Just Say No

Congress is set to tie AIDS funding to abstinence programs. Good idea?

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House-Senate conferees agreed on Monday to provide an unprecedented $2.4 billion in 2004 to combat the spread of HIV/AIDS and other deadly diseases mostly in sub-Saharan Africa. Health groups welcomed the cash but not the condition that one third of the total be spent on promoting abstinence, leaving it unclear whether other crucial strategies, like safe-sex education, would be underfunded.

“Abstinence works, we know it works,” Colin Powell recently told the BBC. “If you’re not actually transmitting the disease through sexual conduct, the disease will not be transmitted.” The president and a growing number of lawmakers share that view.

U.S. proponents of abstinence programs argue this is how Uganda has fought off the epidemic. That country is often held up as the “how-to” guide for AIDS reduction in Africa.
About 1.5 million Ugandans, or 6 percent of the population, live with the disease, down from 30 percent in 1990.

Problem is, Uganda’s programming wasn’t limited to abstinence, but incorporated two other pillars: fidelity to one’s partner, and condom use — a strategy often called the ABC program (Abstinence, Be faithful, and Condoms work).

Although in an interview with the BBC, Powell emphasized that the U.S. focus is not confined to abstinence, health workers are concerned that the administration, presumably for moral rather than medical reasons, is biased toward that approach,
and neglects other approaches,
like safe-sex education. The Alan Guttmacher Institute (AGI), a nonprofit organization focused on sexual and reproductive health research, policy analysis and public education, writes:

    “U.S.-based advocates of abstinence-until-marriage programs, including those within the Department of Health and Human Services (DHHS), are seeking to attribute Uganda’s success mainly to increased abstinence. [AGI’s Director of Government Affairs, Susan Cohen] says these claims alarm reproductive health and HIV prevention advocates, particularly because DHHS, which supports domestic programs that deny U.S. teenagers medically accurate information about the benefits of sexual risk reduction strategies, has recently gained new authority to operate HIV prevention programs overseas.”

Christian Aid, a British humanitarian group, underlined the importance of sex education alongside abstinence programs:

    “These [abstinence] programmes do not include sex education and the use of condoms. While abstinence is clearly the most reliable method of avoiding HIV infection, the reality is that most people, especially young people, do not choose abstinence.”

Africa has around 70 percent of the world’s HIV/AIDS cases; an estimated 28.5 million people currently live with the disease, and 2.4 million died last year alone. During Bush’s three-day visit with Britain’s Prime Minister Tony Blair, 15,000 people will die of HIV/AIDS in sub-Saharan Africa. Secretary of State Colin Powell described HIV/AIDS as a “national security issue,” because of the way it’s hitting African armies, police and even U.N. forces.

The latest forms part of a plan first mentioned by President Bush in his State of the Union Speech last January to provide $15 billion over five years to fight AIDS in the countries hardest hit. The plan was universally commended, representing as it does a near-tripling of previous U.S. contributions. But this year, facing budget problems and an $87 billion tab for Iraq and Afghanistan, Bush asked for only $2 billion. Congressional negotiators added $400 million more, and the bill calling for $2.4 billion in funding will most likely go to the full Congress later this week.

Many are upset over what they see as the administration’s failure to live up to its heralded 5-year plan. Some humanitarian groups feel that the president’s request for $2 billion rather than $3 billion this year may signal a weakening of resolve.

Congressmember Nita Lowey (D-NY) said, “I think it’s truly unfortunate that the President talked the talk but wasn’t willing to walk the walk.” The administration says the difference will be made up in later years, claiming that due to other funding obligations (see war in Iraq) this is all they can afford right now.
Sandra Thurman of the International AIDS Trust argued that it’s
not OK
to excuse failures to provide AIDS aid in favor of other agendas:

    “I do have fears that among competing priorities in the United States, with a growing deficit, that there is a huge challenge getting enough money to fund these programmes. If we’re going to increase our debt, the thing they can’t stop funding are the things that matter most, and that’s providing care and services to people at risk for HIV and living with AIDS.”

But given the gravity of the situation, AIDS advocates and health organizations will take what they can, whether or not in the full amount or conditioned on abstinence programming. A sobering view, though, comes from Austin Ejiet from Kampala, Uganda, argues in an editorial that the reduction of AIDS cases in Uganda may owe as much to the disease itself as to prevention efforts.

    “I do not want to be anybody’s wet blanket; but if truth be told, we have not even begun the conquest of Aids in this country.

    Whatever gains we appear to have registered as reflected in all those astonishing single-digit percentages being paraded all over the place, must be credited to the virus itself. How?

    Well, when this strange illness showed up it slaughtered with such a ruthless and democratic efficiency that Ugandans were forced to pause in their tracks and say, ‘but wait a minute: what is going on around here?’

    You can’t bury half a dozen people everyday for a number of years without getting scared enough to take sensible precautions.”


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