World AIDS Day

President Bush said this today:

"We're working with our partners to expand prevention efforts that emphasize abstinence, being faithful in marriage and using condoms correctly. This strategy, pioneered by Africans, has proven its effectiveness, and America stands behind the ABC approach to prevention."

Interesting. I erred in my post yesterday by not including the administration's emphasis on condom usage.
It's important to note, however, that this is not a shift in policy- it's been the Bush Admin's consistent approach to the issue. And yet African AIDS programs that accept American funding in exchange for promoting this program have been markedly less successful in fighting the epidemic, as my post yesterday pointed out. What gives? Let's go back to the article:

"In a news briefing yesterday, Dybul [deputy global AIDS coordinator at the White House] denied that U.S. assistance in the AIDS fight came with strings attached and relied too heavily on abstinence programs.
'The notion that there's an excessive focus on abstinence is just untrue,' he said. 'The policy both in the guidance we issue and in the programs we support is fully A-B-C -- abstain, be faithful, and correct and consistent use of condoms.'"

Ok, Dybul, I'll bite. The Bush Admin's programs have been unfairly slandered. But really? Let's dig a little deeper on this.

Another article in last year's WaPo mentions this:

"Most prevention messages, and certainly those favored by the Bush administration, focus on the "ABC" approach to fighting HIV-AIDS: abstinence, be faithful, and use condoms. While important messages, these things are often not within women's power to control. It is urgent that we develop a "DEF" approach that responds to needs repeatedly expressed by women living with HIV-AIDS and by AIDS activists in Africa.

The need to go beyond "ABC" grows out of the stark statistics. Sixty percent of those living with HIV in sub-Saharan Africa are women and girls. Girls between the ages of 15 and 19 are infected at rates as much as five times higher than boys their age. This disproportionate impact is linked to social and economic factors that severely undermine women's control over their sexual lives. In a climate where sexual abuse and exploitation of women and girls are widespread and usually goes unreported, how can they practice abstinence? When married women, many of whom were child brides, have been faithful to the husbands who are infecting them, how do messages about monogamy help them protect themselves? When girls are pulled out of school to take care of sick relatives and are denied opportunities to gain skills that would break their economic dependency, how can they avoid survival or transactional sex and negotiate condom use?"

Hmm. Interesting. But Wait! There's more.

"Abstinence-only policies
Uganda receives significant amounts of funding from America, and much of the PEPFAR [The President's Emergency Plan for AIDS Relief] money is being channelled through pro-abstinence and even anti-condom organisations which are faith-based, and which would like sexual abstinence to be a central pillar of the fight against HIV. This money is making a difference - some Ugandan teachers report being instructed by US contractors not to discuss condoms in schools because the new policy is "abstinence only".
Small community-based organisations are increasingly shifting the emphasis of their prevention programmes to comply with the agenda of PEPFAR's favoured donors. This change is also being encouraged by evangelical churches within Uganda, and by the First Lady, Janet Museveni. Around the country dozens of billboards have sprung up promoting only abstinence to prevent HIV infection.

Condom shortages
In 2004 the Ugandan government issued a nationwide recall of the condoms distributed free in health clinics, due to concerns about their quality. Although tests showed there was nothing at all wrong with the condoms, the government said that public confidence in the brand had been badly dented, so they would not redistribute them. By mid-2005 there was said to be a severe scarcity of condoms in Uganda, made worse by new taxes which made the remaining stocks too expensive for many people to afford.
Some have said the US is largely to blame for the shortages. According to Stephen Lewis, the UN Special Envoy for HIV/AIDS in Africa, "there is no question that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing".
Mr Lewis has also said that PEPFAR's emphasis on abstinence above condom distribution is a "distortion of the preventive apparatus and is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred".
However, speaking in August 2005, Uganda's coordinator of condom procurement at the Ministry of Health denied there was any shortage of condoms, and said that new stocks would be distributed soon. She also said the government was committed to promoting all three parts of the "ABC" strategy: Abstinence, Faithfulness and Condoms."

So if ABC doesn't work, what's to be done? WaPo makes some suggestions:

"I asked a leading Ugandan AIDS activist about the lessons of the "ABC" campaign in his country. He replied that "ABC" is insufficient without "D," for "disclosure," which incorporates the importance of knowing your HIV status, changing your behavior appropriately and living positively. Yet women living with HIV-AIDS risk violence or abandonment in disclosing their status and are often blamed for bringing the virus into the household, even when their partners infected them. To address those realities, "D" should be "disclosure in safety," to help women disclose their status with appropriate social and economic support structures, including legal recourse in cases of violence. Training police and law enforcement officials on the links between gender-based violence and HIV-AIDS establishing safe shelters and referral services for women and girls, and providing support to women living with HIV-AIDS are examples of programs that would help women to disclose safely."

I'm not done. The contrary voice needs to be heard as well. But alas, no time. Here's some further reading, if you care:

Why ABC doesn't work:
http://www.iwhc.org/resources/gettingreal.cfm
News South Africa

And why it may:
USAID
http://www.natap.org/2003/Retro/day33.htm

I want to write more on this. Hopefully I will, later.