Friday, June 02, 2006

Abstinence-only education: making African gravediggers richer

Here's a harrowing look at what the US's policy of pushing abstinence in other countries is achieving. I don't understand how someone can be so stubborn about their beliefs that they would effectively encourage people to die just so they can feel good about how righteous their cause is and how they're doing the work of the Lord.

"No No sex! No No Sex!" The chant startles slumbering bats from their trees, repeated until you are left in no doubt that the 3,000 students crammed around this swimming pool really mean what they shout.

"Praise God, I have been saved!" says Isaac Ichila, 24, with a young crowd hanging on every word. "We are fighting the enemy of humanity which is HIV/Aids. It is killing us. I was a drunkard and I slept with 17 women before university. So I took the pledge to abstain from sex and have kept my promise to God. I am physically and psychologically pure."

Isaac is one of those who gather every Saturday night to listen to pro-chastity music and sermons at Uganda's prestigious Makerere University. Abstinence-until-marriage pledge cards fly around for students to sign. Simon Peter Onaba, 24, cautions a friend against flirting with women. "Sex is a progression," he warns. "One minute, you are holding hands with a girl, the next kissing. Don't go in a room with one man and one woman otherwise your pants will go off! Sex is so powerful." Then the clincher: "Remember condoms don't prevent Aids. They have a high failure rate."

Abstinence is working for Isaac and Simon - and for tens of thousands of teens and twentysomethings proudly attending virginity rallies in Uganda. But Aids activists and development officials point to the 130,000 Ugandans infected with HIV last year alone - up from 70,000 in 2002 - and say the recent obsession with abstinence is handicapping the country's once-successful fight against the virus.

Health workers see the fingerprints of America's Christian right all over the chastity message and believe the Bush administration is using its financial might to bully them into accepting evangelical ideology at the expense of public health.

Aids may have killed one million Ugandans and infected a further million but the latest crisis seems strange when you consider that foreign donors still hold up Uganda as Africa's Aids success story. What's more, under Bush's 2003 Emergency Plan For Aids Relief, where he pledged $15bn (£8bn) to fighting Aids in the worst-afflicted countries, Uganda receives more US money than ever: doubling in two years to $169.9m in 2006. But that cash comes with conditions: in a gesture to the Christian right in the US, at least one-third of all prevention money must go to "abstinence-only" projects - $10m in Uganda in 2005. Critics counting each new infection in field clinics say this has dangerously skewed Uganda's previous "balanced" approach which seemed to be working.

At a tiny clinic in the capital's suburbs, women wait for antenatal advice and Aids testing. "We have worked so hard to get people to understand HIV and that there are three options open to them: A, B or C," says Dr Henry Katamba. "That's Abstain from sex, Be faithful or use a Condom, whichever is the one for you. That's what our government used to say - and everyone understood. The message recognised that it wasn't realistic to ask for abstinence from everyone who's not married." Dr Katamba is health co-ordinator of the Uganda Protestant Medical Bureau, an umbrella of churches providing clinical help in the absence of government hospitals.

Under the previous "balanced" strategy, condom distribution grew from four million a year to 118 million by 2001. Thanks to the abstinence message, teenagers lost their virginity about 18 months later than before. People with several partners realised they needed to stop sleeping around so much. In 1992, one in five Ugandans had Aids. By 2001 that dropped to one in 20.

"Because of the US, our government now says Abstain and Be faithful only," says Dr Katamba. "So people stop trusting our advice. They think we were lying about how condoms can stop Aids. Confusion is deadly."

And so it is proving to be: the number of infections is again rising, after years of decline. Questionable government figures say that 6.4 per cent of Ugandans have HIV/Aids. One in three civil war refugees in camps in the north has Aids, a local NGO says.

Uganda's evangelicals preach that abstinence is the only way to halt the spread of the virus. The trusted and influential first lady, Janet Museveni, is a born-again Christian. She has publicly equated condom use with theft and murder and said that Aids is God's way of punishing immoral behaviour. The first lady also offers scholarships to girls who can prove they are virgins.

Helping her in the recruitment of virgins and "secondary abstainers" (the formerly sexually active) is Pastor Martin Ssempa. The evangelical priest rose to prominence as a breakdancing champion - fame he now uses to get across the message that condoms are a "ticket to death". Both Pastor Ssempa and the first lady enjoy influence among Republican Congressmen. Even the President, Yoweri Museveni, has attacked "those who want to condomise the world" - a far cry from two years ago, when he gratefully embraced condoms as a means of saving his people.

Back then, the enormous billboards lining the red dusty road through any Ugandan town advertised condoms. Look now and you see posters of girls urging: "She's keeping herself for marriage ... what about you?" Uganda's first attempt to teach all its schoolchildren about Aids - an initiative bankrolled by the US - was abruptly purged of references to condoms after the abstinence legislation came in. A popular teenage magazine that referred to condoms was burnt. The publisher lost out on a $30m contract to continue its family planning and Aids work because it "believes that condoms are the answer", the former head of Bush's Aids programme said. The condom promoter Marie Stopes was intimidated into withdrawing advertising.

The gag even extends to the respected Straight Talk Foundation. Radio producer Hassan Sekajoolo describes how US funders demanded he excise condoms from sexual health shows in two languages. "We didn't have a choice," he says. "The American donors came and said, 'Our way is Abstinence and Be faithful, full stop'." Abstinence money was given to the first lady's Uganda Youth Forum, which holds huge virginity rallies in Kampala, and to Samaritan's Purse, an American missionary charity that spreads the Gospel of Jesus in the developing world. US law forbids the use of federal funds for evangelising.

What has changed in Uganda is that condoms are no longer promoted to the general population. In line with US Aids policy under Mr Bush, condoms should be promoted exclusively to high-risk groups such as truck drivers, soldiers and "discordant" couples (where just one of the partners is HIV-positive). Everyone else should hear the rubber-free virtues of abstinence and fidelity only. Yoweri Museveni's government hungrily devoured the American abstinence policy and the attached cash. It is dependent on foreign donors for half its budget.

People on both sides of the argument agree that Washington is prolonging tens of thousands of Ugandans' lives through treatment - and that abstinence is crucial. "The evangelicals are absolutely right: abstinence is the best way of preventing the spread of HIV/Aids," says Sigurd Illing, the EU ambassador to Uganda. "But some people aren't receptive. We need an end to this bedevilling of condoms by people who take a high moralistic stance and don't care about the impact that this has on reality."

In the stinking back alleys of the capital's Kisenyi slum, abstinence has little currency among the destitute refugees from the Congo, Sudan, Somalia and northern Uganda.

"I try to use condoms but they burst, or our client says no," explains prostitute Jennifer Natalema, 22, propping a brick against the broken door to her brothel. Posturing, unemployed young men loiter outside the entrance, jeering at passing women.

"I don't argue or there's no money when he finishes using me. He will beat me." She has been selling unprotected sex for 4,000 shillings (£2) for seven years. Somehow she has escaped the feeble wasting of Aids. So far.

Asked what she thinks about abstaining, Jennifer's colleague "Pretty", 23, laughs: "We need the money! What else can I do? Abstinence can't work somewhere like Kisenyi." In this part of Kampala, girls tend to lose their virginity aged between 9 and 11. Sex is a marketable commodity in the struggle to survive. Walk through Kisenyi market, and you get an idea of the local economy: fruit sellers, scrap merchants, barbers, thieves, drug dealers and prostitutes. One in seven girls tested in a study last year had HIV.

"Abstinence is not a message that children with no money listen to," says Maurisia Ssebuggwawo, 58, a volunteer midwife who gives advice at a local youth club, gated and patrolled by armed guards to protect the paltry stock of Aids drugs. "They need condoms and don't have any, because they are so expensive." The arbitrary nature of international aid, where money is here one year and gone the next, doesn't help. Since funding from the United Nations ran out in 2001, her club cannot afford to distribute free condoms.

One of those failed is Musa Kabanda, 24. In 2004, he got a girlfriend and had sex for the first time but didn't use protection. He became a weak man fighting Aids. "The club used to come to my market to talk about Aids but they stopped," he says, a rasping cough punctuating the words, sweat rolling down his waxy face as he rearranges the dirty bedsheets. "All I wish is that I had used a condom. Saying 'abstain' is not realistic."

Nor is saying "Be faithful" at present, given the widespread and accepted male infidelity in Uganda that results in one infected person spreading the virus quickly. "I was faithful to my husband but he told me a man has to have up to 10 women and not less than two," says Sarah Ndagire, 41, infected by her adulterous partner in 1997. Constance Namuyiga, a 28-year-old mother of three young children, found out she was HIV-positive two years ago. "Men think they own us here," she says. "My husband had other women. He laughed when I asked him to use condoms with them." She adds: "I told him to go for a test when I found out I am HIV, but he left me. I hope to see my children grow. I don't tell my parents in case they worry I die before them."

It is 30- to 35-year-old women and 35- to 45-year-old men in marriages, not sexually active teens and twentysomethings who are most likely to be infected.

Another hurdle Aids workers have to jump is the US condition that they sign a pledge opposing prostitution. Ask Mrs Ssebuggwawo, the midwife, why her club does not apply for Bush's Aids funding and her good nature crumbles in an instant. "How can we help the girls if we condemn them?" she demands.

Even senior members of the Ugandan government admit that the first lady and her US backers are dangerously moralising the situation. "There are some prominent people in government, and some outside, who with the help of conservative agents in the US are stigmatising Aids, saying that only sinners use a condom," says Dr Jotham Musinguzi, director of the Population Secretariat at the Ministry of Finance. "That is the message we are struggling with." Ugandans are becoming more reluctant to ask for free condoms, advice and testing - particularly vulnerable groups such as prostitutes and homosexuals.

Not everyone is sad about the escalating epidemic. In a roadside timber yard near Kampala's Mulago Hospital, coffin makers report that business has never been better. "Three years ago, I sell 15 coffins a week. Now it is 20 adult coffins and seven children's coffins," says Lawrence Kiwanuka, the jovial boss of an expanding workforce of 25 carpenters. "I think the Aids deaths are really more than the government says." So is he happy more people are dying from Aids? He laughs: "That is a very difficult question."

Posted by crimnos @ 1:10 PM