When it comes to solving problems like the global spread of
AIDS, just your cash (but not your voice) is welcomed.
At least that was the message delivered to President Bush at the
conclusion of the International AIDS Conference in Toronto on
August 18. The U.N. Special Envoy for HIV/AIDS in Africa, Stephen
Lewis, had much to vent about, not the least of which was PEPFAR
(President’s Emergency Plan for AIDS Relief). His gripe: that 33 percent of prevention
funding from the U.S. go to abstinence and marital faithfulness
advocacy.
“Abstinence-only programs don’t work,” Lewis said in his remarks
on the conference’s final day. “Ideological rigidity never works
when applied to the human condition.” He also called the policy an
“antiquated throwback to the conditionality of yesteryear to tell
any government how to spend its money for prevention.”
Lewis’s point that PEPFAR can’t work because of its “rigidity”
is a misrepresentation of the program, and his logic is flawed
besides. Abstinence is an absolute: If you tell someone the
foolproof way to not get AIDS is to not have sex, and they follow
that advice, then you’ve succeeded with that person, right?
“I’m always a little bit irritated when I hear the criticism of
abstinence, because abstinence is absolutely 100 percent effective
in eradicating a sexually transmitted disease,” said First Lady Laura Bush during her January
trip to Africa. “In a country or a part of the world where one in
three people have a sexually transmitted deadly disease, you have
to talk about abstinence.”
So what of the claim by Lewis that overall plans like PEPFAR
don’t work? Is there any evidence?
Not if you ask the practitioners of the program. For example
John Donnelly, the Boston Globe’s former Africa bureau
chief, wrote on August 20 that “the $15-billion
program is just hitting its stride, and many Africans believe it
has become the single most effective initiative in fighting the
deadly scourge.”
Donnelly, who has reported extensively on the African AIDS
crisis, blames “the tenor of the AIDS debate in Washington” —
including the rhetoric spouted by Lewis and others at the
conference in Toronto — for obscuring the successes of PEPFAR.
“Among those working on U.S.-funded AIDS programs, there’s a
sense of energy and optimism and a belief that they are making
history,” Donnelly wrote. “Every week, faith-based and secular
groups, encouraged and funded by U.S. AIDS specialists, are finding
new ways to treat people, prevent new infections, and care for the
ill.”
What complicates the way the African AIDS crisis is addressed is
the fact that, according to the Joint United Nations Program on
AIDS (UNAIDS), almost 46 percent of the world’s 40 million people
with HIV/AIDS are women. Fifty-seven percent of those infected in
sub-Saharan Africa are women. AIDS also spreads rapidly through needle sharing among
drug addicts in Africa and other parts of the world, like eastern
Europe.
Clearly, the problem is much more complex than visiting a high
school class with a “Just Say No” message.
“We need the tools that will allow women to protect themselves,”
said Microsoft founder Bill Gates, whose (along with his wife,
Melinda’s) foundation has contributed millions of dollars to fight
AIDS. “This is true whether the woman is a faithful married mother
of small children or a sex worker trying to scrape out a living in
a slum. No matter where she lives, who she is, or what she does, a
woman should never need her partner’s permission to save her own
life.”
This, presumably, is the perspective from which Lewis pronounced
his “abstinence-only programs don’t work” comment. But scoring
political points with a sympathetic crowd at the AIDS conference
was more important than disclosing the truth about PEPFAR, which has
advocated the successful ABC (Abstinence, Be faithful, use Condoms)
approach to prevention. Gates praised PEPFAR, by the way.
According to Donnelly, Congress has mandated that only one-third
of PEPFAR prevention money be spent on abstinence
programs. Of the U.S. funding, “just 7 percent of its money goes to
programs that try to persuade young people to avoid sex until
marriage,” Donnelly wrote. That’s a tiny fraction of the overall
funds that are also going to medical care and pharmaceuticals to
prevent the spread of the disease.
But does that contradict or undermine the Bush administration’s
goal to advocate abstinence above all else in combating AIDS? Not
under the circumstances described by Gates and others. The favored
method of funding for PEPFAR is through faith-based organizations,
which is vital considering that prevalent attitudes towards women
include domestic violence, rape, multiple partners among men, and
drug abuse. It’s a spiritual problem, in other words.
“Everyone knows this is a women’s pandemic driven by behavior in
men,” said evangelist Rick Warren, pastor of Saddleback Church in
Lake Forest, California, who recently joined an effort to channel more financial
resources to his worldwide church network to advance the
faith-based effort against the spread of AIDS.
The pandemic exploded due mostly to irresponsible sexual
activity and drug abuse, with many innocent victims along the way.
Therefore, contrary to Lewis’s criticisms, some behavioral rigidity
is required. Let’s hope PEPFAR and Warren’s involvement with
faith-based organizations are allowed to take root.
