Entry eleven - Abstinence, AIDS and Jesus

(From around November 1st)

As I write this at around 10pm, there is a boisterous concert taking place somewhere near my residence. It has been advertised for weeks in advance with posters showing pictures of the speakers and singers from America and Jamaica. From what I can hear, there is a large and excited crowd cheering each performer slightly louder than the one before. There have been several concerts on campus since I moved here, and there is nothing particularly peculiar about this one.… Except of course for the fact that it is a USAID-funded "abstinence-pride" event.

Fifteen years ago, Uganda had one of the most horrific HIV and AIDS rates in the world at around a quarter of the population. The government's response was simple and effective: ABC - abstinence, be faithful, and condoms. In a very short time, infection rates plummeted to as low as 6 percent. The unquestionable success of this approach, which was also inexpensive to promote, was praised by nearly every international organisation related to AIDS prevention.

Unfortunately, ABC has suffered two significant setbacks in the past few years. The first of these is the recent intrusion of the first lady into politics. She opposes condom use on religious grounds and has not been shy about saying so and influencing government policy. She was recently elected to parliament and doesn't appear to be leaving the political scene anytime soon, particularly regarding this issue. The second development comes from George Bush's billion dollar anti-AIDS initiative. While it dishes out tons of cash, the US government will not release any of this money to organisations that promote any form of contraception. As a key recipient of USAID funds, Ugandan policy toward AIDS has changed drastically. Two years ago, billboards for condoms were almost as ubiquitous as Coke advertisements. I have seen two such billboards in my past two and half months in Uganda, and other forms of advertisement have also almost vanished.

Needless to say, this is a sad development that will likely have terrible consequences within a few years. However, with this seemingly bizarre concert blaring in the background, it seems appropriate to speculate about such approaches. Posters promoting abstinence are common sights throughout Uganda and are often linked to Christian groups. The current song that I hear from this concert is "J-E-S-U-S. I love Jesus. Yeah!!" For anyone outside of the Bible belt in North America, it is important to know that nearly everyone in Uganda is religious. There is also not the obsessive (and self-defeating) "separation of church and state" that exists in the United States.

So the two questions are 1) does promoting abstinence work in preventing the spread of AIDS?; and 2) is it ethical to tell people that they will suffer in the fires of hell if they have sex before marriage? My initial response to both questions is no. The little that I have read about such programs in the United States indicates that they are horribly ineffective - something to the tune of over 90 percent. Young people enjoy sex, as they should, regardless of their ideological training, which is inevitably far weaker than their hormones. Rather than preaching fire and brimstone, shouldn't those with the power to do so preach safety rather than abstinence?

However, as much as it is ineffective on its own, A has its place with B and C. For some Ugandans, condoms are expensive, and thus impractical over the long term. Unfortunately, though, poverty is not the main issue driving the promotion of abstinence in Uganda. Rather, some Christian organisations have hijacked the issue and given it a religious rather than health emphasis. Thus far, I have heard nothing from the nearby concert about HIV, AIDS or STDs. Instead, it sounds as if Jesus Christ has replaced the role of teen pop star. The concert seems to have reached its crescendo as the MC chants "Jesus" to the wild cheers of the audience.

Is there anything wrong with this religious bent if, in the end, it helps prevent the spread of AIDS and other diseases? However, the problem is not the fact that religious groups are putting a religious spin on one aspect of ABC, which is indeed an effective way to reach large numbers of people. The obstacle that this phenomenon presents is that Christian groups are exercising their considerable influence to promote abstinence to the exclusion of other forms of protection against HIV. Some - though certainly not most - religious groups remain unconcerned with AIDS on a practical level. Their only role in protecting their congregations is to remind them to be faithful and that condoms are a sin.

On top of this comes USAID, the main organ of American aid that only works with organisations that do not actively promote condoms. Many of its initiatives are linked with religious organisations that are (successfully) seeking to dismantle ABC as a national anti-AIDS policy. Other organisations are now inclined to abandon ABC (or at least the C) in order to cash in on USAID money. With the government now shunning ABC as well, things look fairly bleak.

As the concert winds down, however, things do not seem completely bad. A few nights ago, I saw a discussion of a few influential Christian leaders on television. They all endorsed ABC, and condoms in particular, through some agonizingly veiled language. If they could do so more directly, and with the support of the government and international donors, it is likely that tens of thousands of people could avoid being infected.