Abstinence-only message misguided

Abstinence-only message misguided
Aug. 14, 2006
The Toronto Star

SCOTT H. EVERTZ AND SANDRA L. THURMAN

We come from opposite sides of the aisle, having served in the same role as director of national AIDS policy under President George Bush and President Bill Clinton, respectively. Still, we agree on one thing:
America isn't getting the job done on AIDS.

This week, nearly 25,000 scientists, policy-makers, activists, and HIV-positive people will meet in Toronto for the 16th International AIDS Conference to discuss progress and challenges in fighting the global AIDS pandemic.

One nation under the HIV prevention microscope is the United States. After all, it was to resounding applause that Bush announced in his 2003 State of the Union address his monumental commitment to fight the AIDS pandemic. But advocates and scientists alike fear that U.S. prevention policy has shifted from a truly comprehensive "ABC" approach — abstinence, be faithful
(monogamy) and condom use — to an ideologically-driven abstinence-until-marriage focus that places many at risk of needlessly contracting HIV.

That fear is particularly warranted when it comes to young people. The U.S. prevention policy for the world's youth is limited to abstinence and, for those who are already sexually active, a commitment to refrain from further sexual activity, or "secondary virginity." This policy doesn't make sense given that teens and young adults now account for more than half of all new HIV infections and more than one-third of people living with AIDS.

As representatives of U.S. AIDS policy under two administrations, we have met countless young people around the world for whom a comprehensive approach to HIV prevention can quite literally be a lifesaver: the young AIDS orphan on the streets of Kampala trading sex for food to care for her siblings; the teen girl in Lagos reliant on a "sugar-daddy" to finance her education; the young Indian woman sent to work in a brothel to provide income for her family; the young gay teen in Washington, D.C. told to abstain until married when marriage is not possible.

These young people must be provided with the education and tools to minimize their risk while society labours to eliminate the root causes that landed them in these untenable positions in the first place.

Our first-hand experience has been backed up by hard research. According to Advocates for Youth, a Washington, D.C.-based public health agency, there are more than 11 million unmarried, sexually active youth in countries targeted by the president's AIDS initiative, making a primary reliance on abstinence messaging dangerously misguided. The notion of "secondary virginity" is fine in theory, but has little relevance as a public health strategy in the real world.

A report from the U.S. Government Accountability Office showed that the abstinence-until-marriage funding requirement in the president's AIDS plan is undermining HIV prevention efforts on the ground and creating confusion and fear among grantees regarding the appropriate role of condoms. What's more, the U.S.-based Society for Adolescent Medicine found that the "U.S. emphasis on abstinence may also have reduced condom availability and access to accurate information on HIV/AIDS in some countries." These are serious missteps if the U.S. is committed to stemming the spread of HIV.

Let us be clear: abstinence must be part of any effective HIV prevention campaign. Likewise, condoms are the single most effective prevention tool we have for those who are sexually active. Attempts to censor information about condoms or abstinence are incompatible with sound public health policy and basic common sense.

This country committed — with 188 other United Nations member states — to reduce by 25 per cent the rate of infection in young people by 2005. Now, we must face the grim reality that U.S. HIV prevention policy has helped make that much-needed accomplishment impossible. Every day, more than 6,000 young people, ages 14 through 24, become infected with HIV. In sum, we have failed our youth.

The world's youth need the endorsement of a truly comprehensive approach to prevention — including both lessons in abstinence and condom use. That is the only way the U.S. and its allies in the fight against AIDS will live up to their stated commitments to turning the tide on this terrible pandemic.

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