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Not so easy as ABC

National | AIDS: Abstinence emphasis in the Bush AIDS plan survives Congress, but will it carry the day among African leaders?

Issue: "The Kennedy Assassination," Nov. 22, 2003

Festus Mogae has caught the attention of American lawmakers. For the Botswana president, that's a first. The southern African nation-one of the continent's wealthiest with a strong democracy and unbroken peace-hasn't seen much turmoil since it won independence from Britain in 1966. But Mr. Mogae is staring down a horrific AIDS crisis, which prompted Sen. Bill Frist to invite him to headline a congressional AIDS conference last week. But even as Washington debates the most effective methods of fighting AIDS-behavior change, which the White House prefers, versus disease treatment-Mr. Mogae is one in a very small club of African heroes Republicans in Washington want to draw attention to as they push to enact President Bush's plan to ease Africa's crisis.

About 38 percent of Botswanans ages 15 to 49 are infected with HIV. Average life expectancy has dropped to 44. Out of a population of 1.5 million, the country has 70,000 orphans.

President Mogae hatched an aggressive top-down strategy of his own, heading a national AIDS council and launching a small but symbolic program to offer anti-retroviral drugs nationwide. Already these are helping Botswanans with HIV live longer. And Mr. Mogae volunteered to be tested for HIV to encourage his countrymen to do the same. That, said Senate Majority Leader Bill Frist (R-Tenn.), "sends an unambiguous message to the people.... It focuses attention. It works."

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Botswana's HIV prevalence rate, a measure of how many people already carry the virus, has leveled off, and the government has set a goal of no new cases of HIV by 2016, the country's 50th independence anniversary. But its success could be slowed by the strategy's emphasis on treatment instead of lifestyle change. That runs counter to Africa's only pattern of success against the disease, pioneered by Uganda.

Uganda faced down its AIDS epidemic by emphasizing abstinence and being faithful, with condom use as a last resort. That's become widely known as the ABC approach and is winning support among Bush administration officials. Uganda's president, Yoweri Museveni, who traveled to Washington earlier this month, announced that Uganda's HIV prevalence has dropped from 21 percent in 1991 to about 6 percent. And the country's per-capita use of condoms is now one of Africa's lowest. "All this has happened because of behavior change," Mr. Museveni emphasized. Botswana, by contrast, has one of the highest rates of condom availability in Africa.

On the AIDS home front, the Senate passed language in its foreign-operations bill to make it clear that groups promoting behavior change would be preferred in President Bush's plan. The Frist Amendment exempts faith-based groups from preaching condom use if they don't want to and ensures that a third of the money earmarked for AIDS prevention goes to abstinence-only groups.

The amendment passed unanimously Oct. 28, but not without a counterattack from Democrats (and Vermont independent Sen. Jim Jeffords). Sen. Dianne Feinstein (D-Calif.) introduced an amendment that would throw open prevention funds limited to abstinence-only groups to other organizations. That failed by just two votes.

"It was kind of a one-two punch," said Frist aide Bill Wichterman. "It was a tremendous victory because it put the Senate on the record as still in favor of the ABC approach, which worked in Uganda." The Senate also ignored White House caps on first-year funding and agreed to an extra $289 million in 2004. That brings the total to $2.4 billion.

Entire funding for the five-year plan is $15 billion, and Mr. Mogae hopes Botswana's aggressive response to AIDS will earn his country a big slice of it. His government has already received millions of dollars in aid from the Bill and Melinda Gates Foundation, sponsor of the congressional conference. But money spent on the wrong priorities won't stop an epidemic.

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