School-aged-youth in Kenya understand what it means to be abstinent. Recent studies conducted throughout East Africa, however, suggest that some of the reasons these young people give for not practicing it are quite complex. Some say that young men cannot be expected to control themselves. Others believe that gender dynamics make it impossible for young girls to abstain, even if they wanted to. And still others have such a sense of fatalism regarding HIV that they just don’t see the point in holding out.
The alternative to holding out, though, could mean death. So in a region where millions are living with HIV and thousands die yearly from its complications, the need for clear and culturally appropriate prevention programming is paramount.
But, according to researchers working in this hard hit region, biased promotion of abstinence and “be faithful” messages stemming from the Bush administration’s controversial adaptation of the Uganda developed ABC prevention program (Abstinence, Be faithful, correct and consistent Condom use) has resulted in utter confusion.
“The young people there are far more clear about abstinence than they are about any of the other components,” says Julie Pulerwitz, research director with Horizons. “But just having information about abstinence is hardly enough, especially if you are already sexually active.”
Horizons, a global organization funded by USAID (United States Agency for International Development), exists to test various intervention strategies in different cultural contexts, in an effort to determine what works best and where. They found that 39% of the nearly 1,400 Kenyan students they surveyed were currently sexually active. And, while an even greater percentage (46% of the males and 14% of the females) reported having had sex at least once, only a small number of them were able to clearly define each component of the ABC program.
“A substantial percentage of these young people did not associate being faithful with HIV at all,” Pulerwitz explained in her presentation of the study at the XVI International AIDS Conference in Toronto. “They thought that it meant being loyal to friends or faithful to God, or even having faith that your partner is not having sex with someone else.”
The greatest concern for Pulerwitz and her team, however, was the overwhelming number of young people (ranging in age from 13 to 19) who were miseducated about condom usage and effectiveness.
“We are told it has small holes that can allow the virus to go through,” one Kenyan youth told the research team when asked what she knows about condoms. “The radio says they [condoms] have the virus.”
She is not alone in her thinking. Her perception was found to be common among the young people Horizons surveyed. When asked what “consistent condom use” meant to them, only 13% were able to answer correctly. Instead, many gave definitions of what they believe condoms are, most of which were negative. Repeating what they’ve been told by their teachers, pastors, and parents, a large number said that condoms are ineffective, uncomfortable, and even immoral.
Pulerwitz said she believes that these perceptions are a direct result of U.S. influence on foreign countries that depend on our aid in combating the virus. Currently, 33% of all U.S. (the largest funder of AIDS programs in the world) dollars have been mandated to abstinence-until-marriage-only programming.
U.S. Representative Barbara Lee (D-CA) and several of her colleagues are sponsoring legislation to change that. “What we see is a very ideologically driven administration, both domestically and internationally, trying to put their moral values on communities and countries,” she said during a press conference held at the XVI International AIDS Conference. On a continent where 25 million people are estimated to be living with HIV, policies such as these are unacceptable.
Jonathan Cohen, project director of the Law and Health Initiative at the Open Society Institute, couldn’t agree more. In a separate study presented at the same session with Pulerwitz, Cohen discussed findings published in a report that he co-authored with the Human Rights Watch. Cohen’s presentation dealt with the impact of U.S. emphasis on abstinence-heavy prevention promotion in Uganda—another hard-hit East African country.
“Political leadership in Uganda, which had previously been supportive of comprehensive sex education, has now turned to supporting abstinence-only approaches,” said Cohen. “At the policy level, at the level of school-based education, and at the level of community programming, we are beginning to see a shift towards the abstinence-only model which threatens to roll back decades of progress that places like Uganda have made in HIV prevention. The ABCs have suddenly become the AB.”
Cohen also takes issue with the way in which current prevention programming that is being conducted in Uganda draws a distinction between young people who are at “high risk” of HIV and those who are not—restricting the condom message to those in the “high risk” group.
“In an area where HIV touches everybody in one way or another, how do you determine who is high risk and who is not,” Cohen asks. “Everybody is high risk. From the sexually promiscuous young man to the girl who saves herself for marriage but happens to marry a man who didn’t. Everyone is high risk and everyone has the right to access safer sex messages.” |
