Why is the PEPFAR’s ABC program controversial?
There is almost unanimous agreement among those who work in public health around HIV/AIDS that individuals should be educated about the range of options to reduce HIV transmission, including abstinence, monogamy, and the correct use of condoms.However in practice the U.S. approach is fraught with problems, as it seems guided more by political and religious ideology, than by science and experience. Some of the key problems with the PEPFAR program include:
- PEPFAR legally requires countries and organizations to spend specific amounts on abstinence and monogamy programs, which mean that other programs get cut. A recent report by the US Government Accountability Office (GAO) found that important prevention programs, including prevention of mother-to-child transmission of HIV, have been cut to satisfy the requirement to promote abstinence.
- Promoting “being faithful” and monogamy is misleading and misguided, as being in a monogamous relationship does not protect you from HIV transmission. A 2001 study published in the journal AIDS found that the risk of HIV was actually greater in women who were married compared with those who were unmarried, particularly for women younger than 25. Thomas J. Coates, professor of medicine in the Division of Infectious Diseases at UC Los Angeles, also points out that the majority of young women in sub-Saharan Africa acquire HIV through steady partners or spouses.
- Abstinence programs in the US have been found to be both ineffective, and riddled with factual errors. Abstinence is also of little usefulness in the face of sexual violence. While information about abstinence should be included in HIV prevention programs, placing greater importance on messages of abstinence and monogamy is unrealistic, and simply doesn’t help the people these programs are intended to help.
There is no current evidence to suggest that the ABC program the US government has adopted is effective. And a recent GAO report suggests that the program is causing significant problems for public health workers on the ground.
Sources:
- U.S. State Department, ABC Guidance.
- Avert.org
- United States Government Accountability Office, Global Health Spending Requirement Presents Challenges for Allocating Prevention Funding under the President’s Emergency Plan for AIDS Relief , April 2006.
- Glynn, JR; Caraeel, M; Auvert, et. al. Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia AIDS, 15(4), Aug 2001.
- Thomas J. Coates, San Francisco Chronicle, Science vs. Assumption in Public Health Policy: Abstinence alone not the answer, May 25, 2004.
Published April 13, 2006.
