This is just the latest salvo by the administration and the religous right in the assault on reproductive health rights. To make a long story short, the political climate on this is bad and getting worse. This is also greatly affecting international health and HIV programs as well, as the administration has been convinced that abstinence works, therefore, condoms encourage sex and should not be promoted. As Liz and others can probably attest; the CDC, NIH, USAID and others are being forced to 'tow the line' on this. Article below is a bit biased, but right now we need all we can get:
The Free Lance-Star, Fredericksburg, VA
Religious right should put aside theology to fight AIDS pandemic
Washington's HIV/AIDS policies should not be determined by theology.
THERE'S ALWAYS plenty going on at the Nairobi Youth Center in Mathare, a slum area on the edge of Kenya's capital city. On a recent day when I paid a visit, boys were gathered around a pool table and huddled in the television room watching a British soccer match, while girls, spending their time more productively, sat at sewing machines honing their seamstress skills.
Geoffrey Maina's mission is to reach out to these young people. The fresh-faced 22-year-old volunteers 40 hours a week teaching Nairobi youth how to avoid contracting HIV, which has infected about one in eight Kenyan adults nationwide and at least one in five in Nairobi.
A big part of his message, Maina told me, is abstinence--a claim borne out by the center's literature and posters. However, as he was leading me on a tour of the facility, he took a moment to stop and gesture toward a condom dispenser on a wall. "We have this for those who say they can't really abstain," he said.
Most religious and social conservatives would have been appalled at this point in the tour. In Kenya, after all, Catholic church leaders have organized rallies where they burn condoms.
Back in the United States, the religious right's attacks on condom use take different forms. Lately, they have included distorting the work of groups that promote condom distribution as one of the ways to combat HIV/AIDS. In a letter sent to the head of the U.S. Agency for International Development in October, Rep. Jo Ann Davis, R-1st District, and nine other members of Congress--including the influential Rep. Chris Smith, R-N.J.--protested an allocation of funds to a reproductive-health organization called the Population Council. The conservative lawmakers claimed the group's strategy for fighting HIV/AIDS "focuses only on condom promotion."
Dr. Sam Kalibala, a medical associate for the Population Council, said Davis and the others are spreading misinformation. "They say if you have the word condom anywhere in your program, you don't promote abstinence," he said.
Kalibala and other reproductive-health professionals I spoke with in Kenya insisted that they teach the "ABCs" of HIV/AIDS prevention: abstinence, being faithful, and condom use. "We talk about abstinence," Kalibala said of his organization, which specializes in research on reproductive-health issues. "We talk about reduction of partners. And we promote use of condoms."
But some religious and social conservatives don't want to hear about the ABCs of prevention. Take Dr. Stephen Karanja, an obstetrician/gynecologist who runs a family-owned, Catholic-based clinic in Nairobi. Condom distribution "is not only bad policy, it is bad science, very bad science indeed," said Karanja, who was invited to Washington a few years ago by the Front Royal-based group Population Research International to speak out against the reproductive-health policies of the Clinton administration.
"We have a brush-fire type of scenario here because our people are using condoms because our doctors say it's all right," he told me in an interview in his office at St. Michael's Medical Care. Public-health experts, he continued, "have refused to see the obvious thing: that you give these gadgets to these people, and more and more of them are going to say, 'Now I'm protected.' In fact, they even call it 'protected sex.' They use that term and you want to fall down."
ABCs of prevention in UgandaAbstinence supporters in the United States point to Uganda as an example of how a strong abstinence message can help reduce HIV-infection rates. Claude Allen, the Bush administration's point man for promoting abstinence education, said in a recent radio interview that Uganda is "the only country in Africa that has had a positive increase in its life expectancy, and that's because they focused on young people remaining abstinent until they were married."
USAID confirms that HIV prevalence has dropped significantly in Uganda, especially among youth. It's reasonable to assume that abstinence education has played a big role in that decline. However, abstinence is not the only element involved. A fact sheet on the USAID Web site credits the ABC approach--that is, abstinence, fidelity, and condom use--with altering "community norms and rules of behavior."
Dr. Josiah A. Onyango, senior program officer for service delivery for the Family Planning Association of Kenya, endorses the ABC approach. He believes the abstinence-only tack won't work for all youth. "Those who are able to abstain, let them do so. But young people are not homogeneous," he said.
Kalibala stresses that public-health workers must be concerned about "the implications of people who fail to do what is right, and what implications they have for the rest of the public."
"Religious leaders don't do surveys to find out how many people are sinning," he said. But the Population Council does conduct research, and it reveals "a percentage of people who are not complying" with the abstinence message. "That percentage of people concerns us," he said, "because when we put that percentage in our scientific models, we find that that percentage can potentially cause an exponential epidemic."
A step in the right directionThe Bush administration has displayed ambivalence on the question of condom use. Critics of the administration point to its decision to amend a condoms fact sheet on the Centers for Disease Control Web site; the revised information emphasizes that condoms may not work.
The administration's squeam-ishness about condoms was also evidenced at a population conference in Bangkok in December. The U.S. delegation, which included former Vatican diplomat John Klink, demanded a rewrite of a passage in an international family-planning agreement because it contained the phrase "consistent condom use." The U.S. contingent also extolled the virtues of "natural" family-planning methods, which eschew all forms of contraception.
On the other hand, the president's recently unveiled proposal to spend $15 billion over the next five years to combat AIDS in Africa and the Caribbean includes additional money for condoms.
That's a hopeful--and much-needed--step in the right direction. According to the group Population Action International, a minimum of 8 billion condoms would have been needed in 2000 to significantly reduce HIV-infection rates in the developing world and Eastern Europe. Donors supplied just 950 million condoms that year, less than one-eighth of the number needed.
While it is true that condoms are not very effective in preventing some sexually transmitted diseases (as Davis once rightfully pointed out in a congressional hearing on AIDS), those who are not theologically driven acknowledge that condom use helps stem the spread of HIV/AIDS among high-risk populations.
Kalibala and others I spoke with in Kenya believe public-health workers and faith-based organizations can work together to battle HIV/AIDS.
"The virus is wiser than us," Kalibala said, "but we're trying to get a handle on it. Everybody should use their tools." The faith-based folks, he said, have the tool of what is right and what is wrong, which "can be synergistic with the tool of damage control."
The religious right would do well to put aside theology and listen to the doctor.
RICK MERCIER is Viewpoints editor for The Free Lance-Star. His visit to Kenya was made possible by a World Affairs Journalism Fellowship awarded by the International Center for Journalists and the World Affairs Council. The fellowship is funded by the John S. and James L. Knight Foundation.
Date published: 2/9/2003
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