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Stigma has a place in fight against AIDS

Catherine Nyirenda, a 24-year-old HIV-positive Zambian, wrenched herself from a hospital bed last week to deliver an electrifying address at the 11th International Conference on AIDS in Vancouver, British Columbia. She spoke with a startling honesty about her pride, her poverty and the pain of stigmatization.

"My impression is that the North is sick of poverty and death in Africa _ this is all that gets attention in your news," she said. "Many think that suffering is normal for us, but it isn't. We hurt and grieve and hunger as much as you would. And we hate disease, poverty, poor medical services and "poor schools.'

" She portrayed Americans accurately, I'm afraid, and her words created a sensation among the delegates, most of whom live in wealthy countries.

Yet one part of her story stopped me cold. In 1991, she discovered she had HIV. Two years later she decided to have a child, and two years after that she chose to have another.

How could she have done this?

"I became pregnant because I wanted to," the single mother explained. "It is very difficult to come to terms with not having children, particularly in Zambia _ a place where childless women are outcasts . . . Most people condemned me outright for having two children. I was seen as irresponsible . . . My own needs as a woman and a mother were not considered, and I had little support from people whose support I most needed."

Her older son seems healthy, but the younger one is sickly. Neither apparently has been tested for HIV, but even if the two boys escape the virus, they may wind up orphans.

This brings us to the heart of a question about how we fight AIDS. If one person among the 15,000 meeting in Vancouver had doubts about Nyirenda's decision to bear children, I didn't hear about it. Instead, lecturers repeatedly reminded us that to fight AIDS successfully, society must stop stigmatizing people and stop letting moral judgments stand in the way of public health campaigns. But how reasonable is this article of faith?

Ernest Drucker, who runs a drug treatment program in New York, said stigmas against addicts isolate them from AIDS prevention and other services. "The success of methadone reminds us that addiction is not a moral problem, but a disorder rooted in the characteristics of neurotransmission and brain physiology," he said. "While using drugs is a choice, addiction is not."

Uh, yeah, but the choice leads to the addiction.

Michael Merson, who headed the World Health Organization's program on AIDS, condemned the reluctance of Americans to embrace condom distribution programs. In an article distributed at the conference _ that appeared recently in the British medical journal The Lancet _ Merson said, "As a nation, we have never conquered the "Victorian within ourselves,' preferring to deny our sexual behavior even when the behavior presents an untold risk to ourselves and our loved ones. As a consequence, we have turned a public health crisis into a moral commentary equating disease with sin."

Well, wait just a minute. I'll grant you that these are mean and ugly times in America. Congress is gearing up for the fall elections by hammering gays. Teenagers do indeed need access to condoms, and drug addicts need access to needles that aren't carrying the AIDS virus. Someone who's infected with HIV needs compassion _ not right-wing moral hectoring.

But don't tell me that we must "destigmatize" drug addiction. Or that I'm simply listening to the Victorian within me when I worry about sending mixed messages to kids through condom distribution programs.

Don't tell me I'm supposed to be comfortable with Nyirenda's decision to have two children. Some stigmas are stupid and irrational. Others may simply be society's way of protecting itself against irresponsible behavior.

Mothers who aren't fully prepared to care for their children, drug addicts and kids who have sex before they're ready: All risk hurting themselves and others. Most people in our society understand this intuitively; that's why they frown on such behavior. To be effective, public campaigns for clean needles or condoms must take this into account.

Here's an irony for you: Public health experts constantly warn that AIDS prevention programs in the developing world must take special care to understand and deal with local attitudes. Yet, at home, they forget that lesson. They do so at their own peril, because blithe admonitions against "stigma" and "morality" raise unfounded suspicions that what the AIDS fighters really want to do is sneak a counterculture agenda into public policy.

As uncomfortable as some prevention programs make me feel, I know we need them. But I'll draw my own judgments about some of the behavior that makes them necessary.

Joseph Dolman is a Newsday editorial writer.

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