Effective AIDS response needs more than abstinence

Globally the United States might be spending more money than ever before on HIV/AIDS, but their prevention policies are having a disastrous effect on existing efforts, activists warned at the International Conference on AIDS and Sexually Transmitted Diseases in Africa (ICASA), held in Abuja, Nigeria. Through the US President's Emergency Plan for AIDS Relief (PEPFAR), 15 developing countries will benefit from the five-year US $15 billion programme, which will fund treatment, prevention, orphan and palliative care projects. But there are moral strings attached to the financial aid, and some aspects of prevention are being undermined, according to an analysis of PEPFAR spending over the past three years by the Centre for Health and Gender Equity (CHANGE). Abstinence programmes have received the lion’s share of prevention funds, while the total budget for condom procurement and distribution has “flatlined and [has not] increased by a single dollar”, according to Jodi Jacobson, executive director of CHANGE. UGANDA MAKES A U TURN Nowhere is this more evident than Uganda, where the country’s successful strategy in curbing the spread of the epidemic has now become mired in controversy. Uganda managed to reduce its adult HIV infection rates from 30 percent in the early 1990s to below 6 percent last year. This success was largely credited to President Yoweri Museveni, who spoke out early and robustly about the need to combat HIV/AIDS But for Ugandan activist Beatrice Were, Museveni’s about-turn on condoms and embrace of abstinence as the best way to contain HIV/AIDS at last year’s International AIDS Conference in Bangkok, Thailand, came as a shock. Since then, influential Ugandan leaders have waged a vocal campaign against condoms and the country has become polarized over the issue. As abstinence messages gain prominence, condom supplies have dwindled. Uganda needs 120 to 150 million condoms a year, but only 32 million have been distributed since last October, CHANGE noted. Were also pointed to the rise of the “new kids on the block” – inexperienced evangelical groups that receive financial backing from the United States, and were taking advantage of their newfound exposure. These religious fundamentalist groups were “unleashing a new wave of stigma,” that was causing deep rifts among AIDS NGOs in the country. “Before PEPFAR, we were united on the issue and we have now become divided,” she noted. Jacobson alleged that many of these faith-based organisations were being funded for ideological purposes rather than public health goals. A NEW ALPHABET FOR PREVENTION Ideological battles aside, Rolake Odetoyinbo, national coordinator of Nigeria’s Treatment Access Movement, called for people to suspend their “moral bias” and ask: have abstinence-only programmes worked? With young people being advised to wait until marriage, it had become evident that the US policy considered marriage as a vaccine against AIDS, said Sharonann Lynch, director of international policy for US-based lobby group HealthGAP. But these strategies “have failed me as an African woman … I got infected in my marital bed, by my husband, whom I was faithful to,” Odetoyinbo revealed, adding that condoms on the other hand had been proven to work. Odetoyinbo, who is also a member of the Pan African Treatment Access Movement (PATAM), noted that it was time for a new alphabet for prevention: “A is acknowledge that sex is happening, B is be realistic, C is give people choices, D is delay sexual debut, E is empower people with the right information and F is for financial independence”. PATAM has released a declaration calling for African governments to resist alleged US pressure and ensure that comprehensive prevention, including access to male and female condoms, are integrated in all HIV/AIDS programmes.