A panel discussion was hosted today by the Center for Health & Gender Equity and other NGOs that focused on US sexual and reproductive health policies as they affect HIV/AIDS work abroad. Rolake Odetoyinbo from Nigeria, Beatrice Were from Uganda, Meena Seeshu from India, Gabriela Liete from Brazil, and Rev. Johannes Petrus Heath from Namibia all had nearly the same message to share: that despite the benefits that have come from PEPFAR and other work of the Bush Administration, moralistic policies are making their work difficult.
Beatrice Were was abstinent before marriage, was faithful to her husband, and contracted the virus. Likewise, Rolake Odetoyinbo was infected in the same way. The Bush Administration's policy focus for prevention has been "Abstinence before marriage, Be faithful to your spouse, and for high-risk groups, use Condoms." The A and the B in that policy failed both women. In most of the world, it is not a possibility for a woman to ask her husband to wear a condom, so what options do they have from ABC, when a woman follows the first two, the third is not an option, and her partner makes poor decisions?
Were's work with Action Aid Uganda has been hampered by the radical commitment to abstinence education in her country. While it may be effective, she explained to the audience that this unbalanced focus on abstinence as the only way to prevent infection is fueling stigma and hindering prevention. Under this cultural paradigm, where the First Lady is taking "virginity censuses" among girls and women, people begin to assume that if you had the virus, you must have been unfaithful or sexually promiscuous. This leads to people not getting tested, not disclosing their status, and not seeking treatment for fear of social repercussions.
Meena Seeshu and Gabriela Leite both work with prostitutes in their respective countries. In the fight against the spread of the virus among sex workers and their clients, both women testified that there is no more powerful educator available that the sex workers themselves. And yet the official Bush Administration policy requires that any international NGO receiving federal funding sign a "loyalty oath" declaring their opposition to prostitution as an industry, and effectively alienating themselves from the poeple they serve. (Ms. Leite was quick to point out that her organization sees prostitutes not as "victims of society, but as subjects of political history.") On the ground, this has meant debilitating Ms. Seeshu's work almost entirely, leaving prostitutes in her community without the education and organization to fight the virus. Or, in Ms. Leite's case, that hers and all other Brazilian NGOs have had to refuse US funding and look for resources elsewhere.
"HIV is a virus, not a moral condition," Rev. Heath repeated several times, drawing attention in one phrase to what his fellow panelists said so frequently about their experiences. The Bush Administration's moralistic policies have alienated at risk populations (in the case of prostitutes…and illegal drug users…and gay men), and abandoned women to infection by their husbands, to the point where the largest risk for HIV infection among women in the developing world is now marriage.
Rev. Heath's statement seemed like it would quickly become a rallying cry for the room. HIV is not a moral condition. It is a public health crisis, and like any other public health crisis, it needs to be fought with the most effective available methods. Abstinence-only education and anti-prostitution oaths do not appear to be among them.