Naina Dhingra is the director of International Policy at Advocates for Youth and can be reached at naina@advocatesforyouth.org .
Each and every day, 10,000 U.S. teens contract a sexually transmitted disease, 2,400 get pregnant, and 55 contract HIV. Globally, 6,000 young people between the ages of 15 and 24 are infected with HIV.
So what are the Bush administration and the far right ideologues in Congress doing about it? Pouring taxpayer dollars into abstinence-only programs that censor information about condoms and contraception and spread misinformation about HIV.
This week, researchers, NGOs, people living with AIDS, and policymakers are challenging the U.S. government’s position on prevention at the 16th International AIDS Conference in Toronto . New research is being presented on the importance of comprehensive programs for youth, young people themselves are advocating against abstinence-only policies, and the Swedish government is hosting a dialogue titled, “Morals or Politics of HIV prevention,” with a focus on U.S. policy. The world is tired of U.S. ideology and this week, the world is pushing back.
Domestically, over $1.3 billion has been spent on unproven abstinence-only programs. A 2004 congressional oversight report found that 80 percent of the curricula used by the majority of federal grantees contain gender stereotypes and medical inaccuracies including misinformation about condom effectiveness, HIV transmission and abortion. Many of these programs were found to have overtly religious messages and misrepresented religious beliefs as scientific fact. Despite the inaccuracies and lack of proven impact, abstinence-only programs continue to be a magnet for federal funding. And worse still, they are now being exported to countries ravaged by AIDS though a congressional earmark mandating that 33 percent of global HIV prevention dollars go towards abstinence-only programs.
The official global HIV prevention policy of the U.S. government is ABC—Abstinence, Be Faithful, and Use a Condom—which is comprehensive. But the truth is it’s not A, B, and C. It’s A, B, or, what is only encouraged for those at high risk, like commercial sex workers and injection drug users, C. And, in reality, the U.S prevention policy for youth is abstinence-only: stay abstinent, or, if you’re having sex, become a “secondary virgin.” Secondary virginity may sound nice, in theory, but it has little relevance and even less impact in the real world.
The truth is that U.S. HIV prevention policy has helped make the much needed goals of youth HIV prevention impossible. Abstinence definitely has a role to play—an important role—as part of a comprehensive approach. It is when abstinence is presented as the “only” solution for youth—ignoring the vital role of condoms—that public health gives way to politics and ideology and that the U.S. government's promotion of abstinence-only morphs into an anti-condom campaign.
The global community is supported in challenging this position by a recent GAO report on international abstinence-only programs, “Spending Requirement Presents Challenges for Allocating Prevention Funding Under the President’s Emergency Plan for AIDS Relief." The report found that the earmark “undermine[s] the integration of prevention programs by forcing [countries] to isolate funding” for only the ‘Abstinence’ and ‘Be Faithful’ components of the ABC prevention plan. A lack of clarity about what is permitted in regard to “C” (condom activities) has created a culture of fear amongst implementing partners who are concerned about “crossing the line between providing information about condoms and promoting or marketing condoms.” One organization interviewed in the report said that “although the organization views condom demonstrations as appropriate in some settings, it believes that condom demonstrations, even to adults, are prohibited” in U.S. global HIV/AIDS programs. Apparently the administration’s attempts at democracy promotion and spreading the values of free speech stop at the door of HIV prevention.
The GAO report provides further evidence of the administration's intensely ideological approach to policy issues involving HIV and sexual health. However, the GAO report is not the only "red flag" signaling that core public health principles are being undermined by politics and ideology. Recently, the premier institution for adolescent health, the Society for Adolescent Medicine, in one of the most exhaustive reviews to date of government-funded abstinence-only programs, rejected current administration policy that promotes abstinence as the only sexual health prevention strategy for young people. On the topic of U.S. global AIDS programs, the Society’s report stated, “Human rights groups find that U.S. government policy has become a source for misinformation and censorship in these countries. U.S. emphasis on abstinence may also have reduced condom availability and access to accurate information on HIV/AIDS in some countries.”
Congress is finally starting to fight back. This past June, Congresswoman Barbara Lee, D-Calif., Congressman Jim Leach, R-Iowa, Congressman Chris Shays, R-Conn., and 54 other House members introduced groundbreaking legislation known as the “Protection Against Transmission of HIV for Women and Youth Act of 2006” (H.R. 5674). The PATHWAY Act would repeal the offending congressional earmark that requires 33 percent of HIV prevention funding go towards abstinence-only programs.
Additionally, the bill would require President Bush and the Office of the Global AIDS Coordinator to develop a comprehensive HIV prevention strategy to address the major factors contributing to gender disparities in HIV infection as women and girls increasingly are the face of the pandemic. The bill represents a response to research showing that in a number of African countries, married women are at higher risk for HIV than their unmarried counterparts—data demonstrating that marriage is not the panacea claimed by proponents of abstinence—only programs.
Unfortunately, these enlightened members of Congress are in the minority. The administration and its congressional allies continue to ignore reality and subvert evidence-based public health by funding abstinence-only programs at home and abroad. U.S. prevention policy is impeding, not leading, efforts to stem the tide of HIV/AIDS. The PATHWAY Act offers an opportunity to reverse course and provide people, particularly young people, with all the information and tools they need to protect their health and lives in the era of AIDS.
