US abstinence drive hurts AIDS fight - UN official

The U.S. government's emphasis on abstinence-only programs to prevent AIDS is hobbling Africa's battle against the pandemic by downplaying the role of condoms, a senior U.N. official said on Monday. Stephen Lewis, the U.N. secretary general's special envoy for HIV/AIDS in Africa, said fundamentalist Christian ideology was driving Washington's AIDS assistance program known as PEPFAR with disastrous results, including condom shortages in Uganda. Activists in both Uganda and the United States say the country is now in the grip of condom shortage so severe that men are using plastic garbage bags in an effort to protect themselves. A Kenyan clinical officer examines an HIV-positive child in Kenya's capital Nairobi August 23, 2005. According to UNAIDS, 88% of the 2.2 million children in the world living with HIV/AIDS grow up in Africa. Photo by Wairimu Gitahi/Reuters

US abstinence drive hurts AIDS fight - UN official
Mon Aug 29, 2005 05:23 PM ET
By Andrew Quinn

JOHANNESBURG (Reuters) - The U.S. government's emphasis on abstinence-only programs to prevent AIDS is hobbling Africa's battle against the pandemic by playing down the role of condoms, a senior U.N. official said on Monday.

Stephen Lewis, the U.N. secretary-general's special envoy for HIV/AIDS in Africa, said Christian ideology was driving Washington's AIDS assistance program known as PEPFAR with disastrous results such as a shortage of condoms in Uganda.

Washington rejected the criticism.

"There is no question in my mind that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the U.S. is now pursuing in the emphasis on abstinence," Lewis told journalists on a teleconference.

Uganda had been praised for cutting HIV infection rates to around 6 percent today from 30 percent in the early 1990s, a rare success story in Africa's battle against the disease.

But President Yoweri Museveni's government has been criticized for what activists say is a reduction in the number of free condoms available due to pressure from Washington through the PEPFAR program.

A top U.S. official rejected Lewis's criticism and that it had forced Uganda to reduce the condoms available, saying the Bush administration supported condom use as part of a balanced program that included prevention.

"The statements that I have heard are completely untrue and completely mischaracterize effective prevention programs," Mark Dybul, deputy U.S. global AIDS coordinator and chief medical officer, told Reuters by telephone.

As part of President George W. Bush's global AIDS plan, the U.S. government has already budgeted about $8 million this year for abstinence-only projects in Uganda, human rights groups say.

Activists there and the United States say the country is in the grip of a condom shortage so severe that men are using garbage bags in an effort to protect themselves.

"That distortion of the preventive apparatus ... is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred," Lewis added.

Many health experts say condoms are the most effective bulwark against AIDS. Dybul and a Ugandan minister said there was no shortage in the country.

RELIGION

Lewis said the effects of Washington's "obsessive emphasis on abstinence" were most profound in Uganda, where it resonated with strong local religious traditions.

But he said the drive for abstinence was being felt more widely across Africa and threatened to derail or divert more AIDS-fighting programs

"What PEPFAR has done is to have made it possible for a number of Pentacostal and more fundamentalist churches to pursue the abstinence agenda," he said.

Dybul said around 20 percent of the U.S. government partners in fighting AIDS were "faith-based" groups, many of which were in remote locations ignored by other organizations and providing key support for communities.

The Ugandan government recalled free condoms in 2004 over quality fears and activists say it failed to provide alternatives, pushing up the price of them in the shops.

But Uganda's State Minister for Health Mike Makula told the Monitor newspaper there was no shortage, saying the country had 65 million in stock and had ordered another 80 million.

"That there is a condom shortage in the country is just a rumor by people who want to spoil the image of this country," the newspaper quoted Makula as saying.

Dybul said 15-20 million condoms bought with support from the U.S. government were in a warehouse in Uganda awaiting testing following Uganda's rejection of the flawed condoms.

He said the Bush administration supported the so-called "ABC" program -- abstain, be faithful or use a condom -- developed by the Ugandan government.

"The ABC has been a long-standing program which was developed by the Ugandans and is employed throughout the world because of its effectiveness, but to tell the Ugandans how to run their programs is highly paternalistic," Dybul said.

UN AIDS Envoy Blames Bush Administration's Abstinence Policy For Condom Shortage In Africa
by Chris Tomlinson, Associated Press
Posted: August 29, 2005 9:00 pm ET

(Nairobi) U.S. President George W. Bush's administration's international AIDS policies have worsened a condom shortage in Uganda and could lead to an increase in the East African country's HIV infection rate, a top UN envoy said Monday.

Stephen Lewis, the UN Secretary General's special envoy for HIV/AIDS in Africa and a former Canadian ambassador to the UN, said U.S. cuts in funding for condoms and a new emphasis on promoting abstinence had contributed to a condom shortage in Uganda, one of the few countries which had previously succeeded in reducing its HIV rate.

``There is no doubt in my mind that the condom crisis in Uganda is being driven by (U.S. programs),'' Lewis said in a teleconference sponsored by health and human rights groups. ``To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa.''

A shortage of condoms in Uganda has developed because both the government and its primary donor for HIV prevention, the United States, have allowed condom supplies to dwindle while allocating an increasing proportion of funding for HIV programs to religious groups that oppose condom use, said a report by the Center for Health and Gender Equity.

The group said that while Uganda needs between 120 million and 150 million condoms a year, only 32 million have been distributed since October.

Ugandan officials have denied that there is a problem or a deviation in policy.

``It is not true that there is a condom shortage,'' Health Minister Jim Muhwezi. ``There seems to be a co-ordinated smear campaign by those who do not want to use any other alternative simultaneously with condoms against AIDS.''

Muhwezi said he was co-ordinating Uganda's HIV prevention strategy with the U.S. government, but insisted that condoms remain an important part of their HIV prevention strategy. He said the recent discovery of problems with the quality of condoms imported into Uganda had led to a disruption in supply, but that the problem was sorted out.

Jodi Jacobson, the executive director of the Center for Health and Gender Equity, said all of the evidence collected in Uganda by her group had found that Ugandans had seen a 300 per cent increase in condom prices and free condoms could not be found at the normal distribution points.

Lewis and Jacobson also said that a campaign to discredit condoms and promote abstinence by Ugandan President Yoweri Museveni's wife, was providing misinformation about HIV that could cause an increase in the HIV rate.

``Religious fundamentalists, some financially supported by the U.S. government and the Office of the First Lady Janet Museveni, have become prominent in attacking condoms and those who distribute them,'' the centre's report said.

Muhwezi said the first lady could not be expected to promote condom use.

``Her role is to tell the young people to abstain. She cannot tell young people to use condoms. She is a mother,'' he said.


Bush accused of Aids damage to Africa
Jeevan Vasagar and agencies in Nairobi and Julian Borger in Washington
Tuesday August 30, 2005
Guardian

A senior United Nations official has accused President George Bush of "doing damage to Africa" by cutting funding for condoms, a move which may jeopardise the successful fight against HIV/Aids in Uganda.
Stephen Lewis, the UN secretary general's special envoy for HIV/Aids in Africa, said US cuts in funding for condoms and an emphasis on promoting abstinence had contributed to a shortage of condoms in Uganda, one of the few African countries which has succeeded in reducing its infection rate.

"There is no doubt in my mind that the condom crisis in Uganda is being driven by [US policies]," Mr Lewis said yesterday. "To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa."

The condom shortage has developed because both the Ugandan government and the US, which is the main donor for HIV/Aids prevention, have allowed supplies to dwindle, according to an American pressure group, the Centre for Health and Gender Equity (Change).

In 2003, President Bush declared he would spend $15bn on his emergency plan for Aids relief, but receiving aid under the programme has moral strings attached.

Recipient countries have to emphasise abstinence over condoms, and - under a congressional amendment - they must condemn prostitution.

Brazil announced last month that it would refuse to accept $40m (£22m) in American aid rather than stigmatise prostitutes who Brazilian health workers said were essential to their anti-Aids strategy. Senegal was also cut off from US aid because prostitution is legal there.

Campaigners accuse Uganda's first lady, Janet Museveni, of being instrumental in the switch towards a policy of abstinence. Ugandan government officials say that her religious beliefs, stemming from being a born-again Christian, are central to her promotion of the message of abstinence. In one poster campaign, signed by the office of the first lady, the slogan alongside the picture of a smiling young woman says: "She's saving herself for marriage - how about you?"

While Uganda needs between 120m and 150m condoms a year, only 32m have been distributed since last October, Change said in a report published yesterday.

Meanwhile, religious groups that oppose condom use are receiving an increased share of funding, the pressure group says. "Religious fundamentalists, some financially supported by the US government and the office of the first lady, Janet Museveni, have become prominent in attacking condoms and those who distribute them," Change's report said.

Officially, Uganda remains committed to the threefold "ABC" policy. The initials stand for "Abstinence, Be faithful, use a Condom". The Ugandan government denied yesterday that there is a scarcity of condoms or a policy change. The health minister, Jim Muhwezi, said: "It is not true that there is a condom shortage. There seems to be a coordinated smear campaign by those who do not want to use any other alternative simultaneously with condoms against Aids."

The minister insisted that condoms remain an important part of their HIV prevention strategy, but said the first lady could not be expected to promote the use of contraceptives. "Her role is to tell the young people to abstain. She cannot tell young people to use condoms, she is a mother," he said.

Uganda has had extraordinary success in reducing adult infection rates from 30% in the early 1990s to below 6% last year. This success is largely credited to its president, Yoweri Museveni, who spoke out about what was considered a shameful disease and told people how to combat it.

The row over Uganda's HIV/Aids strategy comes at a time when the financial management of the country's Aids programmes is under the spotlight. Last week the Global Fund for Aids, TB and Malaria pulled all its funding from Uganda's programmes. After an inquiry by accountants PricewaterhouseCoopers, the Global Fund suspended five grants worth $201m over two years and demanded that the unit within the Ugandan ministry of health that manages them should be disbanded.

An American Aids official last night denied that the US had forced Uganda to reduce the condoms available, saying the Bush administration supported condom use as part of a balanced programme that included prevention.

"The statements that I have heard are completely untrue and completely mischaracterise effective prevention programmes," Mark Dybul, deputy US global Aids coordinator and chief medical officer, told Reuters by telephone.