A new report by Human Rights Watch documents how the U.S. government has affected HIV/AIDS-prevention efforts in Uganda, which in recent years has changed from providing comprehensive prevention messages, including support for condom use, to providing abstinence-only-until-marriage programs that promote "unproven and potentially life-threatening messages, impeding the realization of the human right to information, to the highest attainable standard of health, and to life."1 Uganda is widely touted as a success story for having dramatically decreased its HIV/AIDS rate, but, amidst conflicting reports about why the rates went down, the story has become shrouded in politics and ideological battles. The Bush Administration, for example, has paraded Uganda as the shining example of the U.S. government's approach to HIV prevention under the President's Emergency Plan for AIDS Relief (PEPFAR), but in the process has created program and policy changes that barely resonate with Uganda 's original success.
The report, The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda , shows that the U.S. government, the largest single donor to HIV/AIDS programs in Uganda, is leveraging its funding to influence policy, public messaging, and prevention programming. For example, the Ugandan First Lady, Janet Museveni, has used her prominent public position to criticize groups that teach young people about condoms and even called for a national "virgin census" to support her abstinence agenda. In turn, organizations she supports are receiving PEPFAR funding. For example, she has close ties with the Virginia-based Children's AIDS Fund, which was recently approved for a major abstinence-only grant under PEPFAR, despite having been deemed "not suitable for funding" by a technical panel of the U.S. Agency for International Development (USAID).2
The report highlights how U.S. support for abstinence-only-until-marriage programs has resulted in the removal of critical HIV/AIDS information and the addition of misinformation in primary school curricula. This includes perpetuating myths about condoms and promoting marriage as a protective factor regardless of the documented risks of HIV infection in marriage. For example, a draft U.S.-funded secondary school curriculum states, "sex before marriage is not only breaking school rules but against religion and norms of all cultures in Uganda and having pre-marital sex is considered a form of deviance. . . . Condoms are not 100% perfect protective gear against STDs and HIV infection. This is because condoms have small pores that could still allow the virus through."3Furthermore, teachers told Human Rights Watch that they have been instructed by U.S. contractors not to discuss condoms in schools because the new policy is "abstinence only." Abstinence-only-until-marriage programs have failed to prove effective in the U.S. and may potentially cause harm by discouraging the use of contraception. Given the continuing prevalence of HIV (current estimates are approximately 6%4) as well as underlying exacerbating factors, such as poverty and gender inequality, in Uganda , these programs seem even more unrealistic. "I wish those who preach abstinence would come down to the slums and see how people are living," said one AIDS educator. "These girls live five to a room. There is no supper for them. The man outside says he will get her money and a place to sleep. Now, what is she going to do, abstain?"5 This educator explained that people need "assistance, services, and access to protection, not judgmental messages. Better to be delivering services than abstinence messages. Around here, they are a waste of time and money."6
"These abstinence-only programs leave Uganda 's children at risk of HIV," said Jonathan Cohen, a researcher with Human Rights Watch's HIV/AIDS Program and one of the report's authors. "Abstinence messages should complement other HIV-prevention strategies, not undermine them."7
After underwriting this significant programmatic and policy change, the U.S. , along with other proponents of abstinence-only-until-marriage programs, have revised the history of HIV prevention in the country to suggest that this was what Uganda was doing all along. The Bush Administration often cites Uganda as a model of its prevention strategy under PEPFAR, the so-called "ABC" approach-Abstinence for youth, Be faithful for married couples, and Condoms only for "high risk" populations.8 Although elements of Uganda 's AIDS strategy support an "ABC" model, "ABC" as applied under PEPFAR "is a uniquely American invention."9 The research shows "nothing in the demographic or historical record suggests that 'abstinence education' as conceived by the United States is what contributed to Uganda 's HIV prevention success."10 In fact, experienced HIV/AIDS educators in Uganda told Human Rights Watch that they had never heard of "ABC" until the U.S. government began describing Uganda 's approach in those terms.
One educator explained, "We're almost back to square one....[B]ecause of our culture, it was very difficult for us to get people to use condoms. Now, trying to promote abstinence in this social environment...is very difficult. If you tell people to abstain, they'll say, 'You were the people telling us to use condoms, and now you're telling us to abstain. Does this mean condoms weren't effective and you were lying to us?'"11
The Human Rights Watch report presents a clear picture of how the Bush Administration tells a politically expedient story of what happened in Uganda in order to continue pouring money into the abstinence-only-until-marriage industry. It confirms the fact that despite evidence that these programs do not work, this Administration continues to irresponsibly fund the globalization of far-right ideology at the cost of the health of the world's people, especially our young people.
1The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda ( London : Human Rights Watch, 2005), 1, accessed 11 March 2005, < http://hrw.org/reports/2005/uganda0305/ >.
2 Human Rights Watch, "'Abstinence-Only' Programs Hijack AIDS Success Story U.S.-Sponsored HIV Strategy Threatens Youth," Press Release published 30 March 2005.
3Accounts from "The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda ," Human Rights Watch, accessed 11 March 2005, < http://hrw.org/english/docs/2005/03/29/uganda10385.htm >.
4 Human Rights Watch, "'Abstinence-Only' Programs Hijack."
5 Uganda , Joint United Nations Programme on HIV/AIDS, accessed 11 March 2005, < http://www.unaids.org/EN/geographical+area/by+country/uganda.asp >.
6The Less They Know , 1.
9 Ibid., 5.
12 Ibid., 64.