Africans Chafe Under U.S. Abstinence Provisions

c. 2006 Religion News Service WASHINGTON _ Stalled in the gridlocked streets of Johannesburg on her way to a recent AIDS event, Rukia Cornelius fumed about the tendency of Americans to mix their religious and political beliefs. South Africans have suffered as a result, she said. “I’m a little bit tired but I’m also angry, […]

c. 2006 Religion News Service

WASHINGTON _ Stalled in the gridlocked streets of Johannesburg on her way to a recent AIDS event, Rukia Cornelius fumed about the tendency of Americans to mix their religious and political beliefs. South Africans have suffered as a result, she said.

“I’m a little bit tired but I’m also angry, because we need the money but treatment can’t be done with such a provision on abstinence,” Cornelius, national campaign manager of the South African AIDS lobby group Treatment Action Campaign, said by telephone.


Her frustration with President Bush’s AIDS initiative has only increased as a number of organizations formerly devoted to preventing HIV/AIDS have abandoned their efforts in favor of treating it. It’s a shift specifically designed to avoid restrictions attached to U.S. AIDS-prevention funding, Cornelius said.

“In a country like South Africa, the Bush administration’s abstinence-above-all-else approach is simply not working,” she said, pointing to religious, cultural and economic factors that have tangled such efforts.

A growing number of relief workers, activists and scholars agree, saying the abstinence approach that was pushed into law by U.S. religious conservatives has translated poorly to Africa. The Christian doctrine of abstinence, they say, is a concept that doesn’t always resonate in traditional African cultures and is therefore stalling efforts to save lives.

Embedded in the President’s Emergency Plan for AIDS Relief (PEPFAR), the provision dictates that a third of the initiative’s prevention funding should go toward abstinence programming. This amounts to 7 percent of the overall $15 billion that Bush has requested from Congress over five years.

Ironically, each side in the abstinence war of words is loudly demanding identical action _ an evidence-based approach that “works for Africa.” Most support the ABC philosophy successfully implemented in Uganda _ Abstinence, Be faithful, and, if all else fails, use Condoms.

But there’s little consensus over the proper balance between the three, and many fear ABC emphasizes Western ideals at the expense of cultural norms in Africa, home to 12 of the initiative’s 14 “focus countries.”

Sibusiso Masondo, professor of traditional African religion at the University of Cape Town in Rondebosch, South Africa, cited a number of factors that could undermine an abstinence strategy. For example, “sex play” short of intercourse is encouraged for young people in many African cultures.


At the same time, a high value is usually placed on sexual purity before marriage, especially for girls. Africans already have their own conceptions of abstinence, he said, and abstinence programming will only be effective if couched in traditional _ not Western _ ideals.

“Abstinence as defined by the Christian church was never a practice of traditional Africans,” Masondo said. “The only time when people abstained from sexual activity was during rituals and other major events in the life of the community.”

Jacob Olupona, a Nigerian-American and scholar of indigenous African religions at Harvard University, said that is precisely the problem with the abstinence provision in PEPFAR. Creating a policy “to throw down the throats of Africans is not going to work,” he said.

“As far as African traditions are concerned, yes, some promote abstinence before marriage. But we must get away from the Western paradigm. For HIV/AIDS, we have to look at this changing situation today at the community level.”

The rigid nature of the prevention funding restricts efforts to tailor programming to local conditions, said Jodi Jacobson, executive director at the Center for Health and Gender Equity, based in Takoma Park, Md. In the male-dominated societies of Africa, critical gender issues prevent women from controlling their sexual relationships, she said.

According to Jacobson, the highest HIV/AIDS infection rates for women in their 20s and 30s are among married women who contract the virus from their husbands.


“What the abstinence-until-marriage programs do is funnel extraordinarily large amounts of money to particular programming,” she said. “This is completely and wholly ideological and flies in the face of all evidence of what works.”

But ABC advocates point to Uganda where, beginning in the early 1990s, President Yoweri Museveni launched a society-wide offensive on the epidemic, which at that time infected 15 percent of adults. Ten years later and with ABC programming firmly entrenched, the infection rate dropped to 5 percent.

Ambassador Mark Dybul, the U.S. Global AIDS Coordinator charged with distributing the PEPFAR funds, said the Ugandan model represents undeniable success. He uses it to tell participants in the debate to start “listening to the Africans” and stop bickering among themselves.

“I almost flip it on over to (other) people who are contributing to the fight on HIV/AIDS to say: What are you doing on abstinence and faithfulness, where’s your balanced ABC approach?” Dybul said, adding that the United States is still the largest supplier of condoms worldwide.

“We’ve got a balanced ABC approach while most people have a C-only approach.”

Catholic Relief Services _ one of the largest recipients of the PEPFAR funds _ maintains the ABC strategy has worked remarkably well on the ground. Jed Hoffman, director for the organization’s AIDSRelief project, said that despite the legislation’s religious roots, abstinence programming is simply one of the most effective methods available in preventing the spread of the epidemic.

“We’re a very pragmatic, evidence-based society and we want to do what works. And evidence shows that promoting abstinence is one of the things that works,” he said.


Most groups working with U.S. funds in Africa similarly support the Ugandan model, but more than half of respondents to a study conducted by the Government Accountability Office said segregating the “A” and “B” funding from other prevention funding “compromises the integration of their programs.”

In testimony before the U.S. House Committee on Government Reform in early September, Helene Gayle, president of the humanitarian aid organization CARE, said her teams have also been held back by PEPFAR.

“The underlying causes of the spread of HIV and AIDS reflect a combination of many non-health factors such as poverty, gender inequality, stigma and social and cultural norms,” Gayle said.

“A rigid interpretation (of the abstinence provision) results in significant delay, while bold and innovative programming becomes harder to fit and harder to fund.”

The Rev. Mark Hanson, presiding bishop of the Evangelical Lutheran Church in America and president of the Lutheran World Federation, has grown frustrated with the emphasis on abstinence and calls the moral overtones of PEPFAR “harmful.”

“It conveys very much a sense that we have greater morals, greater wisdom and greater values,” Hanson said. “We need to be accompanying other societies in this effort, rather than coming to the relationship with all of these preconceptions.”


KRE/PH END KANE

Editors: To obtain photos of Cornelius and CARE- and CRS-funded AIDS projects in Africa, go to the RNS Web site at https://religionnews.com. On the lower right, click on “photos,” then search by subject or slug.

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