Balancing AIDS prevention

In 2003, CONGRESS required that one-third of all US money spent on preventing AIDS overseas be used for promoting abstinence and fidelity. Ever since, there have been complaints that this was getting in the way of efforts to fight the disease. Now, Congress's investigative arm has confirmed that the requirement is short-changing other prevention programs, including the use of drugs to prevent transmission of the virus from mothers to children.
The congressional mandate was designed to reinforce the ''ABC" approach to preventing AIDS: Abstinence, Be faithful, and use Condoms. That method is given credit for curbing the epidemic in Uganda and elsewhere. But according to the report by the Government Accountability Office, US officials in foreign countries -- who were granted anonymity by the GAO -- have found the abstinence guidelines confusing and difficult to balance with other prevention programs.
The report says officials in nine countries had to reduce funding for programs to prevent mother-to-child transmission in order to have enough money for abstinence programs. Another country's staff said that the abstinence requirement complicated an attempt to deal with a shortage of condoms.
Dr. Mark Dybul, deputy coordinator of the administration's AIDS program, said the emphasis on abstinence and fidelity had raised the average age of first sexual experience and reduced the average number of sex partners. He said that all prevention programs would be adequately funded if Congress had appropriated as much as the president requested. Dybul denied that there has been a reduction in US support of condom purchases. According to US figures, total condom distribution at US expense in 2005 was $429 million, a 23 percent increase over the $348 million distributed in 2001.
But a recent Baltimore Sun article indicates that distribution of condoms might not be sufficient if there is not enough condom education and promotion.
The article described US-funded pro-abstinence meetings in Mozambique led by members of World Relief, the humanitarian arm of the National Association of Evangelicals, a US organization. A US policy prohibits US-funded groups from going into schools to discuss condoms with students younger than 15, even though the median age for Mozambican girls' first sexual experience is 16. But Dybul said teenagers who are more likely to be sexually active are often not in school, so the prohibition wouldn't apply.
Still, the US contribution to prevention would be more effective, the GAO report makes clear, if Congress gave US officials more flexibility in balancing abstinence with other efforts to limit the spread of AIDS.
from The Boston Globe