U.S. strings rankle some in AIDS fight - Funding is tied to abstinence message
By Mark Silva
Copyright © 2007, Chicago Tribune
Published June 29, 2007
LUSAKA, Zambia -- On a bright yellow wall facing the red clay courtyard of Regiment Basic School, rules of the school are painted in bold letters. Among the strictures: Eat healthy foods, drink boiled or chlorinated water, wash hands often and say no to sex and drugs, "because AIDS is real."
In Africa, where the United States is spending billions of dollars in an unprecedented global war against AIDS, the Republican-run Congress that first authorized this money also set a requirement: One-third of the money spent on prevention of the disease must go toward promotion of sexual abstinence.
While the U.S. is widely hailed for spending more than any other nation on a commitment already costing $15 billion -- and with President Bush seeking a doubling of that to $30 billion over the next five years -- Americans also are criticized for attaching strings that some relief advocates insist render the aid worthless.
Some agencies reject funding
Some of the many non-governmental relief agencies offering aid around the world have refused to accept U.S. funding with promotion of abstinence required , and some have sued the U.S. Agency for International Development.
"We have people living with HIV-positive partners," said Paul Kasonkomona, an activist in Lusaka who has had HIV since 2001 and whose wife has tested positive. "We believe that staying abstinent is not healthy. We feel it is not right -- the imposition of another government because it has power and it is telling us what to do."
Administrators of the U.S. aid insist that abstinence is only a small part of a comprehensive program -- representing about 7 percent of the money spent so far on the fight against AIDS in 15 nations, mostly in Africa. They say more than 1 billion condoms have been distributed as part of the program.
In Zambia and other stricken corners of Africa, where schoolchildren are tutored in the basics of abstinence with the help of U.S. funding, the program is known as ABC -- "Abstinence, Be Faithful, Condoms."
It is pictured in a cartoon poster on the classroom wall of teacher Emelde Chewe. It shows three men up to their waist in water, with three small lifeboats strung together by rope: "Life saving boats in an AIDS flood." The boats are labeled: "Abstinence, Be faithful, Condom."
"The ABC program is part of the Zambian national strategy," said Mark Dybul, U.S. Global AIDS coordinator. "The ABC approach was actually developed in Africa by Africans."
For the U.S., he said, it is part of a wider approach under the President's Emergency Plan for AIDS Relief. "You've got to get to these kids to begin with and teach them messages when they're 10 years old."
Since Congress started paying for a program that Bush sought in his 2003 State of the Union address, it has required that one-third of the AIDS prevention money go toward abstinence. Prevention accounts for nearly a quarter of the overall money spent on a program that includes testing for HIV and treatment of AIDS patients using antiretroviral drugs.
'We must save lives'
Yet relief advocates say the restraint on spending has hindered programs that could use more money for treatment. With Democrats in control of Congress, Rep. Nita Lowey of New York has won House approval of an amendment on a bill containing the coming year's AIDS funding that would allow the president to waive the one-third requirement.
"We must save lives," said Lowey, whose waiver is headed to the Senate this summer.
As First Lady Laura Bush completes a four-nation tour of Africa this week to showcase the U.S. campaign against AIDS and malaria on a continent where 1 million children die of malaria each year and where an estimated 30 million people are HIV-infected, she has touted the comprehensive approach to fighting AIDS and staunchly defends abstinence as a strategy.
Bush also has touted church-affiliated programs involved in counseling and treatment of AIDS patients, such as a World Vision-supported and U.S. government-funded program outside Lusaka that trains caregivers for patients.
"One of the greatest sources of hope is the compassion of people of faith," she said Thursday. "In the United States and around the world, I've seen how houses of worship inspire volunteers ... and they are putting their faith into practice across the continent of Africa. ... Their compassion is right on display here in Zambia."
At Chreso Ministries, which treats more than 4,000 people with medicine supplied by the U.S., the first lady met one woman whose family of 18 includes four who are HIV-positive and a man who said medication has given him a "second chance" in life.
First Lady Maureen Mwanawasa of Zambia, who toured the Lusaka area with Bush on Thursday, insists the U.S. spending requirement is not a hindrance in her country, where 17 percent of the people ages 15 to 49 have HIV. .
"What we are saying, the children should not get into sexual activities until they are mature enough to understand the consequences," Mwanawasa said.
"This money regarding abstinence is being spent properly, and it must be encouraged," the Zambian president's wife said. "There are several ways in which we can reach young people. ... One of the effective ways is abstinence. ... It brings back dignity and self-responsibility to young people, because they know their bodies are not supposed to be abused and they should learn to say no."