PEPFAR, far away from effective prevention

This is my first post as part of Blog against Theocracy. Hope you like it - or don't like it. Or whatever. I encourage you to go to the site and see what else is up. Also, check back in here. My goal is to post all three days this weekend.

xo

PEPFAR is the U.S. President’s Emergency Program for AIDS Relief. In May 2003, Congress approved a $15 billion dollar U.S. expenditure on HIV prevention and treatment. 3 billion is supposed to be spent on prevention programs. It is, in my opinion one of the most theocratic, far-reaching, fucked up Bush Administration policies. Here’s why:

1. Just to start with, a major tenet of PEPFAR is ABC, otherwise known as the prevention model (in other words, it's for prevention-he he.).
   
   ABC stands for Abstinence, Be faithful, when necessary use Condoms. I like to say it stands for Arrogance Beyond Credence, Absolutely Bizarre Convictions or perhaps Absurdly Bigheaded Citizens (anyway, I'm sure you can come up with some better ones)
   
   
2. This plan aims to teach people of the third world, the majority of whom do not speak English and for whom the cleverness of ABC means nothing, that in order to prevent HIV infection they must abstain from having sex, be maritally faithful or use condoms as a last resort. Of the 3 billion dollars spent, at least 33% of it MUST go to abstinence-until-marriage programs.
   
3. Here’s why this is a problem.
1. Abstinence is great if you’re into it. I’m not disparaging abstinence AT ALL. It does work. However, in context with human lives throughout the world where people:
   i. Have survival sex
   ii. Cannot deny sex to spouse in order to survive
   iii. Have cultural/religious obligation to have children
   iv. Have hormones like any other human on this planet
   it doesn't work for everyone. Duh.

Let’s take an example: Sarvati is married to Rupesh who has a good job as a truck driver. Sarvati has heard the warnings around town that many of the men who drive trucks see prostitutes but she cannot withhold sex from her husband (abstinence) and she is faithful. Some of the prevention specialists visit the truck stops to teach the ABCs but when they leave, some of the prostitutes get rid of the materials they have left because it hurts business for a while after the prevention specialists come though they do keep the condoms they have brought even though they get paid less for sex with a condom. In order to support their own families, they must get rid of the materials.

Rupesh does not visit the prostitutes though. When Rupesh is driving, he tries not to think about his wife or his home because he knows that they would be ashamed of him. Rupesh likes to have sex with men but this is culturally taboo. He is ashamed, but on the road, some of the men are like him and he doesn’t feel quite so bad. After all, he does love his wife and the sex he has when he is on the road is not the same as real sex.

When Rupesh arrives home, Sarvati asks him if he has ever visited a prostitute. He answers truthfully, no, he has not. She feels lucky that her husband is not like some of the others.

Lets take another, less complex example.

Akwe is 12 years old. She is an only child. Her parents are both living. They want her to be a teacher and they scrape all of their money together for her education. Akwe spends quite a lot of time studying because she loves learning, she wants to be a teacher and she knows how much her parents have sacrificed to send her to school. When her teacher demands sex in order to give her the passing marks she deserved, she feels she has no choice but to accept.

b. The GAO -- a non-partisan investigative arm of Congress -- analyzed the effects of the abstinence-until-marriage requirement. In the report, it found that it limited efforts to design prevention programs that actually met the needs of the local population. This was primarily the teams who had experience with HIV prevention programs.

Well, of course! You might say. Who else is getting funding except those with experience in HIV prevention? Funny you should ask. PEPFARs New Partners Initiative provides funding to community and faith-based programs for HIV prevention outreach. Ideally, partnerships would be with proven effective, evidence-based public health programs. If it was about meeting the needs of communities PEPFAR would be partnering with institutions that have technical expertise in evidence-based HIV/AIDS prevention, treatment, and care, or expertise in poverty reduction, capacity building, reducing gender inequalities, reducing stigma and discrimination, and strengthening health systems.

However, this is not the case. Some of the organizations that have received funding include:
Choose Life - a program for church laity and pastors that advertises "In this programme you will explore knowledge, attitudes and perceptions about HIV and AIDS. You will be empowered to combat HIV and AIDS through ethical and spiritual conduct. You will discover how to transform your community into an ethical community." And all this for 200 Rand - about 10 x the daily average income for an average South African.

Beyond our country, our president is forcing religious morality down the throats of people who need, more than anything, facts. He is contributing to the deaths of thousands. I urge you to ask your Representatives to support the PATHWAY Act which would remove the abstinence-until-marriage earmark that requires that 1/3 of all international HIV prevention funding be spent on abstinence-until-marriage programs and ensure that HIV prevention programs are based on scientific evidence, public health practice, and human rights concerns, not ideology.

Ultimately (this here is my POINT) - If I had kids I'd want them to be perfect. I'm sure your kids are perfect as were your parents in teaching you how to avoid sex until the rings were firmly in place. However, some kids aren't perfect. Some parents are assholes. Some parents are not in the picture, some parents have died of AIDS and some parents have sex with their children to get their rocks off. Let's allow condom distribution for them. OK?

There's a c, d and at least e but I didn't want to write an entire journal article and besides, there's a ton of information out there for the browsing. For more concise, coherent and evidence based information, go to PEPFAR Watch.