Why Are We Still Funding Abstinence-Only Programming?


RH Reality Check is covering issues being discussed at the International AIDS Conference underway in Vienna this week.

It seems you can’t keep a bad idea down. Even though the Obama administration has pledged that science will finally trump ideology when it comes to global AIDS prevention, we recently learned that U.S. funding for failed prevention programs is continuing. 

Obama’s commitment to evidence seemed particularly promising in eliminating the programs that promote only the “Abstain and Be faithful” messages (dubbed “AB programs”) without giving any information about female and male condoms. But just two months ago, the U.S. government called for proposals to implement AB-only programs in Nigeria for youth and couples. 

Get ready for the very ironic title of the government’s request: “Providing Quality Comprehensive HIV/AIDS Prevention, Care, and Treatment Services in the Federal Republic of Nigeria, Under the President’s Emergency Plan for AIDS Relief (PEPFAR).” The U.S. Centers for Disease Control and Prevention (CDC) issued the request in May.

Within the prevention section, the CDC asks for development of AB-only programs for young people and couples, and coordination of the “Abstinence and Be Faithful Initiative.” It also sets targets for how many people should be reached with abstinence-focused interventions. Apparently, they think the “comprehensive prevention” part comes in the brief mention of “targeted interventions among high-risk groups.”  We can guess that this might be part that (probably) includes condoms, as it targets sex workers, men who have sex with men, and truck drivers –although it’s a mystery to me why it isn’t spelled out that these programs should include condoms.

Here’s the thing that U.S. decision makers still don’t seem to get: giving condoms to truck drivers and AB messages to “regular” couples is NOT comprehensive prevention. Marketing female condoms to sex workers while young people can’t get access to them is the same rights-violating, health-endangering idiocy that has been failing for the past decade. 

This is not hard to figure out. If you give condoms only to groups thought of by society as “promiscuous,” what do you think will happen to a woman who insists on condom use with her husband that she suspects of cheating?  If you do not provide information about using female and male condoms to young people, even if they successfully delay sex for years, how do you expect them to know how to use them once they start having sex?

“Comprehensive prevention” is not a country-level concept—it is an individual-level concept. Everyone has the right to, and the need for, full information about how to be healthy. That’s the only way it makes sense.

Each and every person served by PEPFAR prevention programs should receive full information about how to use condoms, and should have access to female and male condoms.  Instead of pouring scarce resources in programs we know don’t work, we have got to start only funding true comprehensive prevention.

Here at the XVIII International AIDS Conference in Vienna, so many activists are talking and protesting about funding, demanding world leaders not let up on funding the global AIDS response.  We’re taking it a step further and asking that world leaders fund programs that work—because especially in this context, it is criminal for the U.S. to fund anything but the best in HIV prevention.

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