Green, a recent appointee to the Presidential Advisory Council on HIV and AIDS, supports the "ABC" model (Abstinence, Be faithful, or use Condoms if A and B are not practiced) of AIDS prevention. He has written a book, Rethinking AIDS Prevention: Learning from Successes in Developing Countries, published last month by Greenwood Press.

"The goal of the book is to change policy," said Green. "The current paradigm of AIDS prevention is based entirely on risk reduction, primarily in the form of condom use. The paradigm does not emphasize interventions that avoid the risk in the first place, such as abstinence or being faithful to one partner."

The ABC model has been sharply debated by AIDS activists, health officials and Congressional members for what critics describe as elevating abstinence-only approaches and de-prioritizing condom use. Claude Allen, deputy secretary of the Department of Health and Human Services, stressed that abstinence should be the first message young people receive about AIDS prevention in his talk at the 2003 National HIV Prevention Conference in Atlanta.

Green said that he is not against condom use as a means to prevent HIV. He asserts that international AIDS prevention funding has increased significantly and that some of the additional funds should support abstinence and faithfulness models–in addition to condom use and anti-retroviral therapies.

"An HIV prevention model that does not include condom use would not be good," said Green. "Some people will not, or cannot, avoid risky behavior, and so they obviously need to use condoms. But I object to putting all of our resources into condom programs."

He is particularly concerned that some Westerners push condom use in Africa because they believe that young Africans are incapable of monogamy by nature, an outrageous attitude that he says he has come across.

Green said his interest in the role of abstinence and faithfulness in AIDS prevention strategies was piqued when he worked with USAID in Uganda in 1993. A country that had the highest HIV prevalence rate in the world in the 1980s was experiencing declines in both incidence and prevalence rates–and condom use was too infrequent to have been a significant factor, said Green.

Uganda’s President Yoweri Museveni was openly encouraging teen-aged Ugandans to delay their first experience of sexual intercourse. For couples, he did not stress monogamy because some Ugandans practice polygamy. Instead, Museveni emphasized faithfulness to partners. The Ugandan leader chose this approach, said Green, because he was not convinced that condoms would be readily available in the country. Museveni also employed frank fear tactics to get prevention messages across to the general population. At a time when many African leaders were in denial about AIDS in the 1980s, said Green, Museveni spoke to crowds through a bullhorn, stating point-blank that they would die unless they changed their behaviors. The HIV incidence rate peaked in 1988-89 and has been declining since then.

Uganda’s AIDS situation attracted international attention, and by 1998, well after the peak epidemic years, more than 1,000 NGOs had sprung up to fight AIDS, said Green. Funded by donors such as USAID, the organizations supported what Green calls the standard package of prevention tools: condoms, improved treatment of sexually transmitted diseases, voluntary counseling and testing and, most recently, prevention of mother-to-child transmission using anti-retroviral therapy.

Green is concerned that the standard approach has drawn attention away from the ABC model. Due to the increasing influence of foreign donor organizations, the ABC model lost ground to other programs that did not include abstinence and faithfulness promotion, he said. Preliminary results from a study by the U.S.-funded Demographic and Health Survey indicate that teenaged Ugandans are starting to engage in sex at earlier ages again, he said, and he predicted a backwards slide in progress unless Uganda is able to return to its ABC approach as it was implemented in the late 1980s.

In May, President Bush signed a bill to fight AIDS in Africa and the Caribbean. The legislation supports the ABC model and for the first time earmarks a portion of prevention funds (one-third) for abstinence-only approaches.

"We must go beyond condoms and pills," said Green.