Last week, in preparation for the international AIDS conference that kicks off in Toronto on August 13, Plan International released a report called "Circle of Hope: A Global Framework for Tackling HIV and AIDS." Among other findings, the report highlights that marriage is often more of a risk than a remedy for women seeking to protect themselves against HIV and that fragile economies mixed with gender discrimination make abstinence an unsustainable strategy for women, who also find it close to impossible to insist on their partners' fidelity or condom use. The report exposes the Bush administration's panacea of "ABC" as the woefully inadequate strategy it has always been. Its findings won't come as a surprise to those who deal on a daily basis with the complex realities of HIV/AIDS.

Here in Nicaragua, the epidemic has not yet taken off (at the beginning of 2005, only 1,668 people were officially living with HIV/AIDS), but the social, economic, and cultural conditions are ripe for an explosion. In a culture where open discussion of sex and sexuality remains taboo, women and young people are particularly at risk. Forty-two percent of Nicaraguans are under 15 years old and many are woefully underinformed about how to protect themselves against HIV/AIDS. A series of conservative governments guided by traditional Catholic values have staunchly opposed comprehensive sexuality education in schools, electing instead to focus exclusively on abstinence and fidelity–which are all well and good until you start having sex or until your husband cheats on you, por ejemplo. Narrow discussions of abstinence and fidelity also tend to reinforce rather than challenge the culture of machismo that makes violence against women so widespread; most women are considered first the property of their parents and later, the property of their husbands.

Beyond gender, abstinence-and-fidelity-based sex ed also fails to equip young people with the skills they need to negotiate the daily decisions and challenges that growing up in the second poorest country in Latin America involves. Nicaragua's infrastructure has never quite recovered from a series of natural and man-made disasters in the past few decades, most notably the U.S.-backed Contra war, which lasted throughout the 1980s. Quality public health services are scant–the only really decent health care available is privately run, a tall order in a country where the average person earns $2 a day. An example: last Saturday morning, my friend's neighbor's 16-year-old son was rushed to a private clinic with a ruptured appendix. The doctors refused to operate without proof that the boy's parents could foot the bill, so he lay in the waiting room in agony for several hours. Salvation finally arrived mid-afternoon when the family managed to reach a relative living and working in the States who was able to wire the money in time. But what of the millions of Nicaraguans without a family member to foot the bill?

Amidst this challenging environment, numerous Nicaraguan NGOs and community-based groups are struggling to fill the yawning gaps in social services left by a succession of governments guided by neoliberal policies and conservative Catholic values. Just like Plan International's report makes clear, these organizations understand that addressing HIV/AIDS doesn't just require talking about HIV/AIDS. It also means talking about violence, and sexual abuse, and machismo, and poverty, and health services, and everything else that makes people–and women in particular–vulnerable to infection, whether they are housewives or sex workers or neither or both. But how long can they hold out before Nicaragua's statistics start to look like sub-Saharan Africa's?