African women speak out against Bush’s abstinence-promoting HIV/AIDS policies

Good on these women:

On July 5, Beatrice Were, the founder of Uganda’s National Community of Women Living with HIV and AIDS, stood before hundreds of other HIV-positive women in Nairobi’s vaulted city hall and denounced the Bush administration’s AIDS policies.
Like many in attendance, Were contracted HIV from her husband, a common occurrence in a region where women make up the majority of new infections and marriage is a primary risk factor. For those like her, the White House’s AIDS prevention mantra — which prescribes abstinence and marital fidelity, with condoms only for “high risk” groups like prostitutes and truck drivers — is a sick joke.

“We are now seeing a shift in recent years to abstinence only,” she said. “We are expected to abstain when we are young girls and to be faithful when we are married to men who rape us, who are not necessarily faithful to us, who batter us.” The women in the audience, several waiting to share their own stories of marital rape, applauded.

Were exhorted her audience to “denounce programs that are not evidence-based, that view AIDS as a moral issue, that undermine the issues that affect us, women’s rights. I want to be very clear — the abstinence-only business, women must say no!”

Abstinence-only policies kill women here and abroad. They do the most harm to those with the least power. And they’re heavily funded by an administration that has otherwise done the laudable work of contributing more money to fight AIDS.

In fact, a full two-thirds of the money for the prevention of the sexual spread of HIV goes to abstinence. What’s left is targeted to groups considered high-risk. HIV-activists have spent the last two decades trying to show that condoms aren’t just for prostitutes and the promiscuous; Bush has undone much of their work.

The truth is that for many women, the major risk factor is simply being female. Marriage doesn’t alleviate anything — it can even make the situation worse, since many women don’t have the right to say no to sex. Sex is already taboo enough, and sexually transmitted diseases like HIV are particuarly stigmatized. And since HIV is deadly, it’s particularly feared and considered particularly shameful. Bringing in the issue of sexual purity, and only giving condoms to people who are considered sexual transgressors, isn’t helpful. Needless to say, this policy is costing lives:

In her brilliant new book, The Invisible Cure: Africa, The West, And The Fight Against AIDS, Helen Epstein shows what some of the ideologues’ policies have meant on the ground. Much of her reporting is from Uganda, a country whose history with the disease is hotly contested. In the 1990s, following a concerted campaign by both grassroots organizations and president Yoweri Museveni, Uganda became the first African country to see a significant drop in its infection rate. This wasn’t the result of an abstinence campaign, but abstinence crusaders in the west claimed the country’s success as their own, and it became a principal justification for Bush’s PEPFAR policies.

Indeed, religious conservatives worldwide now tout Uganda’s example. Last year in Nicaragua, I asked Monsignor Miguel Mantica, spokesman for the Archdiocese of Managua, why he thought abstinence education is appropriate in a country like his, where men rarely stick to one partner at a time. He replied that Uganda has proven that it works.

Epstein, who has a background in biology and public health, argues that people in East Africa, where the spread of AIDS has been especially catastrophic, don’t have more partners over a lifetime than people in other regions, but they are more likely to have simultaneous long-term relationships. Citing the work of the sociologist and statistician Martina Morris, she writes that concurrent liaisons “are far more dangerous than serial monogamy, because they link people up in a giant web of sexual relationships that creates ideal conditions for the rapid spread of HIV.”

Uganda’s initial response to AIDS addressed this, and urged partner reduction, or “zero grazing,” which was not the same as abstinence. Condoms played a role as well. “HIV infection rates fell most rapidly during the early 1990s, mainly because people had fewer casual sexual partners,” Epstein writes. “However, since 1995, the proportion of men with multiple partners had increased, but condom use increased at the same time, and this must be why the HIV infection rate remained low.”

Yet in a grotesque irony, PEPFAR funding has refashioned Uganda’s anti-HIV campaign to fit the distorted notions of American conservatives (and their allies among Uganda’s evangelical revivalists, who include First Lady Janet Museveni). “The policy is making people fearful to talk comprehensively about HIV, because they think if they do, they will miss funding,” says Canon Gideon, an HIV-positive Anglican minister from Uganda who has been a leader in the clerical response to the epidemic. “Although they know the right things to say, they don’t say them, because they fear that if you talk about condoms and other safe practices, you might not get access to this money.”

Today, Uganda’s infection rate is once again rising.

A few weeks before I came to Kenya, I spoke with Stephen Lewis, who until last year was the United Nations Secretary General’s Special Envoy for HIV/AIDS in Africa. I asked how he understood the balance between the harmful and the helpful aspects of Bush’s AIDS initiative. “It really is difficult to quantify,” he said. “The only thing one can categorically say is that the overemphasis on abstinence probably resulted in an unnecessary number of additional infections.” That this policy is celebrated as Bush’s greatest moral achievement shouldn’t be understood as praise.

Perhaps we should start listening to African women like Beatrice Were when they tell us what they need. It doesn’t sound like it’s more talk about abstinence.