Green told NRO, "or put it a better way, the best evidence we have supports the pope's comments."

"There is," Green added, "a consistent association shown by our best studies, including the U.S.-funded 'Demographic Health Surveys,' between greater availability and use of condoms and higher (not lower) HIV-infection rates. This may be due in part to a phenomenon known as risk compensation, meaning that when one uses a risk-reduction 'technology' such as condoms, one often loses the benefit (reduction in risk) by 'compensating' or taking greater chances than one would take without the risk-reduction technology."

Anonymous said...


As people, we have a tendency to believe as fact whatever we declare to the world and rare is he who can admit his mistakes and dare to correct himself. By publicly espousing a certain stand we often back ourselves into a corner where we are forced to defend it even if it's wrong. Some people will do verbal cartwheels just to defend their espoused position. Contraceptives get labeled as medicine and something that works 85% of the time is sold to the public as supergood medicine. Never mind that it ain't medicine at all.

We should not forget what statistics are. They attempt to measure the uncertainty of specific outcomes. Statistics can only tell us the probability of something happening. Drawing conclusions from statistics should always be done with care. Especially when making conclusions that deal with non-events.

How can statistics prove that an infection that did not happen (non-event) did not because a condom was used? You can only say this for sure if you can also prove that the infection that did not occur was supposed to have occurred but did not because of the condom. Otherwise there is always an uncertainty factor with standard deviation, confidence level and even standard error.

To portray something uncertain as fact is to fool people into believing the thing is certain. Conclusions from statistics are never 100% certain. We should not believe they are. Otherwise we can end up like the person who keeps records of everything and notices that over 90% of the time, it rains after he washes his car. He then makes the conclusion that he can ensure sunny weather by not washing his car, which, over time he comes to believe as fact. See how twisted we can get? We need to have a sober look at things.

WillyJ said...

That reminds me of what Mark Twain said about statistics.

Monsod used to be NEDA Director-General, so it's not surprising that she lives and breathes statistics. Sometimes, statistics just need to be interpreted in the simplest terms. For example, when Suzanne says that one in seven regular users will get AIDS even with perfect use, that makes it so much simpler to understand.

To reverse your question, I will ask: How can statistics prove that an infection did happen (an occurence) because a condom was not used? With or without statistics, we already know that the direct cause of HIV infection is high-risk behavior. Definitely, those who are swayed by twisted statistics should sober up.

By the way, summer is so hot hereabouts, I wish I was back there in Black Forest. Not enough reason
to wash my car though :-)

Anonymous said...

It's going to be a good spring. Winter was really bad. Until last Monday, we didn't have a snow-free day since a week before Christmas.

The Black Forest is still thawing out. But the tulips are poking out of the ground. The birds are back. It feels like the earth is re-birthing. There is magic in the air. This is always a special time for me - the days are longer with the approaching equinox, everything coming back to life, and in a couple of weeks we celebrate the resurrection.

Stop reminiscing, my friend. Come back. Bring all the bloggers with you. We can organize a blogger's tour to include pilgrimage sites. Better yet, get on a mission to CFC communities here. Jun Enriquez is here now.

WillyJ said...

I must remember that, TE. Thanks.