Europe, led by the U.K., Wednesday night signaled a major split with the United States over curbing the AIDS pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.
The statement, released for World AIDS Day Thursday, emphasizes the fundamental importance of condoms, sex education and access to reproductive health services. “We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness,” it says.
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.
The HIV/AIDS pandemic is continuing its deadly spread across the globe, infecting 5 million more people last year and bringing the total living with the virus to over 40 million, the United Nations said Monday.
The Joint United Nations Program on HIV/AIDS (UNAIDS), in its latest update on the figures, tried to lighten the gloom by pointing to Kenya, Zimbabwe and some Caribbean countries, where there is some limited evidence that infection rates may be dropping slightly. But in the worst-hit regions, notably sub-Saharan Africa, the trend is steadily upward, and in India there are suggestions that the scale of infection could be worse than the official figures imply.
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.
Brazil Tuesday became the first country to take a public stand against the Bush administration’s massive AIDS program, which is seen by many as seeking increasingly to press its anti-abortion, pro-abstinence sexual agenda on poorer countries.
Campaigners applauded Brazil’s rejection of $40 million for its AIDS programs because it refuses to agree to a declaration condemning prostitution. The government and many AIDS organizations believe such a declaration would be a serious barrier to helping sex workers protect themselves and their clients from infection.
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.”
Uganda, considered a beacon in Africa for its AIDS-beating policies, is adopting sexual-abstinence-only programs financed by the United States that could undo all its successes, a report released Wednesday says. Human Rights Watch warns that the new policies, which promote abstinence until marriage rather than condom use, leave not only young unmarried people but also women married to unfaithful men without the knowledge they need to protect themselves from infection.
Research within Uganda by Human Rights Watch has found that information on condoms, safer sex and the risks of HIV in marriage has been removed from primary schools, while some materials used in secondary schools falsely suggest that condoms have microscopic holes that allow the virus through. The AIDS awareness programs in schools are funded by the United States and overseen by an American technical advisor at the Ministry of Education.
“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.
The HIV/AIDS pandemic is the worst catastrophe in history and is blighting childhood across the developing world, especially sub-Saharan Africa, the United Nations said Thursday. Advances in children’s survival, health and education are being reversed by a “triple whammy” of AIDS, conflict and poverty, according to the U.N. children’s agency, UNICEF. The disease is driving the destruction of basic services for 1 billion children and violating their right to grow and develop, said Carol Bellamy, the organization’s executive director. “We believe AIDS is the worst catastrophe ever to hit the world,” she told the Guardian. “It is just ripping up systems, be it health or education. Our children’s childhood is being robbed from them.”
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 —
Of the 15 million children orphaned by AIDS, 80 percent are African.
One in six (90 million) children are severely hungry.
One in seven (270 million) have no healthcare at all.
Nearly half of the 3.6 million people killed in war since 1990 have been children. “Unless action is taken, swiftly and decisively, to stem the tidal wave of infection and loss, it is estimated that by 2010 over 18 million African children will have lost one or both parents to HIV/AIDS,” said Bellamy. She said there were bright spots: an effort to eradicate polio was back on track, Kenya had introduced free primary schooling and rates of HIV appeared to be falling in Namibia. “We are not saying everything has fallen apart.” But without identifying them she accused governments of “shutting their eyes” to HIV and the erosion of gains made since the adoption of the Convention on the Rights of the Child in 1989.
The report sounded an alarm over the growing number of orphans deprived of a normal family environment and exposed to violence, abuse, exploitation and stigmatization. “The loss of a parent implies more than just the disappearance of a caregiver. It pervades every aspect of a child’s life: their emotional well-being, physical security, mental development and overall health. In the most extreme cases, children can find themselves living on the streets, utterly devoid of family support.”
The extended African family network of grandparents, uncles, aunts and cousins has been credited with shouldering the burden, but UNICEF warned that this safety net was severely stretched, especially in Botswana, Lesotho, Swaziland and Zimbabwe. Aid workers and government agencies have issued similar warnings that romanticized notions of heroic relatives selflessly raising broods of infants can mask an uglier reality.
In the South African village of Kamhlushwa, for example, an uncle offered to care for the six Ndlovu children, ages 4 to 11, after both parents died earlier this year. But neighbors said he was interested only in their social grants and that it would be better if the eldest child, Thembeni, were the head of the household.
Around 1.9 million children under the age of 14 in sub-Saharan Africa have HIV, said the report, and around 1,700 children worldwide become infected every day. But few African countries have followed Brazil’s lead in giving life-extending anti-retroviral drugs to children and adolescents as part of a national treatment program.
Social indicators in many parts of Asia, Latin America and the Caribbean show improvement but almost half of the world’s 2.2 billion children live in poverty. In a foreword to the report, U.N. Secretary-General Kofi Annan said that for such children reality is “starkly and brutally different” from the ideals of the millennium declaration adopted in 2000 as a blueprint for the 21st century. “Poverty denies children their dignity, endangers their lives and limits their potential. Conflict and violence rob them of a secure family life, betray their trust and hope. With the childhood of so many under threat, our collective future is compromised.”
The report is likely to be welcomed by Prime Minister Tony Blair and Chancellor of the Exchequer Gordon Brown as another spur to their plan to write off African debt, tackle disease and break down trade barriers during Britain’s presidency next year of the G-8 industrial nations. But Bellamy said that after a decade at UNICEF she considered the development glass half-full, not half-empty.
However, the Lancet’s Horton is scathing of UNICEF’s approach. In his editorial he is specifically critical of Bellamy, saying it has been her “distinctive focus” to advocate the rights of children. “This rights-based approach to the future of children fits well with the zeitgeist of international development policy,” he writes. “But a preoccupation with rights ignores the fact that children will have no opportunity for development at all unless they survive.
“The language of rights means little to a child stillborn, an infant dying in pain from pneumonia or a child desiccated by famine. The most fundamental right of all is the right to survive. Child survival must sit at the core of UNICEF’s advocacy and country work. Currently, and shamefully, it does not.” He adds: “Child health needs better leadership, improved coordination of services and increased funding.”
The AIDS pandemic rampaging around the globe will not be stopped without radical social change to improve the lot of women and girls, who now look likely to die in greater numbers than men, United Nations agencies said Tuesday. Infections among women are soaring, from sub-Saharan Africa to Asia to Russia. What began as a series of epidemics among men — in some regions gay and bisexual men, in others men who frequented sex workers or male drug users — has spread to their female partners, who are biologically more easily infected.
In many countries, women’s subordinate status, and their lack of education and economic power, have made it impossible for them to negotiate sex with men or to ask for the use of condoms. Tuesday the UN agency set up to combat the pandemic, UNAIDS, called for all that to change in the interests of checking the spread of a disease that killed 3.1 million adults and children last year.
“We will not be able to stop this epidemic unless we put women at the heart of the response to AIDS,” said UNAIDS’ executive director, Peter Piot.
At the launch of the UNAIDS annual report on the pandemic Tuesday, actor Emma Thompson, who is a founding member of the Global Coalition on Women and AIDS launched this year, put it in starker fashion. “There are some countries where women are an endangered species — they will disappear from the face of the Earth,” she said. “I think this is the greatest catastrophe that the human race has ever faced.” Across the globe, 39.4 million people, including 2.2 million children, are carrying HIV and will die without treatment to contain it — up from about 36.2 million two years ago. Only one in 10 in developing countries can get the drugs they need.
Last year, 4.9 million people were newly infected and 3.1 million died. In some regions, such as sub-Saharan Africa, the numbers living with HIV appear to have stabilized, but only because as many are now dying as are getting infected. In the U.K., HIV continues to spread. UNAIDS says it “has become the fastest-growing serious health condition.” A report Wednesday from the Health Protection Agency will confirm the trend. Last year there were 7,000 new diagnoses, taking the total numbers living with infection well above 50,000.
The numbers of women affected globally are rising faster than those of men, and women now make up nearly half of the total. In sub-Saharan Africa, where the pandemic is furthest advanced, the transition is complete — 57 percent of those with HIV are women. In Zambia, Zimbabwe and South Africa, 77 percent of all young people infected with the virus are women. Across nine countries in that region, the infection rate in the whole population is one in four.
In other parts of the world, there have been large hikes in the proportion of women affected. In east Asia, there has been a 56 percent increase in the number of HIV-positive women in the past couple of years. In Russia, where the epidemic began in young, mostly male injecting drug users, the proportion of women infected has gone up from 24 percent to 38 percent in just 12 months. In every region of the world — including the U.S., where AIDS is one of the biggest killers of African-American women, and Europe — it is the same story, said Kathleen Cravero, deputy executive director of UNAIDS, Tuesday, and it means that a new strategy must be adopted.
“The prevention strategies now in place are missing the point when it comes to women and girls,” she said. The ABC mantra favored by the U.S. — abstinence, be faithful and use a condom — is useless to women who do not have the power to refuse sex, sometimes from an older, sexually experienced husband who already has HIV.
Social and cultural change is the only way to check the pandemic in countries where women have no status or power, UNAIDS says — although it accepts that revolution is not on the cards. “What we’re talking about is very specific actions that are doable, moving to a situation where every woman gets to keep her house and her land and her furniture when her partner dies,” said Cravero. “It doesn’t mean turning society on its head. It means getting the right laws in place and making them enforceable. We have to work against the fatalistic idea that you can never change these things.”
UNAIDS is urging governments to reform their inheritance laws, pass legislation protecting women from domestic violence and help girls attend secondary schools. A woman who has some education and some economic power through possession of her own house and garden will be better able to negotiate sex, said Cravero. “We have to turn abstinence on its head and fight for the right of every woman to abstain when and if she wants to, because right now she doesn’t have that right.” Thompson related stories from three trips to Africa of sugar daddies who offered schoolgirls meals or trainers for sex. “I knew of a girl who gave her body to a man because he gave her an apple, because nobody had ever given her anything before,” she said.
Mothers who were desperate for money would gamble that if they were infected with HIV, they could stay alive long enough to bring up their children. “I would sell my body if I had to do it to feed my child,” said Thompson. She suggested that British Prime Minister Tony Blair could contribute by going to Ethiopia, where she had recently been, and publicly taking an AIDS test. “I think it is going to take big gestures like that. Examples have to be set by men of power.”
