Baltimore Sun op-ed

Undermining the AIDS fight
By Paula Tavrow
Originally published October 18, 2005

AIDS has hit Africa hard. But nongovernmental organizations confronting the epidemic have been hit even harder by the Bush administration's ideologically based edicts.

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 percent to 9 percent 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.

Since abortion is largely illegal in Kenya, one would expect the gag rule to have had little impact. But because organizations such as International Planned Parenthood Federation refused to buckle, they experienced major cuts, which they had to pass along to their developing-country affiliates.

Hence, the Family Planning Association of Kenya's budget was halved, and many clinics offering birth control and other vital services were closed. This significantly reduced Kenyans' access to contraceptives and, ironically, probably increased unsafe abortions. One of my colleagues, Dr. Solomon Orero, a Nairobi obstetrician, estimates that more than 200 maternal deaths in Kenya can be attributed to the gag rule.

Second was the President's Emergency Plan for AIDS Relief (PEPFAR). This five-year, $9 billion program supports 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, Samson Radeny, told me that World Vision's activities will include Christian "transformative education" and encourage "abstinence peer models" in schools. For the estimated three in five youths who are sexually active, the organization will promote "teen faithfulness" but will not provide any contraceptive information. Apparently, unprotected "faithful" sex is preferable to safer sex.

Many Kenyans fear that abstinence-only programs will stigmatize sexually active youths and undermine the government's efforts to encourage youth-friendly health services. Moreover, abstinence-only programs prevent vulnerable youths from obtaining lifesaving information. Where I work, about half of Kenyan youths think birth control pills make you sterile and HIV can pass through condoms. Abstinence education skirts these issues.

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, which 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 a public health conference last year, an American colleague declared, "At least under Reagan we could still do our jobs." 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.

Paula Tavrow is director of the Bixby Program in Population and Reproductive Health at the School of Public Health at the University of California, Los Angeles. She is also principal investigator for the UCLA-funded Youth for Youth program in Bungoma, Kenya.





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