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Ideology hinders AIDS efforts in Africa

BY Paula Tavrow

Last month, the U.N. special envoy for HIV/AIDS in Africa, Stephen Lewis, and others declared that the administration’s policy of emphasizing abstinence-only programs and cutting federal funding for condoms has undermined Uganda’s HIV/AIDS effort. Sadly, Uganda is not alone.

Having recently returned from Kenya, where I have worked intermittently for a decade, I can report that the best and brightest health professionals there are despairing not of AIDS, which has infected 7% to 9% of Kenyans, but of numerous U.S. restrictions.

For years, with our assistance, these Kenyans had risked their reputations to challenge their own conservatives who oppose sex education and access to reproductive health services. Now they feel abandoned.

What happened? First was the global gag rule, reinstituted by President Bush immediately after he assumed office in 2001. It mandates that no foreign agencies may receive U.S. assistance if they provide abortion services, including counseling or referrals, or lobby to make or keep abortion legal.

Although the Family Planning Association of Kenya does not offer abortion services, its sponsoring organization lost major funding. Hence, Kenya had to close many of its clinics offering birth control and other vital services. This significantly reduced Kenyans’ access to contraceptives and, ironically, probably increased unsafe abortions.

Another setback has been the President’s Emergency Plan for AIDS Relief (PEPFAR) — a five-year, $9-billion program supporting AIDS treatment, care and prevention activities in 15 countries, including Kenya.

Health professionals have been dismayed by the regulations governing disbursements. One-third of PEPFAR prevention funds must be spent on “abstinence/be faithful” youth programs, even though Kenya’s AIDS control program promotes “ABC” messages (“abstain, be faithful, or use condoms”).

Last year, 11 faith-based organizations — some with no prior youth health experience — were awarded about $1 million each to engage in questionable abstinence-only campaigns in Kenya. Programs such as mine, which offer comprehensive sex and life skills education and services to rural youths, were ineligible.

One recipient was World Vision, which requires that its employees call Jesus their savior. A spokesman for the organization said its activities will include Christian “transformative education” and “abstinence peer models” in schools. World Vision will promote “teen faithfulness” — but will not provide any contraceptive information. Apparently, unprotected “faithful” sex is preferable to safer sex.

The latest indignity was the Bush administration’s decree in June that any nongovernmental organization receiving U.S. government funding must explicitly oppose prostitution and sex trafficking. This caused consternation among NGOs that train sex workers to serve as health educators and condom distributors.

Refusing to adhere to this new requirement, the Brazilian government returned $40 million to the U.S. Treasury. Unfortunately, NGOs in Kenya are too cash-strapped to reject money. Instead, they are quietly ending their prevention programs for sex workers, even though experts believe these activities are vital for combating AIDS.

“At least under Reagan we could still do our jobs,” an American colleague remarked at a public health conference last year. Regrettably, the Bush administration’s policies are reducing the effectiveness of our foreign aid, squandering our reputation and alienating our scientifically minded public health allies in Africa.

Tavrow, a visiting associate professor at the School of Public Health, is director of the school’s Bixby Program in Population and Reproductive Health. She is also principal investigator for the UCLA-funded Youth for Youth program in Bungoma, Kenya.