0,1865059.story?coll=bal-oped-headlines, Congo Kinshasa RPCV Mike Tidwell says Emphasis on abstinence imperils gains in African AIDS fight
Emphasis on abstinence imperils gains in African AIDS fight
By Mike Tidwell
Originally published July 20, 2003
Baltimore, Maryland - ONE STORY completely missed by the media during President Bush's whirlwind tour of Africa is this surprising item: The HIV infection rate on the continent, while still a nightmare across most of sub-Saharan Africa, appears to be leveling off or declining in several key urban areas.
The epidemic, in fact, may have turned a corner in Africa.
But as Mr. Bush stormed through five countries in five days touting his just-approved $15 billion emergency AIDS bill for the continent, there was cause for big concern.
That's because the U.S. plan's big emphasis on abstinence-until-marriage programs - imposed by social conservatives in Congress - could actually undermine the newly emerging gains. Telling Africans to just say no to sex, in other words, is woefully insufficient and could prove counterproductive over the long term.
But first, the good news.
Recently released data compiled by the U.S. Census Bureau and analyzed by the U.S. Agency for International Development show the infection rate is declining in the urban areas in some of the continent's hardest-hit countries: Rwanda, Ethiopia, Tanzania and Uganda.
The data also show the virus leveling off in cities in Zimbabwe, Malawi, Zambia, Kenya, Ivory Coast, Republic of Congo and Senegal.
What's driving these gains? A host of factors may be involved, but most knowledgeable observers within the United Nations, the U.S. government and various aid organizations point to intensive, multiyear, multi-approach prevention campaigns. Such campaigns, initiated across the continent in the past decade or so, typically take the common-sense approach of stressing the value of abstinence and monogamy. But they also aggressively promote responsible condom use for those who stray or are already infected.
Indeed, in Uganda, where the infection rate among sexually active adults has dropped the most - from 30 percent to 5 percent - condoms have played an enormous role, according to David Serwadda, director of the country's Institute of Public Health.
"We must not forget that abstinence is not always possible for people at risk, especially [African] women," says Mr. Serwadda. "Many women simply do not have the option to delay initiation of sex or limit their number of sexual partners."
Yet congressional Republicans still managed to require that one-third of the prevention component of the $15 billion AIDS bill (spent over five years) go exclusively to abstinence-until-marriage programs. This is based on conservatives' fears that the open discussion and dissemination of condoms somehow makes people more promiscuous. There is, however, no credible evidence to support these suspicions.
Ironically, studies now show that African women who abstain from sex until marriage are still often at high risk. That's because experienced husbands frequently come to the marriage already infected. Thus the need for condoms is critical to reduce the risk of infection for women even after marriage.
"It's a real tragedy that Congress wants to rearrange a prevention formula - one that includes abstinence, fidelity and condoms - just as we finally get concrete and widespread information that the multipronged approach is bringing dramatic success," said Phil Harvey, president of DKT International, a U.S.-based nonprofit operating AIDS prevention programs worldwide, including Africa. "Congress should heed the exciting new data and realize the lesson: We need every tool we can marshal to beat this epidemic."
Mr. Harvey points to Ethiopia, where 9 percent of all the world's HIV-positive cases exist and where DKT runs the nation's largest AIDS prevention program. For years, DKT has flooded the nation with abstinence and sexual fidelity messages - on radio, TV, etc. But it has also conducted safe-sex workshops and distributed hundreds of millions of reduced-cost condoms throughout the nation.
The Ethiopian program's efforts were singled out for praise in May by Peter Piot, head of the United Nations' AIDS prevention agency. Mr. Piot said that decline in new cases among teen-agers in the Ethiopian capital of Addis Ababa "means that likely we are seeing the impact of prevention efforts there."
Congress should immediately amend the Africa AIDS bill, dropping the restrictive and cumbersome abstinence-until-marriage emphasis. If this doesn't happen, the Agency for International Development, which has officially promoted overseas condom use for years and will oversee much of the American AIDS funding, should show bureaucratic flexibility to make sure successful AIDS fighters such as DKT International and others get the full support they need from U.S. taxpayers.
When so many lives are at stake, proven success - not Puritan ideology - should drive U.S. policy.
Mike Tidwell was a Peace Corps volunteer in Africa from 1985 to 1987 and wrote a memoir of his experience, The Ponds of Kalambayi (Lyons Press, 1990). He lives in Takoma Park.
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