When Prudery Kills
By Nicholas D. Kristof
New York Times
Wednesday 08 October 2003
Johannesburg - Here on the ground where President Bush's big anti-AIDS program is supposed to unfold, it looks as if the program was drafted more to win American votes than to save African lives.
"We have the opportunity to save millions of lives abroad from a terrible disease," Mr. Bush told the nation in his State of the Union address. But we're busy missing that opportunity.
Mr. Bush was happy to bask in the praise that his announcement of the AIDS program attracted. But now he is delaying some of that spending, holding back $1 billion in the first year, at a time when three million people die of AIDS annually and five million are newly infected.
In fairness, Mr. Bush is doing more about AIDS in Africa than President Bill Clinton ever did. But one can hail these advances and still recognize that administration officials are taking only baby steps.
"They've been in office three years, and they've done almost nothing to get the sick and dying on treatment," said Jeffrey Sachs, a Columbia University economist and expert on public health. "Despite a lot of talk and one famous speech, and one plan that isn't in operation, they've essentially accomplished nothing."
"It's utterly inexcusable," Mr. Sachs added, "that 7.5 million people in Africa have died on their watch, and they've not yet reached even 500 Africans on treatment in U.S.A.I.D.-supported programs. They've talked and procrastinated and dissembled while millions of impoverished people have died. Ultimately, history will judge them very severely."
In his State of the Union comments on AIDS - which were deservedly praised - Mr. Bush pledged $15 billion for AIDS in Africa and the Caribbean over five years. But instead of $3 billion for the first year, Mr. Bush backtracked to just $2 billion (much of it already in the pipeline). He's also trying to cut urgently needed contributions to the Global Fund, an international partnership to fight AIDS.
The administration is also fumbling the AIDS initiative by requiring that one-third of AIDS prevention funds do nothing but encourage sexual abstinence until marriage. This is the kind of stipulation set by people who sit in Washington and have never actually set foot in an African village.
In fairness, there is a growing body of evidence that promoting conservative religious and social mores can reduce the scourge of AIDS. But the only religion that does this effectively is Islam. Muslim parts of African countries like Nigeria tend to have much less promiscuity and much less AIDS than Christian parts.
Somehow I doubt that the lesson that conservatives will take from this is that we should buy veils, encourage stonings and build fundamentalist mosques across Africa.
Frankly, it's going to be very hard to change sexual mores, and pious lectures aren't enough. Countries like Uganda and Thailand that have enjoyed some success in preventing AIDS suggest that abstinence campaigns can be effective, but only in conjunction with straight talk about condoms - not with the administration's approach of beginning and ending the conversation with abstinence.
Restricting funds to abstinence, and nothing more, looks as if the administration is more interested in showing that it shares the Christian Right's sexual squeamishness than in fighting AIDS. And all over Africa you see heartbreaking evidence both that sex kills, and that so does this kind of blushing prudishness.
Incredibly, young men in Botswana pay more to play Russian roulette: several prostitutes there told me that the basic price for sex is $6.50 with a condom or $11 without.
One study found that only 42 percent of at-risk Africans can easily get condoms. As Dr. Marlin McKay, a Johannesburg AIDS doctor, describes the need to promote condoms as well as abstinence: "This isn't condoning sex. It's condoning life."
Sibulele Sibaca, a 20-year-old AIDS orphan from Capetown, put it this way: "I don't think that wasting a lot of money on abstinence is going to work. It's like saying, `AIDS kills.' So what? The government had billboards saying, `AIDS kills,' and AIDS just went up and up."
After he announced his AIDS initiative, Mr. Bush was praised as a humanitarian. But unless he delivers on his promises, then it will all look like the most cynical of gestures - using the great health tragedy of our age as a cheap photo-op to drape the White House with compassion.
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