WHEN PRESIDENT BUSH promised $15 billion to fight Africa's AIDS epidemic in his State of the Union address, he also turned American policy upside down by promoting the singularly successful Ugandan model, which emphasizes abstinence and faithfulness over condom use. To accentuate his point, the president seated Dr. Peter Mugenyi, one of the pioneers of Uganda's ABC approach, next to the first lady.
ABC-Abstinence, Being faithful, and Condom use-caused Uganda's prevalence rate for HIV, the virus that causes AIDS, to plummet from 25 percent in the 1980s to 6 percent today. Ugandan leaders stress behavioral change in A and B, but officials at the United States Agency for International Development have traditionally favored C-and five months after President Bush announced the shift in policy, they're finding it hard to break old habits.
Here's a brief chronology:
3È Last fall President Bush issued an executive order to create a center for faith-based and community initiatives at USAID.
3È In December, agency director Andrew Natsios cabled a communiquŽ to all overseas missions: The ABC model was to be the official strategy for combating AIDS.
3È On May 1, the House of Representatives passed an AIDS bill authorizing $15 billion over five years-with amendments that would protect groups not wanting to promote condom use. The bill in its current form also earmarks a third of the prevention funds for abstinence education.
Meanwhile, USAID has embarked on a $50 million program (dubbed CORE, or Communities Responding to the HIV/AIDS Epidemic) specifically designed to pull in faith-based and local groups. But USAID placed five groups that have promoted "safe-sex" programs in charge of disbursing the $50 million.
For example, Brussels-based CARE, which is heading the program, has been ramping up sex-education programs for African youths. CARE calls the Roman Catholic Church's prescription of abstinence an "obstacle" and acknowledges that its educational comic books, with heroes "Captain Condom" and "Lady Latex," had to be toned down to accommodate local sensibilities.
Another group, the International HIV/AIDS Alliance, backs legalized prostitution and supported a program last year in Zambia that armed taxi drivers with boxes of condoms to distribute to passengers. The other recipients-Johns Hopkins, the International Center for Research on Women, and the World Council of Churches-wield similar prevention philosophies.
With this background, conservatives questioned whether the billions of dollars that Congress is likely to appropriate for anti-AIDS efforts will truly fund groups adhering to the ABC policy. Austin Ruse, executive director of the Catholic Family and Human Rights Institute, said groups that fit the "faith-based" label in name, but tout safe-sex policies and condom giveaways, could still qualify for the president's $15 billion.
"What we really need are organizations-faith-based or not-who will promote abstinence and fidelity," said Mr. Ruse. "It would not surprise me if an organization called the Church of Planned Parenthood applied for funding."
Alfonso Aguilar, a spokesman for USAID, insisted that the preferred prevention methods of the five groups in the CORE initiative would not detract from the administration's ABC policy. "We work with groups because they have a certain expertise in this field. That doesn't mean that there are issues that we don't disagree with them on," he said. "But when it comes to working with them in our policies, U.S. policy is followed."
But two years ago George Mwila ran into U.S. government disdain for abstinence-only programs. His group, Youth Alive Zambia, applied for about $9,000 to buy public-address equipment for its community events. Local agency officials showed initial interest in the group's activities, sitting in on youth sessions and holding meetings with Youth Alive representatives. When the group later requested the status of its proposal, the agency issued a rejection letter suggesting Youth Alive should consider including condom promotion in its program.
Mr. Mwila said he and others protested the decision, referring field employees to the agency's own statements in support of expanding AIDS prevention. (Official agency documents on Zambia as recent as July 2002, however, focus on condom distribution, not behavioral change, as a prevention strategy.) The agency encouraged them to apply again, but after a month of lobbying for the dollars, he said his group was too discouraged to start over. They never went back. "We felt we were left out unfairly," said Mr. Mwila. "For us there's a general feeling that the American government would only give assistance if you're promoting condoms."
Stella Kasirye, World Relief's country representative in Malawi, agrees: She said groups that don't preach condom use are not likely to qualify for large-scale funding. "There's still a lot of skepticism of the viability of the faith-based community," she said. "Unfortunately some of those are fed by faith communities themselves."
African faith-based groups have also been slow to enter into the fight, Ms. Kasirye said, because they see those with AIDS as reaping the results of sin. But that aloofness is beginning to melt. Southern Africa in the last two years has seen churches minister increasingly to AIDS orphans, widows, and patients.
Even so, practical abstinence-education programs are still rare. "It's true to say that many churches promote abstinence but they don't have any strategy put in place to help young people adopt abstinence," said Mr. Mwila, who works for one of Zambia's first abstinence movements.
A lack of know-how could be easily solved if some of the $15 billion went to training faith-based groups and churches in abstinence education, said Patrick Fagan, family and cultural issues fellow at the Heritage Foundation. Large-scale partnerships with faith-based groups are "new ground" for the U.S. aid agency, he said, and noted that "the UN is very hostile to religion in all of its social policies. USAID on issues of abstinence has pretty much had the same hostility."