With 80 percent of HIV cases worldwide transmitted by sexual contact, promoting abstinence until marriage and marital fidelity would seem to make sense as a way to limit the spread of HIV. However, authors of The Secret: Love, Marriage and HIV expose this approach to HIV prevention--which has been popular among some U.S. policy makers--as a fallacy. It is based on the assumption that within marriage, sex is always safe. Yet married women are actually at an increased risk of HIV infection--from their husbands.
Considering the many reasons preaching about abstinence and faithfulness doesn't work, it becomes clear that the only thing we're preventing is HIV prevention. Abstinence-Be faithful (AB-only) prevention approaches are based on some very broad and false assumptions, including:
• Abstinence and mutual fidelity are choices that individuals readily can make.
• All individuals in all cultures value sexual abstinence and fidelity as morally good.
Neither of those things is universally true in practice. In fact, as The Secret concludes as a result of research in five countries, moralizing to men about being faithful only serves to drive extramarital affairs further underground, and discourages condom use.
In addition to The Secret, two separate Congressionally-mandated studies of PEPFAR over the past five years found that AB-only programs undermined U.S. efforts to prevent 7 million new HIV infections by 2008. We all know there is no silver bullet that will stop the spread of HIV. But unfortunately, some of the approaches crafted to stop HIV's spread have actually fueled the fire. The findings in this book give us an important opportunity to rethink these approaches.
This has enormous implications for the President's Emergency Plan for AIDS Relief (PEPFAR). One year after the new PEPFAR five-year strategy claimed to adopt a comprehensive, evidence-based prevention approach, AB-only initiatives are still receiving significant amounts of funding. The PEPFAR 2010 operational plan, distributed Monday, indicates that close to 20 percent of prevention funding is still dedicated to AB-only programs. In Uganda, where unprotected sex is driving the epidemic, the U.S. is spending more money on AB-only programs than on all other programs to prevent sexual transmission.
Exhorting people to be faithful to their partners is not a public health intervention and the U.S. must stop squandering precious global AIDS resources on this moralistic intervention. The continued prioritization of the AB-only approach is diverting funding away from comprehensive prevention programming, despite research and policy pronouncements from Washington suggesting otherwise.
This World AIDS Day the Center for Health and Gender Equity (CHANGE) is calling on the Office of Global AIDS Coordinator to:
• Follow through on its recent indication that the Bush-era Abstinence-Be faithful-Use Condoms (ABC) guidance is now defunct. It should make this clear in its new comprehensive prevention guidance and in all requests for applications and proposals for PEPFAR funding.
• Include recommendations of harm-reduction approaches to HIV prevention within the comprehensive prevention guidance, as proposed by the researchers of The Secret.
• Report on the impact of Congress' reporting requirement for prevention funding on the ability of partners and implementers to provide comprehensive prevention information and services.
• Report on funding that continues to support abstinence and fidelity only programs, providing an honest and thorough accounting of how much money is still spent on these interventions.
• Now that the Catholic Church at the highest level has indicated condom use can be justified in the fight against HIV/AIDS, ensure that Catholic Relief Services (which receives 75 percent of its funding from the U.S. government) and other recipients of PEPFAR affiliated with the Catholic Church are not excused from including male and female condom use in prevention programs based on religious grounds.
To make real progress on HIV prevention, policy makers in Washington must be able to put aside their own moral judgments and face the complexities and realities of individual lives. The bottom line: stop funding attempts to "moralize" men and fund effective prevention programs that meet men, women and young people where they are.