A congressional report on PEPFAR (The United States President’s Emergency Plan for Aids Relief) just released on February 1st has encouraging news regarding efforts to control the spread of AIDS and other sexually transmitted diseases in Africa and other underdeveloped countries. The report begins by saying that the “pandemic” of AIDS cannot be defeated by treatment measures alone. Only efforts to prevent infection hold promise of eventually breaking the cycle of AIDS transmission. More than 25 million people have died of AIDS since 1981. AIDS orphans number in the tens of millions world wide, in 2007 50% of all adults with AIDS are women, and young people (under 25) account for more than half of all new cases.[1]
In sub-Saharan Africa prevention efforts have concentrated on the “ABC” approach to behavior change (Abstain, Be faithful, correct and consistent use of Condoms where appropriate), with particular emphasis on A and B. In a footnote it is stated that “AB programs promote as their primary behavioral objectives that 1) unmarried individuals abstain from sexual activity as the best and only way to protect themselves from exposure to HIV and other sexually transmitted infections, and 2) individuals practice fidelity in marriage and other relationships as a critical way to reduce risks of exposure to HIV.” Compelling evidence is provided that prevention efforts are working in at least fifteen countries including Zimbabwe, Ethiopia, Guyana, Nigeria and Mozambique.
The report explains further:
“ABC programs are more complex than the simple acronym suggests, because changing human behavior is a uniquely difficult undertaking. Achieving ABC requires significant cultural changes. Reaching children at an early age is key if they are to delay sexual debut and limit their number of partners… [I]nfluencing a 10 year old’s future behavior is far easier than changing a 25 year old’s settled behavior. Behavioral impact from programs for children may not immediately be apparent, because programs must work to influence future behavior rather than immediate behavior. Yet we must be patient and persistent — we are only four years into PEPFAR’s partnerships for a generational approach to prevention.
ABC also includes changing gender norms. Partnering with children’s parents and caregivers, supporting their efforts to teach children to respect themselves and each other, is the best way to promote gender equality. In order for the ABC approach to be effective it must address the gender dynamics that affect sexual decision-making and strive to reduce sexual coercion, violence and rape. Through support for delayed sexual debut, secondary abstinence, fidelity to a single partner, partner reduction and correct and consistent condom use, ABC contributes to changing unhealthy cultural gender norms.”
This report to Congress gives all Americans hope that our efforts and our money are being used to the benefit of millions of people and, ultimately, untold millions of lives will be saved from the devastating disease of HIV and other STDs. Yet, back home, there are epidemiologists, teachers’ unions like the NEA and organizations like Planned Parenthood that insist abstinence education cannot work here. The reports vary widely depending on the source, from “marginally successful,” to “little benefit, to “not effective” to “harmful.”
Why would a program in one part of the world be so promising and in another “not effective” or even “harmful?” True, we are dealing with different cultures, traditions and beliefs, but in Africa these indigenous characteristics may have very deep roots in their society and hundreds of years of social acceptance, yet abstinence and fidelity programs seem to be working. Our culture of promiscuity and hedonism is barely sixty years old yet there are those who insist that change in our society is impossible. And they may be right as long as we accept sex among pre-teens as normal and healthy and homosexual behavior as equivalent to monogamous sex between to a husband and wife, and adultery as an acceptable diversion from boredom. As long as we ignore and even promote behavior that only a generation ago was considered perverted, and we now know to be very dangerous, we can expect little to change in regards to AIDS prevention. Condoms alone, even if they are used consistently, cannot stem the epidemic of HIV and other sexually transmitted diseases. Perhaps it is time we too swallow the antedote that we’ve given other countries and begin the healing of our own suffering society.
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