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Q&A: “Abstinence Is Not the Only Way to Go”

Interview with Rosemarie Muganda-Onyando

WASHINGTON, May 21 2007 (IPS) - Few aid programmes have been as controversial among activists and public health experts as the George W. Bush administration’s abstinence-based HIV/AIDS treatment and prevention initiative, called the President’s Emergency Plan for AIDS Relief (PEPFAR).

Rosemarie Muganda-Onyando serves as the director of the Centre for the Study of Adolescence in Nairobi, Kenya and appears in a new nine-minute documentary by the Washington-based group Population Action International titled “Abstaining From Reality”.

Through interviews with AIDS educators and an HIV-positive woman who was never taught about proper condom use, “Abstaining From Reality” builds a case that PEPFAR ignores the realities of young people’s lives in Kenya and Uganda and insists on an abstinence-based AIDS policy that actually endangers the lives the of the people it is designed to protect.

IPS: How did PEPFAR’s approach to HIV/AIDS education differ from the programmes in Uganda and Kenya during the late 1990s? Which was more effective?

RM: What I know from the work that I do in Kenya is that programmes that are more comprehensive and give young people reliable and comprehensive information have a much more positive impact on young people’s decision-making. When young people have access to information that is comprehensive and reliable they are more likely to actually delay initiation of sexual activity and they are more likely to make responsible choices. But when you have programmes that insist on abstinence only you narrow the options that are available to young people. The programmes also do not tell them the truth. They tell them a lot of half-truths that are very moralistic and very judgmental. They do not normally work. PEPFARs own report shows that this abstinence-only policy has not had a much more significant impact than things that were done before. At least it has not shown that abstinence-only is the way to go.

IPS: Has the introduction of PEPFAR corresponded to a rise or decline in HIV/AIDS rates?

RM: It may be too early to tell. One thing is that PEPFAR is not that evidence-based. You do not have before and after studies. One thing we do know is that big surveys that are being done do not show that behaviour is changing. We still have sexual behaviour among people beginning earlier. A lot of that sexual activity is unprotected. You still see high levels of teenage pregnancies. You’re still seeing high rates of unsafe abortion. So surely if PEPFAR is working as well as those who push it claim then one of the things we’d be looking for is not just a drop in HIV prevalence, which would be great, but to also see some positive outcomes with issues such as pregnancy, abortion, age at sexual initiation, things like that.

IPS: How does one effectively teach both abstinence and condom use in the schools? Is it possible for both to be taught?

RM: At least in Kenya, we have a very strategic plan to deal with HIV and AIDS. It talks about A (abstinence), B (being faithful) and C (condom use). While you cannot distribute condoms in school, you can talk about abstinence, you can talk about being faithful and you also talk about condom use because you need young people to know you are not doing this so they can go out and get condoms and use them. But you need young people to have this information early so when they make that transition to adulthood they will know what to do when they eventually decide to have sex and when they are old enough to have sex. You see what the abstinence-only policy of PEPFAR does is to push it as the only option. Yet it is not the only option. Giving young people information does not mean they will go out there and be promiscuous.

IPS: Dr. Mark Dybul, the State Department’s Global AIDS Coordinator, said earlier this month that: “The U.S. government opposes prostitution and sex trafficking because they spread HIV and demean women, yet we support many programmes that work with people engaged in prostitution” and that the U.S. is by far the largest supplier of condoms in the world. Is this an inaccurate statement?

RM: One thing I know, to start with the last part, is the U.S. puts money into buying condoms but we know that not enough money is going into buying family planning commodities [such as] contraceptives, including condoms. When it comes to these programmes protecting women, since that’s the implication in that statement, the thing is that you have a programme that says you should abstain until marriage and when you do get married you should remain faithful to your husband, in a context in which many women are not independent. They’re dependent a lot on men. They are economically dependent and not able to control their own destinies. You are putting women at risk when you tell an African woman who has no job and lives within a cultural context among men where promiscuity is not frowned upon or such a big deal or is in a relationship that is polygamous where her husband has multiple sexual partners, what are you telling that woman? Are you saving that woman’s life by telling her to rema in faithful and failing to make available to her services and information that would enable her to protect herself? So how then is the U.S. protecting women?

IPS: Democratic lawmakers are proposing to allocate 30 billion dollars over five years to PEPFAR – twice the funding originally authorised. But what about lifting some of the restrictions, such as the “anti-prostitution pledge”? Are you aware of support for that?

RM: PEPFAR in itself is a good initiative since it has made available tonnes of money for treatment and care. I don’t think any other initiative has been able to do that or will ever be able to do that. On that there is no issue. People are actually benefiting. As an African woman I must say I’m really grateful that this programme exists. What spoils it are these restrictions since it locks out some of the people who need these services the most. So if it would be possible to get these restrictions lifted it would be good. It would mean that PEPFAR would have a much bigger impact than it currently does. Instead of just waiting for people to get sick so we can treat them using PEPFAR funding, it would mean that we could prevent, in the long run, infection. Everyone in this sector knows that treatment is not sustainable if infection rates remain at this level. Even if they were to drop a little it would still be impossible to sustain the treatment. While we treat people who are already infected, our focus should be a lot more on prevention, especially keeping young people and women safe.

It is important to start talking and doing things now because if these restrictions could be removed, it might not even need extra money. Extra money would be useful but even the money that is there now, if it could be used well, if the restrictions could be lifted, it could still have a much more positive impact than it currently does.

*Interview by Eli Clifton