Abstinence and AIDS

FROM AFRICA, the continent most afflicted with the HIV-AIDS epidemic, the news is mixed at best on this World AIDS Day. But in the United States, the nation that surpasses all others in its AIDS funding in Africa, there is one solid piece of good news. Thanks to the change of power in Congress, US-financed prevention programs could be freed of the requirement that one-third of all their funding go to abstinence-only efforts.

There is a definite role for abstinence, especially among the young, where the training has been shown in some cases to delay the age of first sexual activity. Abstinence-only programs, however, are of little help to some of those most vulnerable to infection, including impoverished young women under pressure to have sex for economic or cultural reasons.

The changeover in Congress will greatly improve the prospects of a bill sponsored by a critic of the abstinence-only rule, Representative Barbara Lee of California. Lee's bill would also direct President Bush to develop a full strategy to reduce the particularly high risk of HIV infection faced by women and girls in developing countries. In southern Africa, 76 percent of infected persons between age 15 and 24 are female.

Lee's bill calls for greater access to female condoms and better educational and job-training opportunities for young women. The measure's sheer scope might endanger its chances in the Senate, where the Democratic margin is hair-thin, but it should be possible for both houses at least to agree on eliminating the abstinence-only earmark.

A report this year by the Government Accountability Office showed that US officials working in AIDS prevention overseas found the earmark confusing and difficult to balance with other programs. In nine countries, the officials, who were granted anonymity by GAO, said the abstinence mandate forced reductions in programs to inhibit mother-to-child transmission of the virus.

Another problem is the administration policy opposing needle-exchange programs, which would be an effective counter to AIDS in a country like Vietnam, where many infections are related to drug use. Reversing that policy might require a change in the White House, but it would be a welcome first step in improving the US role in preventing AIDS if Congress drops the abstinence earmark. The focus should be AIDS-only.

AIDS in the world, 2006

New HIV infections in 2006	4.1 million
People living with HIV/AIDS	38.6 million
AIDS-related deaths in 2006	2.8 million
AIDS-related deaths since 1981	39.8 million

SOURCE: World Health Organization and UN Program on AIDS