For those of you who know me well, you know that this is an issue very very close to my heart. Please take the time to become educated and speak out and tell our government just how fucked up Bush's abstinence only programs are!!!
The Real ABCs- Access Denied!
The Fix the GAP Campaign is a direct organizing effort, led by Advocates for Youth's Youth Activist Network. The long-term goal of the Campaign is to ensure that Congress removes the abstinence until marriage earmark from the President's Emergency Plan for AIDS Relief (PEPFAR). The Campaign's more immediate goal is to outreach to 150 congressional offices to build support for a bill to be introduced in early 2006 by Representative Barbara Lee (D-CA). This bill will focus on comprehensive HIV prevention for women and girls that highlights PEPFAR's faults in prevention.
BACKGROUND: HIV AND AIDS IS A PANDEMIC!
As many as 40 million people currently live with HIV or AIDS.[1]
In 2005, HIV infected 15,000 additional people every day.[2]
As many as 95 percent of HIV-infected people live in developing countries.[1]
Over half of all people infected with HIV during 2003 were ages 25 and under.[2]
In 2005, as many as three million people died of AIDS, most in sub-Saharan Africa.[2]
Best current projections suggest that an additional 45 million people will become infected with HIV in 126 low- to middle-income countries before 2010.[4]
Yet, HIV prevention programs reach only about 20 percent of those who need them. At the same time, only about one in 10 HIV-infected people around the world receives treatment for HIV-related opportunistic infections, and less than one in 14 receives antiretroviral treatment.[2]
IMPACT ON YOUNG PEOPLE
Youth ages 15 through 24 currently comprise 28 percent of adults living with HIV or AIDS.[2]
Three-fourths (75 percent) of the young people living with HIV or AIDS reside in sub-Saharan Africa, as do over 90 percent of AIDS orphans.[3]
Adolescents are at higher risk in all countries_both more and less developed_because, among other factors, they more often have short-term relationships (serial monogamy), use condoms less consistently than adults, and frequently lack sufficient information and understanding about HIV and AIDS.[3]
Young women below the age of 25 are particularly vulnerable to HIV infection. In fact, young women ages 15 to 19 in some countries in sub-Saharan Africa are five to six times more likely to be HIV infected than are young men their age.[3]
HOW THE BUSH ADMINISTRATION ADDRESSES GLOBAL HIV/AIDS
During his 2003 State of the Union address, President Bush unveiled the President's Emergency Plan for AIDS Relief (PEPFAR). He called for a commitment by the United States of $15 billion over five years to fight global HIV and AIDS, including two billion dollars for prevention strategies and programs. Thereafter in February 2003, Congress passed a global AIDS bill (H.R. 1298), authorizing up to $15 billion over five years. Included in the bill's findings were references to the successful "ABC_Abstinence, Be faithful, and use a Condom" strategy that reduced the incidence of HIV in Uganda.[5,6]
Studies indicate that delays in sexual debut, reductions in the number of new sexual partners, and increased condom use all contributed to Uganda's declining HIV infection rate, with reductions in the number of sexual partners probably playing the most important role. Whereas Uganda achieved these results through a comprehensive public education campaign that provided multiple behavior options,[5,6] PEPFAR segments prevention education into 1) abstinence-only-until-marriage for adolescents, 2) faithfulness for married couples, and 3) condom use for "high risk" groups.[7]
A TROUBLING AND POTENTIALLY DISASTROUS DISTORTION OF ABC
While researchers and policy makers continued to debate the "lessons learned" from Uganda's success, conservative members of Congress inserted a controversial amendment into the global AIDS bill, mandating that "at least" one-third of the prevention dollars had to go toward "abstinence-only-until-marriage" programs.
In February of 2004, Ambassador Randall Tobias, the new U.S. Global AIDS Coordinator, issued the five-year implementation plan for PEPFAR, focusing on 15 countries. Key components of PEPFAR ignore scientifically proven prevention strategies and instead reflect the administration's ideologically driven approach to combating the spread of HIV and AIDS. Although President Bush has applauded Uganda's successful "ABC" strategy for reducing the spread of HIV, the administration has adopted only the A and the B while decrying the effectiveness of C. Rather than funding science-based, proven prevention strategies, PEPFAR exports ineffective, unproven programs.
Groups receiving funding may also avoid providing sexually active people with condoms and may refuse to refer them to places where they can get condoms, all on "moral" or religious grounds. The "conscience clause" was modified before final passage, to prevent groups from denigrating the effectiveness of condoms;[8] yet, the clause stands as a clear example of this Administration's willingness to place ideology over science, even when people's lives are at stake.
Uganda successfully coordinated abstinence, faithfulness, and condom use messages, in part by obtaining the agreement of local faith-based organizations to refrain from disparaging condoms. However, the United States' ideologically-based policy pits these useful ABC messages against one another. With the abstinence-only-until-marriage policy, PEPFAR exports the Administration's anti-condom movement to nations in desperate need of all their options for combating HIV.
FOUR MISGUIDED ASSUMPTIONS UNDERLYING PEPFAR'S APPROACH FOR YOUTH
Assumption 1: The majority of adolescents in PEPFAR's focus nations (including 12 nations in sub-Saharan Africa) are not sexually active.*[7,9]
Fact: In fact, more than 11 million young people in PEPFAR's focus countries are sexually active.[10] For example, the median age for first sex among young women is 16.5 in Kenya; 16.6 in Botswana, Tanzania, and Uganda; and 16.8 in Zambia. The median age for first sex among young men is 16.8 in Tanzania, 17.1 in Kenya, and 18.3 in Uganda. Abstinence-only-until marriage education offers these youth no way to protect themselves other than to adopt "secondary abstinence."[9]
Assumption 2: Adolescents, whether or not they are currently sexually active, can be persuaded to practice abstinence without exception until marriage.*[7,9]
Fact: A study of virginity pledge programs found that pledges can help delay the onset of sex for some youth in some circumstances. Yet when youth break their pledge, they are significantly less likely than non-pledgers to use contraception or condoms, putting them at 35 percent higher risk of pregnancy and significantly greater risk for HIV.[11] Further, once pledgers begin to have sex, they are as likely as non-pledgers with a history of more partners to experience STIs, simply because pledge takers are far less likely to use condoms. Pledge takers are also less likely to seek STI testing and treatment than non-pledgers.[12]
Assumption 3: Risk elimination (abstinence) is the most effective approach for reducing the spread of HIV infection among youth. Risk reduction strategies (such as condom use) should be targeted only at "high risk" groups (such as sex workers and injection-drug users) and are not appropriate for youth and other groups.*[7,9]
Fact: There is no evidence that abstinence-only-until-marriage programs work. In fact, studies by organizations such as the World Health Organization, UNAIDS, the Institute of Medicine, and the American Medical Association show that comprehensive sexual health education programs_which provide accurate information about abstinence and about risk reduction, such as condom use_help youth delay the onset of sexual intercourse and also help sexually active young people protect themselves from pregnancy, HIV, and other STIs.[13,14,15,16,17] The Centers for Disease Control & Prevention and the U.S. National Institutes of Health agree that correct and consistent condom use is highly effective in preventing HIV transmission.[18,19]
Assumption 4: Marriage is a protective factor against HIV infection.*[7,9]
Fact: More than 51 million young women and girls, under the age of 18, are already married. International Center for Research on Women reports that married girls in Kenya and Zambia are more likely to be HIV-positive than their sexually active, unmarried counterparts, because their husbands are often 10 or more years older than the girls and may already be infected with HIV. Moreover, young married women seldom have power within marriage to protect themselves and are seldom able to refuse sex or negotiate condom use.[20]
WHAT CAN I DO?
Please, take immediate action. Sign the petition urging national governments to listen to young people and to include them in leadership positions in the battle against HIV and AIDS.
References:
UNAIDS. AIDS Epidemic Update, December 2003. Geneva, Switzerland: UNAIDS, 2003.
Joint United Nations Programme on HIV AIDS (UNAIDS). 2006 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2006.
UNAIDS. Young People and HIV/AIDS: Opportunity in Crisis. Geneva, Switzerland: UNAIDS, 2002.
Global Health Organization. HIV/AIDS. Washington, DC: The Council, 2003, http://www.globalhealth.org/view_top.php3?id=227.
United States Agency for International Development, Hogle JA, editor. What Happened in Uganda: Declining HIV Prevalence, Behavior Change, and the National Response. Washington, DC: Author, 2002, http://www.usaid.gov/our_work/global_health/aids/Countries/africa/uganda_report.pdf.
Blum RW. Uganda AIDS prevention: A, B, C and politics. Journal of Adolescent Health 2004; 34:428-432.
U.S. Agency for International Development. Annual Program Statement: HIV/AIDS Prevention through Abstinence and Healthy Choices for Youth: President's Emergency Plan for AIDS Relief. [APS No. M/OP-04-812] Washington, DC: USAID, March 11, 2004, (p. 8).
Cohen SA. Beyond slogans: lessons from Uganda's experience with ABC and HIV/AIDS. Guttmacher Report on Public Policy 2003; 6(5):1-3, http://www.guttmacher.org/pubs/journals/gr060501.html.
Center for Health and Gender Equity. Debunking the Myths in the U.S. Global AIDS Strategy: An Evidence-Based Analysis. Takoma Park, MD: The Center, March 2004, (p. 5).
United Nations. World Population Prospects: The 2002 Revision, Volume II: Sex and Age. New York, NY: UN, 2003, [used with USAID acknowledged percentages of unmarried adolescents in sub-Saharan Africa who are sexually active prior to age 20, citation 3, p. 9]
Bearman PS, Brckner H. Promising the future: virginity pledges and first intercourse. American Journal of Sociology 2001; 106:859-912.
Bearman PS, Brckner H. The Relationship between Virginity Pledges in Adolescence and STD Acquisition in Young Adulthood. Presentation at the National STD Prevention Conference, Philadelphia, PA, March 9, 2004.
Baldo M et al. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presented at the IXth International Conference on AIDS, Berlin, 6-10 June 1993. Geneva, Switzerland: World Health Organization, 1993.
UNAIDS. Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: A Review Update. [UNAIDS Best Practice Collection, Key Material] Geneva, Switzerland: UNAIDS, 1997.
UNAIDS. Young People and HIV/AIDS: Opportunity in Crisis. Geneva, Switzerland: UNAIDS, 2002.
Institute of Medicine, Committee on HIV Prevention Strategies in the United States. No Time to Lose: Getting More from HIV Prevention. Washington, DC: National Academy Press, 2001.
American Medical Association, Council on Scientific Affairs. Report of the Council on Scientific Affairs [Action of the AMA House of Delegates 1999 Interim Meeting, CSA Report 7-I-99] Chicago, IL: AMA, 1999.
Centers for Disease Control & Prevention. Condoms and Their Use in Preventing HIV Infection and Other STDs. Atlanta, GA: CDC, 1999.
National Institutes of Health. Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention: Workshop Summary, June 12-13, 2000, Herndon, Virginia. Rockville, MD: U.S. Dept. of Health & Human Services, 2001.
Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington, DC: International Center for Research on Women, 2003, p.9.
* Advocates for Youth gratefully acknowledges the Center for Health and Gender Equity for analyzing PEPFAR's underlying assumptions in the Center's Debunking the Myths in the U.S. Global AIDS Strategy: An Evidence-Based Analysis, 2004.
The Real ABCs- Access Denied!
The Fix the GAP Campaign is a direct organizing effort, led by Advocates for Youth's Youth Activist Network. The long-term goal of the Campaign is to ensure that Congress removes the abstinence until marriage earmark from the President's Emergency Plan for AIDS Relief (PEPFAR). The Campaign's more immediate goal is to outreach to 150 congressional offices to build support for a bill to be introduced in early 2006 by Representative Barbara Lee (D-CA). This bill will focus on comprehensive HIV prevention for women and girls that highlights PEPFAR's faults in prevention.
BACKGROUND: HIV AND AIDS IS A PANDEMIC!
As many as 40 million people currently live with HIV or AIDS.[1]
In 2005, HIV infected 15,000 additional people every day.[2]
As many as 95 percent of HIV-infected people live in developing countries.[1]
Over half of all people infected with HIV during 2003 were ages 25 and under.[2]
In 2005, as many as three million people died of AIDS, most in sub-Saharan Africa.[2]
Best current projections suggest that an additional 45 million people will become infected with HIV in 126 low- to middle-income countries before 2010.[4]
Yet, HIV prevention programs reach only about 20 percent of those who need them. At the same time, only about one in 10 HIV-infected people around the world receives treatment for HIV-related opportunistic infections, and less than one in 14 receives antiretroviral treatment.[2]
IMPACT ON YOUNG PEOPLE
Youth ages 15 through 24 currently comprise 28 percent of adults living with HIV or AIDS.[2]
Three-fourths (75 percent) of the young people living with HIV or AIDS reside in sub-Saharan Africa, as do over 90 percent of AIDS orphans.[3]
Adolescents are at higher risk in all countries_both more and less developed_because, among other factors, they more often have short-term relationships (serial monogamy), use condoms less consistently than adults, and frequently lack sufficient information and understanding about HIV and AIDS.[3]
Young women below the age of 25 are particularly vulnerable to HIV infection. In fact, young women ages 15 to 19 in some countries in sub-Saharan Africa are five to six times more likely to be HIV infected than are young men their age.[3]
HOW THE BUSH ADMINISTRATION ADDRESSES GLOBAL HIV/AIDS
During his 2003 State of the Union address, President Bush unveiled the President's Emergency Plan for AIDS Relief (PEPFAR). He called for a commitment by the United States of $15 billion over five years to fight global HIV and AIDS, including two billion dollars for prevention strategies and programs. Thereafter in February 2003, Congress passed a global AIDS bill (H.R. 1298), authorizing up to $15 billion over five years. Included in the bill's findings were references to the successful "ABC_Abstinence, Be faithful, and use a Condom" strategy that reduced the incidence of HIV in Uganda.[5,6]
Studies indicate that delays in sexual debut, reductions in the number of new sexual partners, and increased condom use all contributed to Uganda's declining HIV infection rate, with reductions in the number of sexual partners probably playing the most important role. Whereas Uganda achieved these results through a comprehensive public education campaign that provided multiple behavior options,[5,6] PEPFAR segments prevention education into 1) abstinence-only-until-marriage for adolescents, 2) faithfulness for married couples, and 3) condom use for "high risk" groups.[7]
A TROUBLING AND POTENTIALLY DISASTROUS DISTORTION OF ABC
While researchers and policy makers continued to debate the "lessons learned" from Uganda's success, conservative members of Congress inserted a controversial amendment into the global AIDS bill, mandating that "at least" one-third of the prevention dollars had to go toward "abstinence-only-until-marriage" programs.
In February of 2004, Ambassador Randall Tobias, the new U.S. Global AIDS Coordinator, issued the five-year implementation plan for PEPFAR, focusing on 15 countries. Key components of PEPFAR ignore scientifically proven prevention strategies and instead reflect the administration's ideologically driven approach to combating the spread of HIV and AIDS. Although President Bush has applauded Uganda's successful "ABC" strategy for reducing the spread of HIV, the administration has adopted only the A and the B while decrying the effectiveness of C. Rather than funding science-based, proven prevention strategies, PEPFAR exports ineffective, unproven programs.
Groups receiving funding may also avoid providing sexually active people with condoms and may refuse to refer them to places where they can get condoms, all on "moral" or religious grounds. The "conscience clause" was modified before final passage, to prevent groups from denigrating the effectiveness of condoms;[8] yet, the clause stands as a clear example of this Administration's willingness to place ideology over science, even when people's lives are at stake.
Uganda successfully coordinated abstinence, faithfulness, and condom use messages, in part by obtaining the agreement of local faith-based organizations to refrain from disparaging condoms. However, the United States' ideologically-based policy pits these useful ABC messages against one another. With the abstinence-only-until-marriage policy, PEPFAR exports the Administration's anti-condom movement to nations in desperate need of all their options for combating HIV.
FOUR MISGUIDED ASSUMPTIONS UNDERLYING PEPFAR'S APPROACH FOR YOUTH
Assumption 1: The majority of adolescents in PEPFAR's focus nations (including 12 nations in sub-Saharan Africa) are not sexually active.*[7,9]
Fact: In fact, more than 11 million young people in PEPFAR's focus countries are sexually active.[10] For example, the median age for first sex among young women is 16.5 in Kenya; 16.6 in Botswana, Tanzania, and Uganda; and 16.8 in Zambia. The median age for first sex among young men is 16.8 in Tanzania, 17.1 in Kenya, and 18.3 in Uganda. Abstinence-only-until marriage education offers these youth no way to protect themselves other than to adopt "secondary abstinence."[9]
Assumption 2: Adolescents, whether or not they are currently sexually active, can be persuaded to practice abstinence without exception until marriage.*[7,9]
Fact: A study of virginity pledge programs found that pledges can help delay the onset of sex for some youth in some circumstances. Yet when youth break their pledge, they are significantly less likely than non-pledgers to use contraception or condoms, putting them at 35 percent higher risk of pregnancy and significantly greater risk for HIV.[11] Further, once pledgers begin to have sex, they are as likely as non-pledgers with a history of more partners to experience STIs, simply because pledge takers are far less likely to use condoms. Pledge takers are also less likely to seek STI testing and treatment than non-pledgers.[12]
Assumption 3: Risk elimination (abstinence) is the most effective approach for reducing the spread of HIV infection among youth. Risk reduction strategies (such as condom use) should be targeted only at "high risk" groups (such as sex workers and injection-drug users) and are not appropriate for youth and other groups.*[7,9]
Fact: There is no evidence that abstinence-only-until-marriage programs work. In fact, studies by organizations such as the World Health Organization, UNAIDS, the Institute of Medicine, and the American Medical Association show that comprehensive sexual health education programs_which provide accurate information about abstinence and about risk reduction, such as condom use_help youth delay the onset of sexual intercourse and also help sexually active young people protect themselves from pregnancy, HIV, and other STIs.[13,14,15,16,17] The Centers for Disease Control & Prevention and the U.S. National Institutes of Health agree that correct and consistent condom use is highly effective in preventing HIV transmission.[18,19]
Assumption 4: Marriage is a protective factor against HIV infection.*[7,9]
Fact: More than 51 million young women and girls, under the age of 18, are already married. International Center for Research on Women reports that married girls in Kenya and Zambia are more likely to be HIV-positive than their sexually active, unmarried counterparts, because their husbands are often 10 or more years older than the girls and may already be infected with HIV. Moreover, young married women seldom have power within marriage to protect themselves and are seldom able to refuse sex or negotiate condom use.[20]
WHAT CAN I DO?
Please, take immediate action. Sign the petition urging national governments to listen to young people and to include them in leadership positions in the battle against HIV and AIDS.
References:
UNAIDS. AIDS Epidemic Update, December 2003. Geneva, Switzerland: UNAIDS, 2003.
Joint United Nations Programme on HIV AIDS (UNAIDS). 2006 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2006.
UNAIDS. Young People and HIV/AIDS: Opportunity in Crisis. Geneva, Switzerland: UNAIDS, 2002.
Global Health Organization. HIV/AIDS. Washington, DC: The Council, 2003, http://www.globalhealth.org/view_top.php3?id=227.
United States Agency for International Development, Hogle JA, editor. What Happened in Uganda: Declining HIV Prevalence, Behavior Change, and the National Response. Washington, DC: Author, 2002, http://www.usaid.gov/our_work/global_health/aids/Countries/africa/uganda_report.pdf.
Blum RW. Uganda AIDS prevention: A, B, C and politics. Journal of Adolescent Health 2004; 34:428-432.
U.S. Agency for International Development. Annual Program Statement: HIV/AIDS Prevention through Abstinence and Healthy Choices for Youth: President's Emergency Plan for AIDS Relief. [APS No. M/OP-04-812] Washington, DC: USAID, March 11, 2004, (p. 8).
Cohen SA. Beyond slogans: lessons from Uganda's experience with ABC and HIV/AIDS. Guttmacher Report on Public Policy 2003; 6(5):1-3, http://www.guttmacher.org/pubs/journals/gr060501.html.
Center for Health and Gender Equity. Debunking the Myths in the U.S. Global AIDS Strategy: An Evidence-Based Analysis. Takoma Park, MD: The Center, March 2004, (p. 5).
United Nations. World Population Prospects: The 2002 Revision, Volume II: Sex and Age. New York, NY: UN, 2003, [used with USAID acknowledged percentages of unmarried adolescents in sub-Saharan Africa who are sexually active prior to age 20, citation 3, p. 9]
Bearman PS, Brckner H. Promising the future: virginity pledges and first intercourse. American Journal of Sociology 2001; 106:859-912.
Bearman PS, Brckner H. The Relationship between Virginity Pledges in Adolescence and STD Acquisition in Young Adulthood. Presentation at the National STD Prevention Conference, Philadelphia, PA, March 9, 2004.
Baldo M et al. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presented at the IXth International Conference on AIDS, Berlin, 6-10 June 1993. Geneva, Switzerland: World Health Organization, 1993.
UNAIDS. Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: A Review Update. [UNAIDS Best Practice Collection, Key Material] Geneva, Switzerland: UNAIDS, 1997.
UNAIDS. Young People and HIV/AIDS: Opportunity in Crisis. Geneva, Switzerland: UNAIDS, 2002.
Institute of Medicine, Committee on HIV Prevention Strategies in the United States. No Time to Lose: Getting More from HIV Prevention. Washington, DC: National Academy Press, 2001.
American Medical Association, Council on Scientific Affairs. Report of the Council on Scientific Affairs [Action of the AMA House of Delegates 1999 Interim Meeting, CSA Report 7-I-99] Chicago, IL: AMA, 1999.
Centers for Disease Control & Prevention. Condoms and Their Use in Preventing HIV Infection and Other STDs. Atlanta, GA: CDC, 1999.
National Institutes of Health. Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention: Workshop Summary, June 12-13, 2000, Herndon, Virginia. Rockville, MD: U.S. Dept. of Health & Human Services, 2001.
Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington, DC: International Center for Research on Women, 2003, p.9.
* Advocates for Youth gratefully acknowledges the Center for Health and Gender Equity for analyzing PEPFAR's underlying assumptions in the Center's Debunking the Myths in the U.S. Global AIDS Strategy: An Evidence-Based Analysis, 2004.
VIEW 12 of 12 COMMENTS
I'm in Park City right now, though. It's cute. Last night we were in West Wendover, NV. We drove through the salt flats. That shit is, like, straight up moon territory. It looked like an alien planet.
And I went to my first casino, which also kind of looked like an alien planet, but in different ways.
And how are you?