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NOVA: Rx for Survival

Ugandan child, photo by Betsy Rate
Science and Health:
Global Health: America's Response
More on This Story:
AIDS Policy Debate

In "Global Health: America's Response" NOW examines the U.S.'s HIV/AIDS policy from its beginning in the early 1980s through President Bush's historic plan, announced in 2003, to spend $15 billion for treatment and prevention of HIV/AIDS around the world. The one-hour documentary takes viewers on the ground in Uganda to examine how Uganda's successful three-pronged approach, which has become known as ABC: "Abstinence," "Be faithful," and "Condom use," has sparked controversy among both American and Ugandan groups which don't believe condoms are effective in reducing HIV prevalence and that they contribute to promiscuity. Buoyed by the fact that at least 33% of U.S. money in President Bush's plan set aside for prevention must go to groups that promote so-called "abstinence-only" programs, which downplay or ignore the importance of condoms in HIV prevention.

Photo Essay
Read below disparate voices in the public debate over AIDS policy. Learn about the history of the epidemic and see how U.S. AIDS spending priorities have changed. Plus, NOW Field Producer Betsy Rate narrates a Photo Essay about NOW's visit to Uganda.

Two years ago the Alan Guttmacher Institute published an article full of praise for Uganda's "ABC approach" to HIV/AIDS prevention — Abstain, Be faithful, use Condoms:

Between the late 1980s and mid-1990s, at a time when HIV/AIDS was well on its way toward ravaging Sub-Saharan Africa, Uganda achieved an extraordinary feat: It stopped the spread of HIV/AIDS in its tracks and saw the nation's rate of infection plummet. As word of the "Uganda miracle" spread, journalists, researchers, policy-makers and advocates all descended to try to ascertain how it was accomplished.

In September, 2005, THE ECONOMIST published an article on Uganda and AIDS with quite a different tone:

AIDS has killed about 1 [million] Ugandans, while some 1.1m may still be infected with HIV—big figures in a population of 27m. But by African standards, alas, they are something of a success story. Much of the credit has gone to Yoweri Museveni, president since 1986. But now the campaign against AIDS is faltering amid accusations of moralistic grandstanding and financial mismanagement.
What has changed? Some critics point to an aspect of President Bush's Emergency Plan for AIDS Relief (PEPFAR), and its emphasis on "abstinence-only" programs. Others say that the A in ABC has long been the key to Uganda's success in fighting AIDS.

Pro-Condom Distribution Programs:Abstinence Emphasis:
"No less than twelve U.S. government-funded evaluations at the state level have shown that U.S.-based abstinence-only programs have little influence on participants' sexual behavior and may cause harm by discouraging the use of contraception. Additional studies have suggested that "virginity pledges," a staple of abstinence-only programs in which young people promise to abstain until marriage, often fail and may result in lower contraceptive use (and higher STD rates) among sexually active unmarried youth.

Officials in both the U.S. and Ugandan governments have ignored these studies. Instead, they have misleadingly used national survey data to suggest that abstinence and fidelity are more popular among Ugandans than condom use. Not only do such data provide a poor substitute for evaluation of abstinence programs, but research in Uganda clearly indicates that a comprehensive approach to HIV prevention—one emphasizing positive behavior change, high-level political leadership, condom use, widespread HIV testing, and a myriad other factors—is what allowed the country to reduce HIV prevalence in the 1990s. 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."

- The Less They Know, the Better Abstinence-Only HIV/AIDS Programs in Uganda, Human Rights Watch, March 2005

"[Uganda] have promoted a traditional message of celebrating virginity at marriage, encouraging young people to be abstinent until marriage and then asking those who are married to be faithful to their partners, with little emphasis on condom promotion (what has become known as their ABC message). They have had some success in highly targeted condom campaigns, and no documented success in broader condom campaigns. America needs to become known as the biggest promoter of the A and B of ABC, not known as we are now as the biggest provider of C.

Uganda's message contrasts sharply with the messages given out in the southern part of Africa. There the dominant and primary message has been the promotion of condoms. We saw this in the early '90s and were surprised to see an even greater emphasis on our return trip last year. Very few government funded programs focus on abstinence or faithfulness, and certainly most US sponsored programs, whether government or private, focus on the broad social marketing of condoms. There is some emphasis on diagnosis, but even that is often anonymous in nature.

We should remember that the biggest predictor of any sexually transmitted disease is the number of lifetime partners; the more partners the more risk, fewer partners less risk, and one uninfected partner in a faithful relationship virtually no risk. The President has it right, Uganda can teach us many important lessons."

- Shepherd Smith, President and Founder, Institute for Youth Development, testifying before the House Subcommittee on Health.

More on HIV/AIDS Policy

BBC News: The HIV Debate
In-depth analysis and interactive features about AIDS past and present.

Centers for Disease Control Divisions of HIV/AIDS Prevention
Statistical information and medical information from the CDC.

Center for Health and Gender Equity
The Center for Health and Gender Equity (CHANGE) is a U.S.-based non-governmental organization focused on the effects of U.S. international policies on the health and rights of women, girls, and other vulnerable populations in Africa, Asia, and Latin America.

Concerned Women for America
The mission of CWA is to protect and promote Biblical values among all citizens - first through prayer, then education, and finally by influencing our society - thereby reversing the decline in moral values in our nation.

Global AIDS Alliance
The Global AIDS Alliance (GAA) is a nonprofit organization based in Washington, DC. Their mission is to galvanize the political will and financial resources needed to address the global AIDS crisis and reduce its impacts on poor countries that have been hardest hit by the pandemic.

Kaiser Network Daily HIV/AIDS Report
Reports from the health research group on HIV/AIDS.

The HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) was formed in August 1997 to consolidate all programs funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

The Joint United Nations Programme on HIV/AIDS, UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the epidemic.

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