Thursday night the Lancet medical journal fast-tracked the survey to publication on its Web site after rapid, but extensive peer review and editing because, said Lancet editor Richard Horton, “of its importance to the evolving security situation in Iraq.” But the findings raised important questions also for the governments of the United Sates and Britain, which, said Horton in a commentary, “must have considered the likely effects of their actions for civilians.”

The research was led by Les Roberts of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md. Five of the six Iraqi interviewers who went to the 988 households in the survey were doctors, and all those involved in the research on the ground, says the paper, risked their lives to collect the data. Householders were asked about births and deaths in the 14.6 months before the March 2003 invasion, and births and deaths in the 17.8 months afterward.

When death certificates were not available, there were good reasons, say the authors. “We think it is unlikely that deaths were falsely recorded. Interviewers also believed that in the Iraqi culture it was unlikely for respondents to fabricate deaths,” they write.

They found an increase in infant mortality from 29 to 57 deaths per 1,000 live births, which is consistent with the pattern in wars, where women are unable or unwilling to get to the hospital to deliver babies, they say. The other increase was in violent death, which was reported in 15 of the 33 clusters studied and which was mostly attributed to airstrikes.

“Despite widespread Iraqi casualties, household interview data do not show evidence of widespread wrongdoing on the part of individual soldiers on the ground,” write the researchers. Only three of the 61 deaths involved coalition soldiers killing Iraqis with small arms fire. In one case, a 56-year-old man might have been a combatant, they say; in the second, a 72-year-old man was shot at a checkpoint; and in the third, an armed guard was mistaken for a combatant and shot during a skirmish. In the second two cases, American soldiers apologized to the families.

“The remaining 58 killings (all attributed to U.S. forces by interviewees) were caused by helicopter gunships, rockets or other forms of aerial weaponry,” they write. The biggest death toll recorded by the researchers was in Fallujah, which registered two-thirds of the violent deaths they found. “In Falluja, 23 households of 52 visited were either temporarily or permanently abandoned. Neighbors interviewed described widespread death in most of the abandoned houses but could not give adequate details for inclusion in the survey,” they write.

The researchers criticize the failure of the coalition authorities to attempt to assess for themselves the scale of the civilian casualties. “U.S. General Tommy Franks is widely quoted as saying ‘we don’t do body counts,’” they write, but occupying armies have responsibilities under the Geneva Convention. “This survey shows that with modest funds, four weeks and seven Iraqi team members willing to risk their lives, a useful measure of civilian deaths could be obtained.”

While the United States is not named, there is widespread anxiety over the effect of its pro-abstinence agenda in countries such as Uganda, where statements by Janet Museveni, the president’s wife, and alleged problems with supply have led to a serious shortage of condoms.

The U.S. has pledged $15 billion over five years to fight the disease, most of which is channeled through the President’s Emergency Plan for AIDS Relief. PEPFAR grants come with conditions, however — two-thirds of the money has to go to pro-abstinence programs, and it is not available to any organizations with clinics that offer abortion services or even counseling. The U.S. is also opposed to the provision of needles and syringes to drug users on the grounds that it could be construed as encouraging their habit.

But the statement from 22 European Union member states, released at a meeting under the U.K. presidency in London Wednesday, calls on developing world governments to use every prevention tool, from condoms to clean needles to sexual health clinics, in a bid to slow down the spread of HIV. UNAIDS’ latest figures show 40 million people are now infected, and the rate is rising as fast as ever.

“We, the European Union, firmly believe that, to be successful, HIV prevention must utilize all approaches known to be effective, not implementing one or a few selective actions in isolation,” the statement says.

The international development secretary, Hilary Benn, told the Guardian that the evidence had shown what worked, from tackling stigma to supplying condoms and clean needles. “It is very important that those messages are heard loud and clear by everybody,” he said.

Asked whether the U.K. disagreed with the U.S. emphasis on abstinence, he said: “Abstinence works if people can abstain, but I don’t think people should die because they have sex. We need to make sure people have all the means [of prevention] at their disposal — condoms and clean needles. It includes education and access to sexual and reproductive health services. We are very clear about that.”

In August the U.N. secretary general’s special envoy for HIV/AIDS in Africa, Stephen Lewis, accused the United States of “doing damage to Africa” by cutting funds for condoms in Uganda while promoting abstinence. “There is no doubt the condom crisis in Uganda is being driven by” U.S. policies, said Lewis. “To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa.”

Only 35 million condoms were distributed in Uganda between October 2004, when the government said there was a problem with the quality of the stock, and August of this year, compared with 120 million in previous years.

Uganda has historically been cited as one of the HIV/AIDS success stories, and experts generally agree it was partly the availability of condoms that brought the infection rate down. But Museveni has said condom distribution pushes young people into sex and recently equated condom use with theft and murder in an interview with the BBC World Service. The shift in government thinking is being linked within Uganda to PEPFAR.

AIDS activists in the U.K. are pleased by the E.U. stance. “Activists have been warning for years that the U.S. prevention policy is reckless and could cost lives,” said Fiona Pettit of the U.K. Consortium on AIDS and International Development. “The relentless promotion of abstinence only is already having an impact in countries like Uganda. Abstinence only is an unrealistic policy in many communities and a one-size-fits-all approach simply won’t work.”

“In reality, people have sex … much as conservative evangelists in the U.S. might prefer that they didn’t,” said Andrew George, the Liberal Democrats’ spokesman on international development.

This article has been provided by the Guardian through a special arrangement with Salon. ) Guardian Newspapers Limited 2005. Visit the Guardian’s Web site at http://www.guardian.co.uk.

Peter Piot, executive director of UNAIDS, said it was encouraging that prevention efforts had led to gains in some countries. “But the reality is that the AIDS epidemic continues to outstrip global and national efforts to contain it.”

At a press conference in New Delhi, India, he said Asia, which contains half of humanity, was particularly at risk. China and Burma, which he said had the worst epidemics in Asia, have been slow to acknowledge the scale of the problem. “In the world’s most populous nation, China, the overwhelming majority of the population does not know how the virus is transmitted.”

India, which has officially 5.1 million people living with HIV — a number not far behind South Africa’s — announced earlier this year that new infections had fallen dramatically to 28,000 in 2004, from 520,000 in 2003, sparking disbelief among volunteer groups.

Piot said he had two concerns with India’s data. One was that most of the sampling was done in rural areas when most of the affected population is in cities. The second was that in some states the surveillance of the disease was of “poor quality.” “It does not make sense that migrants from a poor state like Bihar who live in Mumbai do not then infect their wives when they come home. Something is missing.”

The UNAIDS report called for new efforts to prevent people from becoming infected, provoking protests from some activists who fear a slackening in the world’s efforts to get drugs to all those who need them. Only 1 million are so far on the drugs, while 6 million will soon die without them. Three million people died of AIDS last year.

The World Health Organization, which set a target of 3 million on treatment by the end of this year, stressed that treatment is now essential to prevention work because people will not be tested for HIV and therefore will not change their behavior unless drugs are available. “We can now see the clear benefit of scaling up HIV treatment and prevention together and not as isolated interventions,” said the WHO’s director-general, Lee Jong-wook.

However, Piot said the emphasis on prevention after a few years of vociferous campaigning for drugs was deliberate because the balance had tipped too far the other way. “We’re very concerned that prevention has slipped off the agenda,” he said. “From the developed to the developing countries, whether you look at funding or intensity of programs, most attention is going to treatment. In the long run, that is really bad.” He called for “a rapid increase in the scale and scope of HIV prevention programs.”

The report shows that while projects with commercial sex workers in Thailand and India and drug users in Spain and Brazil have borne some fruit, the most intractable problems are in sub-Saharan Africa, where 77 percent of those infected are women. Their social status is very low, they have few rights, and they are unable to negotiate with men for safe sex.

Some programs to try to improve the standing of women have been started in Africa, said Purnima Mane, director of policy, evidence and partnerships at UNAIDS. “It saddens me to say that the results are very, very small scale. I often worry whether they will remain sustained because the prevalent norms are so much against gender equality.”

In Kenya, Zimbabwe and Uganda, HIV prevalence rates, measured among pregnant women at antenatal clinics, have dropped, which is being attributed partly to changes in sexual behavior, with a greater use of condoms, but also to increases in death rates.

This article has been provided by the Guardian through a special arrangement with Salon. ) Guardian Newspapers Limited 2005. Visit the Guardian’s Web site at http://www.guardian.co.uk.

The demand from the U.S. administration, heavily influenced by the religious right, follows what is known as the “global gag” — a ban on U.S. government funds to any foreign-based organization that has links to abortion. This has resulted in the removal of millions of dollars of funding from family-planning clinics worldwide.

Tuesday Pedro Chequer, the director of Brazil’s HIV/AIDS program, said the government had managed to resist U.S. pressure during negotiations on the AIDS funding to focus on promoting abstinence and fidelity rather than condoms — another ideological battle being waged by the religious right. But the U.S. negotiators insisted that the clause on prostitution had to stay.

“I would like to confirm that Brazil has taken this decision in order to preserve its autonomy on issues related to national policies on HIV/AIDS as well as ethical and human rights principles,” Chequer told the Guardian.

Campaigners congratulated the Brazilian government for its stance, and voiced concerns that the declaration on prostitution could damage efforts to tackle AIDS among sex workers in many countries. Jodi Jacobson of the Center for Health and Gender Equity in the U.S. said that, unlike the global gag, the declaration on prostitution looked likely to be imposed on U.S.-based organizations as well as their subsidiaries abroad. The office of Randall Tobias, the global AIDS coordinator who is responsible for spending the $15 billion President Bush promised for the fight against AIDS, was working on the language to be adopted, she said.

“Any organization receiving U.S. global AIDS funding will have to agree to the policy,” she said. That would include charities as large as Care, Save the Children and World Vision.

“It is a hugely problematic policy from the standpoint of public health alone. It goes against the entire grain of public health principles in not judging the people you are trying to reach.”

But Sam Brownback, a leading Senate conservative, told the Wall Street Journal: “Obviously Brazil has the right to act however it chooses in this regard. We’re talking about promotion of prostitution, which the majority of both the House and the Senate believes is harmful to women.”

Most U.S. AIDS funding goes directly to organizations working in the field, and much will be channeled through faith organizations that back the no-abortion, pro-abstinence and anti-prostitution stance of U.S. conservatives.

But the Brazilian government has strong HIV/AIDS policies and insists that all negotiations go through its own committee. It also has a strong partnership between governmental and nongovernmental organizations, which encouraged a united response to Washington.

“This would be entirely in contradiction with Brazilian guidelines for a program that has been working very well for years. We are providing condoms, and doing a lot of prevention work with sex workers, and the rate of infection has stabilized and dropped since the 1980s,” said Sonia Correa, an AIDS activist in Brazil and co-chairwoman of the International Working Group on Sexuality and Social Policy. “The U.S. is doing the same in other countries — bullying, pushing and forcing — but not every country has the possibility to say no.”

Adrienne Germain, president of the International Women’s Health Coalition, said: “The importance of the Brazilian government’s decision can not be overstated.”

“These abstinence-only programs leave Uganda’s children at risk of HIV,” said Jonathan Cohen, one of the report’s authors. “Abstinence messages should complement other HIV-prevention strategies, not undermine them.”

Human Rights Watch says condoms have been widely available in recent years in Uganda and have helped keep HIV prevalence down to around 6 percent, after the big fall from an estimated 15 percent in 1992. The infection rate dropped when President Yoweri Museveni’s government promoted openness about AIDS and awareness of the dangers of HIV infection. But recently the president and his wife have spoken out against the use of condoms, which are considered by most AIDS experts to be the most effective protection against the virus.

Human Rights Watch says Uganda is falling in with the Christian right in the United States, which backs sexual abstinence before marriage and believes that promoting condoms leads to promiscuity. Uganda, says the report, is redirecting its AIDS strategy away from scientifically sound policies. “Although endorsed by some powerful religious and political leaders in Uganda, this policy and programmatic shift [are] nonetheless orchestrated and funded by the U.S. government.”

A spokesman for Museveni denied that the U.S. was influencing policy. “The president and the first lady are being misunderstood. They have been consistent in advocating for a multipronged approach,” he said. “He says that those who are sexually active should be faithful to their partners; that others should abstain, and those who cannot abstain should use condoms.”

But while the United Nations and most organizations fighting AIDS back the “ABC” mantra — abstinence, be faithful and condoms — Uganda’s AIDS commission last November issued a draft “Abstinence and Be Faithful” policy document, which argues that promoting condoms and abstinence at the same time would be confusing for young people.

Government-sponsored youth rallies have also cast doubt on condom use, says the report. At one rally it was said that using a condom to protect against disease was like “using a parachute which opens only 75 percent of the time.” In October the government withdrew all free condoms, saying they had failed quality-control tests, and imposed new tests on all imports.

But the agency and Bellamy have been strongly criticized by the editor of one of the world’s leading medical journals, the Lancet. In an editorial published Friday, Richard Horton said UNICEF’s “preoccupation” with children’s rights meant that the fundamental right to survival was, “shamefully,” not at the core of its work. “In sum, for almost a decade, child survival has failed to get the attention it deserves,” he writes.

In UNICEF’s 150-page annual report, “The State of the World’s Children 2005,” the agency paints a bleak picture of sub-Saharan Africa slipping further behind other developing regions such as southern Asia, Latin America and the Caribbean. Researchers also found that —