The more than $1.3 billion the United States government has spent to encourage abstinence and fidelity among Africans in the last 10 years has done little to change sexual behavior and curb the spread of HIV, a recent study determined.
Nathan Lo, a second-year student at Stanford School of Medicine, came to this conclusion after a year-long analysis of international survey data collected between 1998 and the present that included information about the age people had sex for the first time, rates of teenage pregnancy, and the number of sexual partners. Nearly two dozen African countries were featured, the majority of which received funding from the President’s Emergency Plan for AIDS Relief, also known as PEPFAR.
While the study challenged a conservative notion that sexual education centered on abstinence could quell the spread of HIV on the Motherland, former and current affiliates of PEPFAR remain reluctant to acknowledge Lo’s findings, citing a need to further examine his research before making a comment.
This recent news, however, represents a shift in thinking among health experts about how to best combat the spread of HIV/AIDS that has been years in the making.
“Many of us who are active in the fight against HIV in Africa, where AIDS has hit the hardest and where most PEPFAR funds have been spent, watched with disappointment in the early days of PEPFAR as the Bush administration redefined the “ABC” approach as a preference for abstinence-until-marriage programming,” Scott Evertz, formerly of the Center for American Progress, wrote in his 2010 report critiquing PEPFAR’s focus on abstinence-centered sexual education.
“NGOs doing good work lost their funding as a result of the prostitution pledge; and as foreign governments, implementing agencies, and USAID program officers exhibited a stunning disregard for the needs of men who have sex with men and other HIV-vulnerable groups,” Evertz wrote.
When President George W. Bush enacted PEPFAR in 2003 and increased the amount of antiretroviral medication that would go to Africa, conservative House Republicans added a provision that allocated one-third of AIDS prevention funds to a campaign titled ABC — short for “abstinence, be faithful, and use condoms” — that aimed to dissuade Africans from sexual activity.
The ABC program particularly targeted young people between the ages of 15 and 24, a population that accounts for half of new infections. Proponents of the program said that a decline in the number of sexual partners among men and women will decrease the likelihood of HIV spreading on the continent. Abstinence-centered education in tandem with correct and consistent condom use would help Pepfar advance its mission.
But that hasn’t been the case. Even with nearly $1.7 billion spent to launch a public health campaign focused on abstinence in Uganda, rates of HIV infection soared, in part because authorities didn’t take into account the impact of the country’s banning of homosexuality — which fueled the spread of HIV — and other factors, including the number of people who didn’t use condoms during their extramarital affairs. Even if faithful women wanted to use condoms, Pepfar only doled out contraception to “at-risk” groups like prostitutes and truck drivers.
U.S. lawmakers heard the outrage against the ABC campaign from across the Atlantic Ocean. In 2008, PEPFAR dropped its directives for abstinence only education during its reauthorization process. In recent years, funding for the PEPFAR’s abstinence program has decreased by more than $47 million. As PEPFAR focused less on abstinence only programming for youngsters, more room has been available for science-based programming and methods of HIV prevention that’s tailored to local needs.
The shift away from abstinence-only education didn’t occur by happenstance. Public health officials domestically too have realized the fallacy in teaching youngsters to abstain from sex, rather than equipping them with information that would enable them to make smart decisions, as shown in a 2013 study that showed a concentration of HIV infections in states that lacked comprehensive sexual education requirements.
“These false, ideologically-driven programs are turning out sexually illiterate young people whose lives and health are put in literal danger by ‘educators’ handing out false information. All this, just so your teenager might be scared straight enough to forgo sex for a few extra months,” columnist Jessica Valenti wrote in The Guardian in July 2014. “Students need sexual education that’s comprehensive, medically accurate, and free from shame and ideology. Not just because sexuality is an integral part of our humanity, but because when you withhold medical information about sexuality from children and teens, you are endangering health and lives.”
While there’s much work to be done in the fight against AIDS, particularly when it comes to educating children about the dangers of unprotected sex, some organizations have been making gains in productively sparking conversation about sex and sexually transmitted diseases among middle and high school students in the Motherland.
For example, a team of researchers from the University of Cambridge developed technique named “photo voice” that allows children to talk about what they already know about sex and from whom and what they learned those facts as part of the ASKKIDS project. Proponents of this project say it does away with the assumption that children don’t know much about sex.
“The format we devised for the dialogues was engaging, interactive and rooted in the reality of the children’s experience — what is in fact simply a model of good sex education,” Dr. Colleen McLaughlin, head of the ASKKIDS project, wrote in a press statement in 2012. “Because we want this to be a sustainable program that will continue long after the duration of the project, we packaged the findings as a toolkit to support teachers through the process.”