Abstinence under attack

"Abstinence under attack" Continued...

Issue: "Faculty follies," April 29, 2006

"The notion that because people have always received aid money that they'll get money needs to end," Deputy U.S. global AIDS coordinator Mark Dybul told the Associated Press. "The only way to have sustainable programs is to have programs that are wholly owned in terms of management personnel at the local level."

That's good news for faith-based charities and church groups in Africa that once could only qualify for federal AIDS-fighting money as subcontractors to the larger NGOs like PSI and FHI. Now, under the plan's New Partnership Initiative, those who qualify on their own include Samaritan's Purse, Catholic Relief Services, World Vision, HOPE (a relief organization founded by the International Churches of Christ), World Relief, and others.

The emphasis on the ABC approach as a prerequisite to funding, according to Debbie Dortzbach, director of international HIV/AIDS programs for World Relief, "has focused the priorities-bringing all prevention efforts out into the open for application. For too long the AB part of prevention was given little focus and certainly almost no funding."

Last July Mrs. Dortzbach hosted first lady Laura Bush and U.S. global AIDS coordinator Randall Tobias at a secondary school in Rwanda where World Relief runs one of the U.S.-funded abstinence programs. At that time, federal officials and members of Congress were more concerned about not spending enough on abstinence. The president's plan in 2004 allocated only 27 percent of the 33 percent of prevention funds required by law to AB programs, and in 2005 only 25 percent. Meanwhile, condom procurement under PEPFAR has increased by nearly 50 percent-from 115 million condoms in 2001 to 240 million in 2005.

Mrs. Dortzbach said she is "disappointed" by recent negative reaction to abstinence-based programs-particularly given that the required level of funding is not fully into the pipeline. But "we are not thwarted," she said. "We know abstinence and faithfulness work. We also know faithful women are particularly vulnerable in Africa, due to their unfaithful husbands. We have a lot of work still to do." Data on the success of ABC programs, she said, "will be much more concrete than the words flying around from both sides of the political divide."

Recent studies do suggest that the shift in U.S. funding priorities is having an effect in Africa even before all the money gets there. In Kenya and Zimbabwe, two countries not highlighted in the GAO report, abstinence is up while HIV prevalence is down. The journal Science reported in February that sexual activity among men age 17 to 19 in Zimbabwe dropped from 45 percent in 1998 to 27 percent in 2003. Among women age 15 to 17 over the same time period it fell from 21 percent to 9 percent. Overall HIV prevalence in Zimbabwe has dropped by 23 percent among young men and by 49 percent among young women.

Kenya's Ministry of Health has reported similar statistics, with an overall decline in HIV prevalence from 10 percent in 1998 to 7 percent in 2003. Young Kenyan men reporting more than one sexual partner dropped from 35 percent in 1998 to less than 18 percent in 2003. UNAIDS director Peter Piot admitted that the declines in HIV rates in Zimbabwe and Kenya "have been due to changes in behavior, including increased use of condoms, people delaying the first time they have sexual intercourse, and people having few sexual partners." Such implicit endorsement of the ABC approach may suggest to government auditors and other critics that the ABC success story is only beginning.


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