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.
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