HARM REDUCTION WINS, ABSTINENCE LOSES

It's A Scientific Fact, Biologist Declares

TORONTO - About midway through the International AIDS Conference, Dr.
Mark Wainberg, the bookish-looking AIDS scientist from Montreal and
meeting co-chair, found himself in the thick of a chanting
demonstration of prostitutes.

As the sex workers and their supporters, including a statuesque
transvestite, shouted out for legalization, Dr. Wainberg shouted
along. As they punched the air in defiance, the dark-suited
microbiologist punched too.

At this massive and extraordinary conference, supporting such causes
is almost compulsory, as is speaking out for the rights of
injection-drug addicts, lamenting the plight of the overlooked
transsexual community and tolerating promiscuity, so long as that
multiple-partner sex involves condoms.

Abstinence is a dirty word and human rights take precedence over
quarantine.

To some, it might seem like political correctness run amok. But as the
largest-ever AIDS conference ended yesterday, researchers and agency
leaders said the science is irrefutable that judgmental approaches to
the groups most at risk of getting HIV do not work. Trying
non-coercively to change that behaviour or make it less likely to
spread HIV -- known as harm reduction -- is the best hope, they say.

"Yes, a number of people can get emotional about the issues -- but the
fact is that it ought to be scientific agendas that drive what we do,"
Dr. Wainberg said in an interview.

"And it's as simple as this: harm reduction works -- that is
established medicine -- abstinence does not work and people lie about
their sexuality and their sexual behaviour all the time. Anyone who
would articulate that being faithful is the solution to this problem
is clearly putting their head in the sand."

Only by reaching out to "marginalized" and, in some case,s criminal
groups like drug addicts and prostitutes, can public health hope to
communicate ways to make their behaviour safer, scientists stressed at
the forum.

That largely meant, though, that the role of personal responsibility
in avoiding infection, at a time when gay men in North America, for
instance, are increasingly neglecting safe-sex methods, was largely
overlooked.

Still, some aspects of the liberal approach were challenged at the
meeting, which drew 17,000 delegates and 2,300 media people from
around the world. A few public-health leaders called for more
aggressive HIV screening systems, which some human rights activists
oppose.

And in a closing news conference, the acting head of the World Health
Organization said the conference did not deal enough with personal
behaviour and condom use.

"We have one magic bullet that works," said Dr. Anders Nordstrom,
holding aloft a condom, after colleagues suggested there is no one
method that can always prevent HIV infection through sex.

Said Dr. Kevin DeKock, the UN agency's head of infectious disease:
"The WHO believes in a rights-based approach but as the epidemic has
changed -- keeping on doing the standard approaches that we always
have used is reactionary. We need to evolve. Evolve or die."

Scientists also voiced guarded hope about a range of experimental drug
technologies -- and old-fashioned male circumcision -- that could
eventually prevent many HIV infections biologically or chemically.