United Press International - July 13, 2004
Ed Susman, United Press International

Many attendees at the XV International AIDS Conference have found reason to criticize the United States and/or the Bush administration because of its controversial AIDS prevention message: Abstinence. Be faithful. Use Condoms if necessary.

Few people argue about condoms but most observers agree that parts A and B are problematic.

"The amount of money being contributed to fight against AIDS by the United States is wonderful, but ... ," said Princess Mabel, of the Dutch House of Orange-Nassau, at a news briefing.

That "but" is the administration's insistence that, along with the billions of dollars earmarked for the fight against AIDS, recipient nations must spend a portion of the money on prevention -- and part of prevention, in U.S. policy eyes, is abstinence.

Abstinence, noted Princess Mabel -- now a spokeswoman with the Open Society Institute, a private philanthropy in New York City dedicated to public health and public policy issues -- does not work to prevent AIDS in countries such as South Africa, where one-third of the first sexual experiences among young girls are involuntary.

The B part of the message does not work well, either.

For example, Dr. Suniti Solomon, who operates an AIDS hospital in Chennai, India, said 88 percent of the women she is treating have had sex only with their husbands. They were faithful, yet they still have AIDS.

"The ABCs of prevention work well, except for women," said Kathleen Cravero, deputy executive director of the Joint United Nations Program on HIV/AIDS, also known as UNAIDS.

She cited cases similar to those mentioned by Mabel and Solomon, and also noted the prevention measure of condom use is rarely an option for spouses.

"Sex workers in India now are more empowered than housewives," Solomon said Tuesday at a briefing on the AIDS crisis that is building in India. "A sex worker can tell a client, 'Wear a condom or get lost,' but no housewife in India could say that to her husband."

The ABCs are a lightning rod that give people a chance to mock U.S. AIDS policy, said Sandra Thurman, president of the International AIDS Trust in Washington, D.C.

"It's really the 'A' of the ABC that is the lightning rod," Thurman told United Press International.

Thurman, who was head of the White House AIDS policy office during the Clinton administration, said there is no evidence that abstinence programs work to prevent transmission of AIDS.

"Abstinence programs have had as much impact on preventing AIDS as saying 'have a nice day' has had on combating clinical depression," she said.

Thurman said condom use can be an effective way to prevent the spread of AIDS, but "we have to teach the people about having sex. This is a no-brainer for anyone who has been close to the epidemic. In the absence of a vaccine, the only thing we have left is prevention. If we don't do well on prevention, every dime we spend on AIDS will be squandered."

She agreed that abstinence is the best way to prevent AIDS transmission, but abstinence is unrealistic as a widespread prevention strategy.

Jeff Richardson, executive director of Step Forward -- an initiative by Abbott Pharmaceuticals aimed at meeting the needs of orphans and vulnerable children -- said promoting abstinence is "an easy answer to a complex question," which results in self-deceit.

"How do you teach abstinence and sexual responsibility to a 12-year-old girl who has been raped by someone twice and three times her age?" Richardson asked.

"There may be some situations in which abstinence can play a role in preventing early sexual conduct, depending on local culture," said Anne Reeler, chief operating officer of Axios, a public policy think tank in Paris.

Richardson said the reason U.S. AIDS policy has been attacked and laughed at by some individuals and organizations at the conference has to do with inflexibility. About 20 percent of the President's Bush's program to spend $15 billion on fighting AIDS around the world is earmarked by statute for prevention practices, and one third of that money is dedicated to abstinence programs.

Bush administration officials attending the conference did not respond to UPI requests to discuss the issues raised by critics of the its program.

Richardson said abstinence should not be rejected out of hand, however.

"We should try everything," he told UPI. "We don't really need cynicism or skepticism, but we must be willing to adopt those programs that do work."

Ed Susman covers medical policy and research issues for UPI Science News. E-mail sciencemail@upi.com
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