The lesson is not that this has been a messy process that needs fixing. Indeed, it is supposed to be a long and messy process. Profound change in representative democracies is a test of fortitude and always comes by way of gradualism. The Founders intended it to be so and for better or worse - my own sense is for the better - the structures and institutions that were set into place more than two centuries ago and have matured since, help ensure that, to use Madison's phrasing, we are not "decreeing to the same citizens, the hemlock on one day, and statues on the next."
No, the big lesson is that this same system stymies our ability to advance additional notions of rights that lie outside of our founding documents. No truer an example can be found than that of healthcare. What has become abundantly clear is that Americans just still do not buy into the notion that healthcare is a right. Plain and simple. When citizens and elected officials alike vocally oppose a so-called public option, the underlying premise is that this remains an affair for the marketplace, not the realm of politics.
The problem, of course, is that we already have a public option. It is when people show up at the emergency room and receive care regardless of their ability to pay. At some level, this example underscores the moral dimension of this debate to the core. It would be immoral to deny someone care who shows up at an emergency room with serious health issues and our society recognizes and compels that care in many, many instances. This is a moral judgment in practice, but whose articulation in our nation's debate seems non-existent. Yet, it is entirely relevant because after all, moral judgments and frameworks are the natural pathway to securing rights.
We had a moment at the end of the summer where the Administration began to use moral language to muster support for its efforts. It disappeared into the ether without notice and again, the discussion shifted to money. However, if we are to actually win and secure healthcare for all, it is precisely the moral argument that needs to be front and center.
Let me give you an example. How in the world was it decided that the guarantee of coverage for all would be the "public option." What a silly and technical term to describe what is, in its essence, a moral vision for how our society ought to approach healthcare. It put the debate on the typical grounds of the scope of federal powers in our limited scheme of government and to that extent, provided the embers for yet another firestorm between small government conservatives and liberals who see a more expansive role for government. Did we learn nothing from this same framing of the debate during the Clinton years?
We will never know if a deliberate and consistent moral framing may have won the day, but imagine if the guarantee of coverage was called "the moral society option" or some such term that communicated an entirely different message. Imagine the hypermoralistic social conservatives having to engage that discussion. That is the real nexis of the debate but we lost it entirely.
This is the lesson of healthcare reform in 2009; we have to communicate a morally persuasive argument that sways the public and our representatives and we have yet to do so. Lest one jump to the conclusion that the simple solution would be a campaign trumpeting "healthcare as a human rights" mantra, that too is wrongheaded.
I have often counseled my liberal friends to read the conservative scholar Mary Ann Glendon's brilliant work, Rights Talk. Glendon's great insight is that we have become so sloppy in tossing about rights-based language that it increasingly rings hollow and fails to carry with it the inherently moral message that is at the roots of the conception of rights itself. More sloppy "rights talk" merely serves to further impoverish our rights-based discourse and further alienates the need for all Americans to have a heartfelt belief that it is a special type of discussion. In other words, the magic is gone from the word and we, ourselves, are in many ways to blame.
So, I think she has the diagnosis nailed down - uncomfortable as it may be for many of us. But what is the way forward? Here is where I return to the lament about the lack of consistent and penetrating moral framework to our domestic discussion about healthcare. Moral language is the bridge back to securing rights and reviving the special sense in the American consciousness that the term ought to inspire. They are not mutually exchangeable terms or frames of reference. Further, morals lead to rights, not the reverse. Positing rights language without first successfully providing the moral argument perhaps serves short term advocacy goals, but in the end, creates a hollow shell that is ultimately difficult to defend. And here is where we find ourselves.
In the present, it has become clear that whatever results from these many months of debate on healthcare will be wholly insufficient to attain universal access for all. The lesson we take forward must be that concerted efforts must be made to frame securing universal healthcare coverage as moral issue for a moral society. Perhaps then, the next law will have a better chance of securing and codifying the "right" to healthcare for our posterity.
]]>This week, SIECUS is offering up some welcoming guidance to Dr. Goosby, his team at OGAC, and colleagues at USAID by releasing the second in our series of reports on how PEPFAR has shaped prevention policy in select countries. This report focuses on Zambia and, while I have previously written on RH Reality Check about the impact of the still-existent anti-prostitution loyalty oath on prevention work in this African nation, our new report focuses on the larger prevention dynamics in the country.
Titled Making Prevention Work: Lessons from Zambia on Reshaping the U.S. Response to the Global HIV/AIDS Epidemic , the report highlights just how severe the impact of recent U.S. HIV/AIDS prevention policy has been on this nation where an estimated 15% of the population is HIV positive and where life expectancy has plummeted to less than 39 years.
Our report highlights what $577 million in U.S. funding has accomplished during the first four years, specifically focusing on prevention. Based on extensive research and on-the-ground interviews with a wide diversity of parties, our report reveals the qualitative impacts of U.S. policy and we highlight six specific areas of concern.
First, the overemphasis on abstinence-until-marriage served to further constrict the range of prevention programs required to meet the diverse needs of a multilayered epidemic.
Second, our extensive interviews on the ground with a wide array of partners made clear that widespread confusion resulted from U.S policy and that very little direction was offered at the country level to help clarify what types of prevention programs could and could not be funded.
Third, comprehensive sex education is nearly non-existent and, without it, even the best intentioned HIV prevention programs have an uphill battle.
Fourth, even U.S. funded implementers acknowledged a pervasive “Silent C” reality means condoms have virtually disappeared from the prevention paradigm. We ourselves noticed that social marketing of condoms was non-existent in the Zambian capital where approximately 10 percent of the population lives.
Fifth, the chilling factor of the U.S. anti-prostitution loyalty oath has left entire communities with active commercial-sex sectors without sufficient prevention outreach.
And, sixth, local NGO’s have thus far not been adequately brought into solving their own nation’s epidemic raising serious concerns about the sustainability of prevention as U.S. funding is eventually scaled back.
The report covers a great deal more ground on these points than can be provided here, but, taken together, these six areas represent a prevention agenda in the country that needs an immediate course adjustment as the second phase of PEPFAR rolls out. And, we have to remember, this is not just about politics and policies. This is about what we can do to help the Zambian people help themselves and save the next generation from the fate met by approximately one million of their countrymen who have died from AIDS-related illnesses since 1990. Yes, one million – and in a country with only 12 million people.
So what can be done to make prevention work? The report highlights seven recommendations that, with the election of Barack Obama as President, become not a cry into the wind, but rather concrete steps to be undertaken with swiftness.
1) The time has come to shift away from the abstinence-until-marriage nonsense that has been proven ineffective, and has also been disastrous in nearly destroying a more comprehensive approach to prevention in many countries who received the largess of U.S HIV/AIDS assistance, including Zambia. This is a matter wholly solvable by new leadership at OGAC.
2) After years of requests for more transparency around how PEPFAR funds are being spent, little progress has been made. The transparency promised by the Obama Administration must be translated to PEPFAR and, in particular, what types of prevention activities are being carried out, what materials and curriculum are being used, and who exactly are the multitude of sub-grantees receiving funding but not appearing on grantee lists?
3) PEPFAR was originally crafted as an emergency plan and as it now transitions to a greater emphasis on sustainability, it must focus on developing the capacity of local, in-country NGO’s to more substantially contribute to the prevention work in their country. The tired thinking that bemoans that local NGO’s lack absorptive capacity must transition from being an excuse into a challenge to be met. These NGO’s must also increasingly become engaged alongside their governments in developing the operational plans to address their epidemics. We heard many times in Zambia that the country’s plan was written primarily by U.S. mission staff with minimal country input. That has to be flipped on its head by new OGAC leadership.
4) Congress must rescind the anti-prostitution loyalty oath. Yes, it is a long shot that this will happen before another PEPAR reauthorization, but it is the moral and right thing to do. In the meantime, OGAC should work with countries to ensure that prevention activities are re-established to meet the needs of those engaged in commercial sex work.
5) Greater efforts must be made to implement programming and create policy which connects HIV/AIDS to other sexual and reproductive health issues. This can be supported at a number of different levels if OGAC provides explicit leadership to prioritize this at the decision making levels both in Washington and on the ground. It can no longer be just a principle in the ether but must be concretely carried out and models of best practices need to be widely supported.
6) The refusal clause in current law allows any funded provider of prevention, care and treatment to deny services based on moral or religious objections. This is a violation of human rights and its persistence is a troubling reminder of just how far the previous U.S. Administration debased our moral standing in the world. It must be repealed by Congress. OGAC can also do a great service by finally collecting data from grantees about who is taking advantage of the refusal clause. This can help in planning supplemental interventions from other donors until this embarrassing vestige of darker days can be put to rest.
7) Finally, and perhaps most importantly for SIECUS’ own work going forward, is that U.S. HIV/AIDS assistance must prioritize comprehensive sex education as the foundation for HIV prevention. We cannot expect to significantly impact generalized epidemics if we are not reaching the maximum number of people with basic literacy on how to protect their health and to do so before they are sexually active. Comprehensive sex education works and every major public health entity around the world is calling for it to be scaled up. OGAC and US AID should quickly join that consensus. The work that has moved forward in Latin America and the Caribbean and encompassed in the Mexico City Declaration on Sex Education and HIV Prevention provides an excellent model to follow.
New leadership at the helm in Washington creates an opportunity. As advocates, we need to seize that opportunity and need to move from the position of critical observer, outside the mechanisms of decision making to being the civil society partner, alongside our colleagues in government. In other words, we need to take back our rightful place that for the past eight years has been occupied by the likes of extreme organizations like Concerned Women for America.
The end of our isolation is at hand. But rejoining the effort must be balanced with the thoughtful and often difficult work of making sure that we hold our new leaders accountable for the change that is needed. SIECUS’ new report on lessons from Zambia provides a roadmap to help right prevention. Our cards are on the table – face up – and we look forward to Dr. Goosby’s arrival and working together to realign sane policy with the enormous and compassionate investment of our nation to end the HIV/AIDS pandemic.
]]>What came out of meeting in Jamaica was intended to be a genuine articulation of the region’s needs. What continues to emerge is unequivocal support--by governments and civil society--for comprehensive sex education. No euphemisms. No politicking around the edges. Last August, just prior to the International AIDS meeting in Mexico City, these same ministers gathered and endorsed a landmark ministerial declaration committing their countries to begin reforms in their health and education sectors to institutionalize and sustain the delivery of comprehensive sex education. And, last week in Jamaica, countries did not reopen debate on political matters related to sex education, but rather reaffirmed their commitments to make this change happen.
The Mexico City Declaration on Sex Education and HIV Prevention also sets out ambitious targets. Perhaps most importantly, one goal is to achieve a 75 percent reduction in each country of schools that do not provide comprehensive sex education by 2015. Countries also agreed to halve the current number of adolescents not covered by adequate reproductive and sexual health services. In other words, the goals are about sex education, but also about sex education being the appropriate gateway and empowering mechanism through which young people access sexual and reproductive health services. These two advances go hand in hand and the Jamaica meeting endorsed the assembling of a technical team to bring the promise of the Mexico City Declaration to fruition.
To this extent, the meeting in Jamaica marks a transition point where the paper commitments of the Mexico City Declaration become concrete priorities reaffirmed by political leaders and given additional resonance across the region. It also marks the involvement of the UN system in seeking to magnify and support countries in Latin America and the Caribbean as they attempt to make good on their commitments. And, finally, civil society is increasingly recognizing the promise that the Mexico City Declaration holds for achieving success on better reproductive and sexual health in their countries and throughout the region.
The message from the region is clear and, now, donors must also follow suit. Again, the UN system is increasing support to implement the Declaration, and representatives from the World Bank and the Global Fund attended the meeting in Jamaica and heard the chorus of consensus. And, here is where it comes home – with the US being the largest donor on HIV/AIDS and development in the region, it too must be educated and align its funding rationale with the region’s priorities. “prevention through education” is the mantra and the US can responsibly re-engage with leaders in the region after eight disastrous years of ideological and political unilateralism by supporting the Mexico City Declaration’s bold agenda.
As we approach the first year anniversary of the Declaration on August 1, it is fully recognized that much works remains. But all the right players are being assembled and the Mexico City Declaration on Sex Education holds the promise to advance sexual and reproductive health and rights in the region in the most important, concrete and sustainable ways. More detailed information on the Ministerial Review meeting can be found at http://www.un.org/ecosoc/newfunct/amr2009jamaica.shtml
]]>
This week SIECUS released the
sixth edition of our SIECUS
State Profiles: A Portrait of Sexuality Education and Abstinence-Only-Until-Marriage
Programs in the States.
Since the beginning, we were clear with our readers that this is not
a publication to be read from beginning to end. The current edition
covering Fiscal Year 2008, for example, spans more than 700 pages replete
with graphs and notes and a profile on every state in the country.
To that extent, SIECUS State Profiles is a reference volume and
is the most complete resource of its kind. We are pleased that
over the years, it has served us, our advocacy colleagues, and policymakers
in advancing a mission that recognizes that young people have a right
to full and comprehensive information if we as a society expect them
to make good and responsible decisions about sex.
Bill Smith, VP of Policy at SIECUS, discusses the release of the 2008 report detailing the spending of federal abstinence only funds on a state by state basis.
And make no mistake - this year's edition documents the progress that has been made over the years and couches it within the larger and more favorable environment we are in. First, let it not go unsaid that we have now, for the first time in history, a President in the White House who supports age appropriate, medically accurate sex education for America's school-aged youth. It's a far cry from the unfulfilled plea to double funding for failed abstinence-only-until-marriage programs offered by President Bush in his 2004 State of the Union Address to Congress. What a difference an election makes. And while we await the details of how President Obama will lead on this issue, we and others are already calling for an unequivocal end to federal money to the failed abstinence-only-until-marriage industry and a significant investment in a proven, more comprehensive approach to sex education.
Taking such a step nationally would be recognition of the national paradigm shift away from abstinence-only-until-marriage programs and toward comprehensive sex education. Our research this year shows that there are now seven states that are completely free of any federal abstinence-only-until-marriage money. The list is not made up of bastions of leftist thinking, as some might expect. The current list of seven states includes Delaware, Idaho, Minnesota, Montana, Rhode Island, Vermont, and Wyoming. Up from just four states the year prior and only one the year prior to that, we continue to see a rejection of the failed and extremist proposition that expects much from young people while providing them with only a fraction of the information they need.
Our research also shows that nearly half of the states continue to reject federal abstinence-only-until-marriage money they are eligible to receive under the Title V abstinence-only-until-marriage program. Twenty-three states from Alaska (I'll spare all of us yet another Palin crack) to Maine are telling the federal government that taking funding for failed and extreme programs is anathema to the responsibility of government to its citizens and they need money for more comprehensive programs that actually have evidence behind them. If science is back, abstinence-only-until-marriage is out and the states are speaking that language in spades. That nearly every state in the Union finds itself in a severe financial crisis and could use money - any money - also speaks volumes about leaving this particular tainted federal money on the table.
We did focus on a few specific
trends this year though to highlight where additional attention ought
to be paid. First, our research shows that despite the complete
rejection of abstinence-only-until-marriage programs on the grounds
of evidence showing they are a failure and the total rebuke they garner
from every major public health entity in this country, nearly 50 hospitals
and health departments are recipients of federal abstinence-only-until-marriage
dollars. We know that in many cases, it was the lure of easy money
that led these entities down this path, but they are betraying the public
trust and it is time for them to side with the public health rationale
and end participation in the failed abstinence-only-until-marriage experiment.
We also looked this year at
where abstinence-only-until-marriage funding is trending geographically
given the collapse in support for the failed industry. Not surprisingly,
the south, which can least afford failed programming given its high
teen pregnancy rates and other less than admirable adolescent health
indicators, now consumes nearly half of all federal abstinence-only-until-marriage
money. Almost $82 million was funneled into sixteen southern states
in 2008. One colleague from Mississippi summed this up well for me:
"We're a poor state, we'll take any money we can get."
Also new this year, we included
three new profiles covering Puerto
Rico, the U.S Virgin Islands and the U.S.
Outer Territories.
Puerto Rico is in the midst of its own HIV/AIDS crisis so it was bit
shocking to learn that more than $3 million goes into the island.
One grantee operating in 25 of San Juan's schools uses some of the
worst abstinence-only-until-marriage curricula available.
Taylor's struggle to advance the most basic of American values - justice and equality - underscores just how inhospitable our country's schools are for an entire cadre of young people - lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. After all, if a teacher isn't allowed to explain and defend the rights each student has regardless of sexual orientation, as well as the responsibilities that come with those rights, what lesson are the students really learning?
The precarious day-to-day existence in schools for LGBTQ students is not entirely a mystery. Thankfully, last year the Gay, Lesbian and Straight Education Network (GLSEN) released its fifth National School Climate Survey. The report is based on responses collected from LGBTQ students across the country in 2007. The results paint a picture of a community of young people in crisis.
Three main issues emerge in GLSEN's report: increased absenteeism, lowered educational aspirations and academic achievement, and an overall hostile school climate for LGBTQ youth. On this latter point, for example, nearly three-fourths of students heard homophobic remarks often or frequently at school; nine in 10 LGBTQ students surveyed reported they were called names or threatened because of their sexual orientation; nearly half had been pushed or shoved; and of these incidents, almost a quarter involved punching, kicking, or injury with a weapon. This hostile environment results in nearly a third of LGBTQ students surveyed missing a class or an entire school day because of feeling unsafe.
GLSEN also found that this climate of fear, intimidation, and hate has long term repercussions on young people; nearly twice as many LGBTQ young people report that they do not plan to further their education past high school - or even finish high school - than was reported by a broad national sample of all students.
So, what can be done? GLSEN recommends three concrete steps. First, schools should welcome clubs such as Gay-Straight Alliances (GSA)s, which have been shown to reduce the marginalization of students in schools where they exist. And, I do not hesitate to add: EVERY school should have a GSA. These clubs promote understanding and inclusivity which, of course, means that extreme right wing voices engaged in a cultural war against the rest of us are constantly assailing these GSAs.
Second, comprehensive safe-school laws and policies can prevent the bullying and systemic discrimination that LGBTQ young people experience daily. These take the form of anti-bullying policies that are inclusive of sexual orientation and gender expression. The wide spread institution of comprehensive sexuality education fits squarely into this an endeavor as does the elimination of failed abstinence-only-until-marriage programs which by their very nature ignore the needs of LGBTQ students.
And, finally - and this returns us to the case of Debra Taylor - GLSEN's report shows just how important supportive educators are in the lives of LGBTQ students. They can help create a safe environment for LGBTQ youth and their friends, which, in turn, helps alleviate all of the negative indicators we've just mentioned.
Of course, the bigoted views of those who seek to inject injustice into our society through their own righteous myopia know this all too well. And that is why, in this small town in Oklahoma, a brave teacher finds herself out of a job. But, it is more than that; at the very core of this, we must speak the truth, and the truth is that while there is significant space between calling someone a faggot, firing a teacher because of intolerance, and brutally murdering someone because of their sexual orientation, all of these things spring from the same dark corner of mankind's worst potentialities ]]>Still, the showdown in the Senate over the remaining Fiscal Year 2009 appropriations has certain members of the Republican party clamoring to cut spending. Senator McCain (R-AZ), for example, sought to have the entire appropriations bill set aside and allow programs to continue at Fiscal Year 2008 levels. That is the same backward thinking that lost him the election. And the ever reliable Senator Tom Coburn (R-OK), always seeking to pass judgment on what he sees as "acceptable" public expenditures, is seeking support for a series of amendments to cut "wasteful" spending.
Noticeably absent from Coburn or McCain's list of suggested cuts is the failed abstinence-only-until-marriage funding that remains in the bill. True, this bill cuts the current funding by just over $14 million dollars - the first cut to these programs in American history - but a whopping $95 million remains. Expectations are high that President Obama's budget will provide the leadership that zeroes out these funds for Fiscal Year 2010, but we have to get through 2009 first.
If Coburn and the rest of the crew are serious about cutting wasteful spending, why not start with the abstinence-only-until-marriage earmarks in the bill sponsored by Senator Specter, a fellow Republican from Pennsylvania. Yes, the same party that is crying about wasteful spending is not only not going after the failed abstinence-only-until-marriage money that is regularly in the bill, but even the earmarks for these programs in the bill seem to be escaping their attention.
Senator Specter has more than a half-million dollars of abstinence-only-until-marriage earmarks in the bill for projects in his home state. It is no wonder that these dollars escape scrutiny. Abstinence-only-until-marriage money remains a vestige for funneling money to the extreme right wing and in this case, including those who strangely enough oppose Senator Specter's moderate record on reproductive health issues.
For example, two of the intended recipients of these earmarks are for extreme right-wing crisis pregnancy centers: Tender Care Pregnancy Center in Hanover, Pennsylvania and Women's Care Center of Erie County. A quick review of the latter's website (www.wccerie.org) reveals the same sensationalist and deceptive anti-choice rhetoric and scare tactics that have become a hallmark of the agenda of these abstinence-only-until-marriage providers.
But the big question beyond the failed folly of what these dollars fund is why Senator Coburn and his colleagues seem so fit to pass judgment on certain spending projects but not on their own pet programs. Why should we turn a blind eye to the inconsistency of their posturing when they throw an additional $528,000 into the bill, in pork-laden earmarks nonetheless, for failed abstinence-only-until-marriage programs? We shouldn't.
It
would be laughable if not so tragic because in this case - it is about
young people and their health and lives. But moreover, it is an
indication that Senator Coburn and his ilk still did not get the memo
on the change the American people are seeking and that these
disingenuous attempts to regain the banner of fiscal conservativism
should not be allowed to stick. Fiscal conservatism is a principled
stand, but where it is put into service to wield ideologically
motivated mischief, as it is in this case, the real bearers of the
principle should come forward and send the charlatans to the back bench.
Illinois is becoming an island unto itself in promoting these extreme programs. The neighboring states of Iowa, Minnesota and Wisconsin are just a few of the principled states siding with every major public health entity in this country in closing down these programs. Sadly, Illinois persists. In Fiscal Year 2008, the state of Illinois accepted over $1.8 million in abstinence-only-until-marriage funds through a federal funding stream known as Title V. So the question is: Why?
Perhaps the state's decision to continue accepting Title V abstinence-only-until-marriage funding is based on the private interests of certain people involved in the movement in Illinois. Not only does Illinois receive one of the largest chunks of abstinence-only-until-marriage funds, but it hosts two of the largest providers of the curricula which seep into schools, organizations, and after-school programs nationwide. For example, Scott Phelps, who got his start in anti-choice crisis pregnancy centers in the Chicagoland area, is the founder of the Abstinence and Education Marriage Partnership in Wheeling, and co-author of three of the most popular abstinence-only-until-marriage curricula, Game Plan, Aspire, and Navigator.
Project Reality, based in Glenview and one of the oldest abstinence-only-until-marriage industry leaders nationwide, distributes Phelps's fear- and shame-based Game Plan curriculum. Illinois supplied Project Reality $81,560 in Title V abstinence-only-until-marriage sub-grant funding in Fiscal Year 2008. But, starting on December 15, 2008, Project Reality will close its doors and merge with Phelps's group, marking an important combination of the resources and people of the two largest abstinence-only-until-marriage providers in the state. Phelps will continue to be the leader of the Abstinence and Education Marriage Partnership.
Despite his extreme views, Phelps seems to have unabated access to the Illinois Department of Human Services, the agency which is responsible for the distribution of Title V abstinence-only-until-marriage funds. Specifically, Anna Maria Accove, the Title V abstinence-only-until-marriage coordinator for Illinois, has apparently kept Phelps updated on SIECUS' research and requests for information, as documented on the Parents for Truth Illinois page. (SIECUS regularly contacts all coordinators in every state). Why is a state employee disclosing this information to a grantee if not to assist that grantee in continuing to feed at the trough? Whatever the case, it is unethical at best.
In addition to strong ties with two of the largest abstinence-only-until-marriage industry leaders in the country, Phelps also helped found the National Abstinence Education Association (NAEA), the lobbying arm of the abstinence-only-until-marriage industry. Among other activities, the NAEA propagates misinformation campaigns about the content and effectiveness of comprehensive sexuality education programs.
Make no mistake, Game Plan represents the extreme and dangerous approach that has left our young people vulnerable to making poor decisions. For example, Game Plan teaches: "Even more widespread than disease are the emotional scarring and deep wounds that come out of broken relationships. No matter how strong a condom is, it won't protect you from a broken heart" (p. 36). Another example directly from the curriculum reads, "The only safe sex is in a marriage relationship where a man and a woman are faithful to each other for life" (p. 38).
The problem, of course, is that even though we can encourage teens to wait to have sex, we have to make sure we send messages that don't undermine their ability to make good, responsible decisions when they do have sex. These examples from Game Plan do just the opposite; they persuade young people that there is no other option but to have sex in a marriage between two heterosexual people. Perhaps a worthwhile goal, but unfortunately, one that doesn't pan out in reality. In the third century, Saint Jerome wrote endless letters to women about how to keep their virginity and this is the same mantra now funded with tax dollars.
For her own part, Illinois'
Secretary of Human Services, Carol Adams, replied to SIECUS' questioning about Illinois' dogged support
of abstinence-only-until-marriage programs by writing:
"The Department of Human Services supports a myriad of services designed to address the goals of reducing teen pregnancies and sexually transmitted diseases. The Abstinence Education Program is part of the continuum of services designed to address these goals. We are also supportive because the Abstinence Education Program addresses youth development through the promotion of life skill development."
The problem? Secretary Adams is wrong on the facts. Research shows that abstinence-only-until-marriage programs do not offer any real "life development" skills. The U.S. Department of Health and Human Service's own study of federally funded abstinence-only-until-marriage programs conducted by Mathematica showed no delay in sexual initiation, reduction in sexual partners, or improved used of contraception.
Dr. Adams continues, "Many communities are in favor of this approach."
There are surely some individuals in support of these programs--but every major public health, medical, and education entity supports a comprehensive approach to sex education: the American Medical Association, American Public Health Association, The Society for Adolescent Medicine, and the National Education Association are just a few. Statewide polling shows that over 83 percent of Illinois voters and 92 percent of Illinois sex education teachers believe that whether or not young people are sexually active, they should be given accurate information about birth control and condoms according to research from the Illinois Campaign for Responsible Sex Education.
In addition to funding Project Reality with Title V abstinence-only-until-marriage dollars, Secretary Adams' department funds four crisis pregnancy centers (CPCs)--anti-choice establishments that typically advertise as providing medical services and then use anti-abortion propaganda, misinformation, and fear and shame tactics to dissuade women facing unintended pregnancy from exercising their right to choose. CPCs fail to offer young people any real information to make healthy decisions-yet the Secretary awarded nearly $250,000 towards these establishments in Fiscal Year 2008 alone.
If the goal is to reduce teen pregnancies and STDs in Illinois, the state must follow the national trend--not buck it--and halt taxpayer funding for extreme abstinence-only-until-marriage programs. Such action will provide additional relief to the rest of the country and help end the gravy train for one of the most extreme providers nationwide, Project Reality. According to SIECUS' State Profile research, the two curricula sold by Project Reality are used in at least 15 states. By supplying funds for Project Reality, Secretary Adams is not only putting Illinois youth at risk, but financially backing one of the worst abstinence-only-until-marriage curricula nationwide.
Finally, Secretary Adams and Governor Blagojevich need to know that in every instance, the 25 states that have ended these extreme programs have done so without any political fallout whatsoever. Our leaders should lead. But they are more likely to do so when it is the safer option politically. Ending Illinois' subsidy of the abstinence-only-until-marriage industry is the politically safe option. Let's get it done.
]]>I won't rehash all the disasters here, but will focus on the remedy to one of these areas where President Obama can lead: the restoration of evidence-based programs to provide sex education, prevent teen pregnancy, and reduce incidence of HIV and other sexually transmitted diseases.
First, President Obama must end the nearly $200 million a year going into abstinence-only-until-marriage by zeroing it out of the budget he submits to Congress in February. He has pledged to end funding for programs that do not work and, after almost 30 years of federal funding and $1.5 billion in tax payer money, the evidence is clear that these programs do no work. The Democratic Party platform also calls for their end so we have a very clear policy statement and priority in print. Many abstinence-only programs are also homophobic and anti-woman, so it is important to stress these arguments as well. And last but not least, the vast majority of recipients of these dollars are the base of the extreme right wing in this country. It is now time to end the gravy train. Doing so benefits our youth, our communities and oh yeah, incidentally, benefits the progressive common good against which these same groups, by their very nature, consistently rail.
But, ending ab-only has always
been part of a broader vision of what young people really need.
The other side of this coin, of course, is the second part of what President
Obama must do: establish the first ever federal funding stream for a
comprehensive approach to sex education. As a member of the Senate,
Obama was a co-sponsor of the Responsible Education About Life (REAL)
Act and, again, his party's platform supports a strong move toward
more comprehensive programs because they work. For example, we
now have the evidence to show that more comprehensive programs do a
better job of helping young people wait to have sex than abstinence-only-until-marriage
programs. I don't play chess but I believe that is checkmate.
Many groups from the broader
reproductive health community, as well as the HIV/AIDS community, have
assembled requests to the Obama Administration for a new pot of money
to support comprehensive sex education. We know that is an uphill
request given the budgetary situation but it must be a priority nonetheless
and cost-savings from cut programs must be redirected.
Of course, President Obama cannot do this alone. His budget will send the strongest of signals to Congress to follow suit. But will they? It is a real question. Even the abstinence-only-until-marriage industry's lobbying arm, the National Abstinence Education Association, pondered in their day-after-the-election lament: "Remember that naysayers expected abstinence education to go away when leadership in the Congress first changed from Republican to Democrat two years ago. But it didn't." Indeed. So, Speaker Pelosi and Majority Leader Reid will also play key roles in getting this done by exercising discipline over wayward Members and remembering the platform that brought about the most momentous political shift in our lifetime.
Thankfully, the ascendency
of Barack Obama and a new agenda represents the repudiation of the culture
wars that have dominated and impoverished our domestic political discourse
since Reagan. Make no mistake: these same culture wars are
embodied in the work of most abstinence-only-until-marriage programs
and their many providers. It is no wonder that they are facing
repudiation from at least half the states across the country that no
longer even take the money to do these junk programs.
Let history be our guide. Abstinence-only-until-marriage programs were part of the socially conservative Republican "Contract With America" when they swept into power in the early 1990's. President Obama, let's make a clean start. It is a new day in America and change has indeed come. Let it include a change in how we empower young people to make responsible decisions. Let it start with an end to extreme abstinence-only-until-marriage programs and a renewed commitment to our youth by investing in comprehensive sex education.
Related Posts
This annual project provides us with a wealth of information and, this week, SIECUS released some additional information about the status of one of the three federal abstinence-only-until-marriage pots of money: the Title V abstinence-only-until-marriage program, which doles out $50 million in tax payer funds each year to states to fund programs. Harsh restrictions prohibit programs that receive these funds from discussing the effectiveness of contraception, but require that they teach that sex outside of marriage can cause psychological problems. No, that is not a joke.
The encouraging news is that
this program is in a state of utter collapse.
The collapse has occurred in no small part because of the diligence and dedication of advocates around the country. It has also been hastened by a report that the Bush Administration's own Department of Health and Human Services issued showing that the program was an utter failure. Even more embarrassingly, the failed programs included in the study were a cherry-picked cadre designed to represent the crème de la crème of the abstinence-only-until-marriage industry. Predictably, the Bush Administration's preference for ideology over science also led them to dismiss the report and simply carry on as if it did not matter.
But the Administration's blind faith in its failed programs could not save them. As of the end of August, our research shows that 25 states have decided to no longer participate in this federal funding scheme. But, even more importantly, this mass exodus has occurred, for the most part, for all the right reasons.
Of the twenty-five states that
have withdrawn, 20 of them -- or 80% -- have taken their leave because
of principled stands that abstinence-only does not work or that their
state supports a comprehensive approach to sex education.
The spin of the abstinence-only-until-marriage industry has been that the collapse of the Title V abstinence-only-until-marriage program is largely the result of sporadic and inconsistent Congressional support. Our research shows that to be the case with fewer than a handful of states. In other words, the spin of those seeking to explain away our collective success in getting states to walk away from this dirty money simply is not supported by the research.
On Capital Hill, the Title V abstinence-only-until-marriage program has been a source of consternation for Congress. It has seen no fewer than 19 short term extensions, creating a problem for states to run the program. States work on fiscal years, which do not mesh well with the three or six month funding cycles which have kept the program hobbling along. But these short term extensions are largely the result of a Congress wrestling with how to end or alter the program. To date, they have failed, and earlier this year, made a disastrous decision to extend the program through June of 2009.
This recent extension will
have an impact on the number of states involved in the program. For
example, Pennsylvania's pro-choice Democratic Governor, Ed Rendell,
has given every indication that he will do a flip-flop on a previously
principled stand and drag his state back in. This is regrettable
and unjustifiable. A spokesperson of Rendell's own Department
of Health said they "know that the best approach is comprehensive
sex education" and the director of the Governor's Philadelphia office
told a crowd of ACT UP Philly protestors last week that "Rendell and
myself know that abstinence-only doesn't work."
Still, the collapse of the Title V abstinence-only-until-marriage program is likely unprecedented in American history. Never have so many states abstained from the lure of raking in federal money. That the vast majority are doing so for principled reasons is even more encouraging and shows the payoff of years of investment in strategy carried out by hundreds of individuals and groups from coast to coast.
Finally, the collapse of the Title V abstinence-only-until-marriage program indicates major progress by the advocacy community in helping policymakers address the issue of sex education in America. Wisconsin's Governor, Jim Doyle, for example, summed it up well for us in describing the decision to keep his state out of the program: Ideology isn't more important than our kid's health. ]]>As recently as Fiscal Year 2003, only one state, California, did not accept Title V abstinence-only-until-marriage funding. Pennsylvania refused the funds the next year, becoming one of the first states to actually turn back the money. And over the past years, more and more states have come to realize that abstinence-only-until-marriage programs are not the best way to educate their young people. By the beginning of 2007, nine states had decided that they would opt out of the Title V abstinence-only-until-marriage program. Now, halfway through 2008, that number has skyrocketed to 25.
Thanks to mounting evidence against abstinence-only-until-marriage programs, the overly restrictive requirements that come with receiving funding, and the bureaucratic nightmare of applying for the funds while coordinating the state and federal funding cycles and Fiscal Years, forward-thinking governors and states are taking the opportunity to mitigate the damage that has been done by these programs.
Numerous studies over the past year and a half have shown that abstinence-only-until-marriage programs don't work. An April 2007 study commissioned by the Department of Health and Human Services, and conducted by Mathematica Policy Research, Inc. shows that these programs have no positive effect on the sexual behavior of youths. At the same time, Dr. Douglas Kirby, a leading sex researcher, found that comprehensive sex education programs hold the most promise for lowering the rates of teen pregnancy and STDs.
Proponents of the abstinence-only-until-marriage industry will often cry poverty whenever their funding is in jeopardy. In Pennsylvania, this is far from the truth. Even without any Title V abstinence-only-until-marriage funds, Pennsylvania still received the fifth-most abstinence-only money of any state. How? Title V abstinence-only-until-marriage funding is only one of three federal abstinence-related funding streams. In fact, the Community Based Abstinence Education (CBAE) grants make up the vast majority of federal abstinence-only-until-marriage dollars. Unlike Title V abstinence-only-until-marriage grants, CBAE grants go directly to organizations in the state, and are not regulated by the state government.
The majority of the organizations that receive abstinence-only-until-marriage funds have noticeable right-wing leanings. These groups are often not satisfied with spreading their fear-based misinformation in schools, but also have broader political goals that include opposing many of the proposals, plans, and values that Governor Rendell supports. Why would the Governor hand an undeserved windfall to organizations that fight tooth-and-nail against his agenda at every turn and work feverishly to elect his opponents?
Some facts about teen sexual health in Pennsylvania to consider:
With the high profile role that Governor Rendell has been playing in national politics recently, he may have forgotten that his first duty is to the health and safety of the people of Pennsylvania. Like other Americans across the country, Pennsylvanians are sick and tired of politics and ideology being put before scientific evidence, common sense and basic mainstream American values. This is especially the case when the health of our young people is concerned. Governor Rendell needs to take this opportunity, while he is in the national spotlight, to show that he is willing to do the right thing and continue to reject failed Title V abstinence-only-until-marriage funding.
]]>From a numbers perspective, it is alarming, but the rate of new infections was something experienced by AIDS service organizations across the country during this same time frame. For them, it is confirmation that the constant clarion call for a real investment in stemming the epidemic was warranted and now embarrassingly long overdue.
At the IAC, several sessions
focused on the domestic epidemic in the U.S. and many included civil
society and government, demonstrating the need for us to work together.
Dr. Fenton of the U.S. Centers for Disease Control and Prevention, for
example, joined civil society on at least two panels and while holding
his own with great aplomb, but nonetheless was subject to our own justified
anger and outrage about the scale and lack of a strategic, comprehensive
response to our epidemic. One session was even interrupted by
advocates in a direct action to illustrate the frustration is palpable.
U.S. advocates are asking for
the creation of a National AIDS Strategy (NAS) and it was a recurrent
them in the various IAC sessions. The NAS is an important step
whose success largely hangs on the details of what such a strategy looks
like and the existence of political will to actually get it done.
Our previous experiences with such plans do not suggest optimism, but
we must insist of our leaders that the present time be different.
My fellow co-chairs of the Federal AIDS Policy Partnership, Gene Copello of The AIDS Institute and Paul Kawata of the National Minority AIDS Council, and I have argued elsewhere that the NAS must be part of a broader domestic emergency plan on AIDS that begins at once and is comprehensive not just on talk, but also on money. This must begin first and foremost with prevention where the domestic prevention budget, in real dollars, has shrunk each year since 2001.
The new data has created an immediacy to address our domestic epidemic that is sure to take center stage when the United States Conference on AIDS convenes in Miami on September 18. The Caucus for Evidence-Based Prevention will be there as well, raising our collective voices. We'll see you in Miami.
]]>The Administration of Children and Families (ACF), which is currently overseeing the collapse of this hallmark initiative of the Gingrich Congress, says that the following states are participating for Fiscal Year 2008: AL, AZ, AR, FL, GA, HI, IL, IN, IA, KS, KY, LA, MD, MI, MS, MO, NE, NV, NH, NC, ND, OK, OR, SC, SD, TX, UT, and WV. ACF has also indicated that it is aware that Arizona and Iowa will not be participating after the end of the current fiscal year.
Thus, at this moment even according to ACF's rosy, "by-the-letter" optimism, half the states have sent the message that they will not be participating by October of this year.
Freking's inquiry was sparked by SIECUS' own research -- to be released in our annual SIECUS State Profiles publication -- which shows that an additional two states, at a minimum, will also reject abstinence-only funding. That brings the number of states opting out to 27. All told, our calculations are showing that nearly $24 million will be turned down by states next year.
As recently as September of 2005, California stood alone in rejecting ab-only funds, until Maine joined in. In those early days, most people thought it impossible that we would end up with more than half the states rebuffing the federal program and its promise of easy money. But, as Freking reports, participation has dropped 40% in just two years. The strong and clear message coming from the states is that this is, at best, a floundering program growing weaker by the minute.
States Opt Out for Both Substantive and Administrative Reasons
The challenge in the present moment, however, is that the reasons for reaching this critical mass of states are complex and diverse. Some are outright rejections; states telling Washington they don't want money for junk programs when they desperately need funds for effective programs, including comprehensive sex education. Others are not participating for administrative reasons. The program has been hobbling along on short term extensions from Congress that make budgeting and implementation at the state level difficult. Others have submitted comprehensive applications that are deliberately non-compliant with the strict definitions of what must be taught such that these applications also send a clear message of what states want and need.
Congress Considers Yet Another Extension
Congress is currently mulling an extension of the Title V abstinence-only-until-marriage program that may prolong the program's life for a year or longer. This would be the longest extension granted by Congress since the original authorization of the program expired in 2002. That seems an odd parting gift for the 111th Congress to give a program in collapse. Further, because the longer extension creates fewer administrative hurdles to using the money, a few states not participating for these reasons are likely to again accept the funds.
This Congress still has time to remedy its record on sex education by abolishing the program in one fell swoop. But if Congress feels the need to extend it (and they do because it seems inextricably linked to another priority piece of legislation), it should do so for a very short period of time and give a new Congress and a new President an opportunity for a fresh look.
States Lead the Way
States are leading the way. They're already making the paradigm shift: they're embracing a more comprehensive approach to sex education. In fact, our research shows that for the first time since 1998, there are a handful of states that are totally free of any federal abstinence-only-until-marriage funding. Coupled with the repudiation of the Title V abstinence-only-until-marriage program from coast to coast, we have more than just a trend on our hands -- we have a virtual watershed.
It is much too early to celebrate. It took a quarter of a century for the abstinence-only-until-marriage industry to reach its zenith and it will not disappear overnight. But we are making enormous progress.
And there is one more new trend
that should lend substance to my optimism: the abstinence-only-until-marriage
industry itself seems to have tossed in the towel on defending its own
programs. The lobbying arm of the industry, the National Abstinence
Education Association, now rarely speaks of the benefits of abstinence-only-until-marriage
programs at all, focusing instead on demonizing the majority of Americans
who support a more comprehensive approach to sex education as condom
pushers and purveyors of promiscuity. That is the exact type of
dishonest, fear-based, culture war blather that the nation has seen
too much of since the ascendancy of the religious right some three decades
ago. It's tired and a bit pathetic.
And so it was last week when one lone researcher working from his home-based "institute" tried to outwit the major public health institutions of our country. By his own words, Stan Weed, the only witness last week suggested by the Republican minority to scientifically defend the Bush administration's funneling of billions to their favored kin, has spent more than 20 years working on these issues, interviewed more than 500,000 teens, and studied more than 100 abstinence-only programs. Okay, it sounds impressive, right? Until you learn, that after all that bluster, Weed has just one - ONE - peer reviewed and published study in a refereed journal showing abstinence-only-until-marriage programs can have a modest impact among seventh graders in delaying sex. And with that, Weed urged - straight-faced - to continue the gravy train that is the abstinence-only-until-marriage industry.
It should also be noted that Weed's guest on his back-up chair while testifying was not an assistant at his "institute" or some other public health professional. It was the head of the National Abstinence Education Association, the abstinence-only-until-marriage industry's lobbying arm, Valerie Huber. For what purpose did the researcher need the hired gun lobbyist at his side? Her presence stretched the credibility of Weed's objectivity, to say the least.
On the side of public health evidence, however, were the Institute of Medicine, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and many others. All concurred that more than a decade worth of research demonstrates that abstinence-only-until-marriage programs are not working and a change in course is long overdue.
The clear imbalance left some right-wing Congressional Members scrambling during the hearing.
Representative Mark Souder (R-IN), one of the most extreme right wing lawmakers in the Congress, praised Weed - the man with thread-bare credentials who works out of his home - as the lone voice of sound public health in the room. As for the real luminaries at the witness table with Weed, Souder charged all of them with advancing ideological positions. He might as well have decried the entire thing a vast left wing conspiracy among the protectors of our public health and left the room.
Representative John Duncan, a Republican from Tennessee, said it was "rather elitist" that those with public health degrees thought they knew better than parents what type of sex education works. Well, yes, Mr. Duncan, isn't that why we fund and support public health as a vocation - to assist individuals, parents and families in promoting good health practices? And isn't this why the Congressional Committee on Oversight and Government Reform on which you sit, has jurisdiction over health programs and spending? The entire purpose is to consult those who actually "know" in order to arrive at informed decisions instead of opinions formulated from ignorance. One can reject their findings - as Mr. Duncan did - but it ought to be done honestly and with full confession for a "science-be-damned" mentality.
Duncan and Souder however, were left with little else to rely on. The evidence is in and the programs were finally called to account for the boon they've experienced at the taxpayer's expense. In desperate times, people do desperate things and Duncan and Souder were headed down that sad road.
For those present at the hearing, there was no more desperate a sign of the abstinence-only-until-marriage industry's questionable future than Heritage Foundation's Robert Rector's attempts at spin. Rector, credited as the architect of the state grants through Title V to pay for abstinence-only-until-marriage programs, tried valiantly to stave off the hearing's impact. The day prior, he and another colleague at Heritage, attempted some up-front spin by assembling and regurgitating previous so-called "evidence" to support their position. At the close of the hearing, a crest-fallen and clearly annoyed Rector was observed to be expressing his deep displeasure to Representative Souder for apparently failing to carry the Heritage Foundation's banner. It almost made me feel sorry for Souder. Almost. Perhaps I actually would have if Souder had not earlier told the two youth witnesses on the panel - one of whom acquired HIV due to abstinence-only-until-marriage instruction - that they were irrelevant to the purpose of the hearing. Far from laughable, this was downright appalling.
What was most miraculous at the hearing was just how much had been conceded by the supporters of abstinence-only-until-marriage programs. Next week, I'll be writing about this in terms of the key pieces of good news that emerged from the Congressional hearing and will answer the most consistent question I've gotten since the hearing: So what does this mean? I assure you, it was a lot more than just words that came out of last week.
]]>Now, more than 40 members of the Caucus are preparing in earnest for the 2008 International AIDS Conference in Mexico City in early August 2008. Our work is clearly cut out for us. The current politicization of HIV prevention by the US Administration and its favored groups here at home and around the globe, remain the largest single threat to curbing the spread of HIV/AIDS. This is not the first time the US has supported ideology over evidence. Past International AIDS Conferences have revealed the US administration's reluctance to embrace sound science over moral rhetoric. And while advocates continue to press for comprehensive HIV prevention grounded in evidence, the US government ceases to withhold its support of questionable programming.
For example, as we await revised and higher estimates of new infections each year here at home, country successes such as Uganda's success in curbing HIV prevalence appears to be unraveling and the largest donor in the world to HIV/AIDS, the United States government, continues its staunch support for abstinence and marriage promotion over a more comprehensive approach that would include condom and contraception education and distribution. Other effective interventions with evidence behind them, such as harm reduction programs and targeted outreach work with high-risk groups, are also set aside in pursuit of politically safe, feel-good nonsense that only hampers global efforts to turn the tide against HIV. Why does this story continue to repeat itself?
As we gather in Mexico City with colleagues from around the world, we know how the optics of political ideology and moral rhetoric can cast a shadow over the substance of science. Our efforts provide a clear lens in a time when sanity and science are desperately needed to return our country to its evidence-based prevention paradigm.
This year, we ask you to help us change the storyline from one of ideology to evidence-based prevention. We invite you to join list of newsletters recipients by sending your e-mail to sonia.kandthil(AT)yahoo(DOT)com. At the Mexico City conference in August, as we begin to turn the tide on HIV prevention, you'll be getting the same timely coverage from the Caucus that we delivered in Toronto in 2006. If your organization wants to become part of the Caucus, we welcome your participation as well by sending an e-mail to this same address.
In 2006, we provided a united front in the fight to end AIDS and we will do so again in 2008. We will continue to be the voice of sound science where ideology abounds.
The opinions of the author do not necessarily represent those of The Caucus for Evidence-Based Prevention.
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I've spent the past week in Zambia, attempting to understand the implications of our country's HIV assistance policy for actual implementation here in one of the world's poorest countries. Last night, I spent the evening doing what every Washington ideologue who supports the "prostitution pledge" should be required to do--I walked through the main street area and hung out in the bars in a community called Kafue, just 50 kilometers outside of the Zambian capital of Lusaka.
Zambia's unemployment rate hovers around 50%, with nearly 70% of the population living in poverty. HIV prevalence is about 17% but rises to nearly 30% in some communities. Rates of secondary education enrollment are less than a quarter of the eligible population. Worse still, is that the average age of life expectancy in Zambia is 37 years old. AIDS has shaved 15 years off the average age of life expectancy since the pandemic took its grim grip on the country a quarter century ago. It is a sobering portrait to be sure.
In Kafue, the portrait in numbers becomes a real-life picture of people living on the edge. Tourists do not venture to Kafue. One guidebook declares "there is little of interest here." However, Kafue lies on a major highway running through Zambia, connecting it directly to Zimbabwe and serving as a major artery in the trucking route in sub-Saharan Africa. As a result, the thousands of truckers that are fueling the spread of HIV across Africa, visit Kafue. Each night, trucks on the highways are required to stop driving at 8pm and not drive again until 6am because the roads are unlit, not very well maintained and trucks contribute regularly to accidents. They pull over in Kafue every night in a disturbing ritualistic act that sets the stage for Kafue's struggling women and girls to support themselves and their families at any cost.
It is here, at nighttime, that the folly of the United State's hypermorality becomes not just embarrassing, but complicit in shutting down the comprehensive approach to combating the epidemic that is so desperately needed. Women selling sex for money in Kafue are not trying to get a leg up or buy the latest styles. Most are unskilled as Zambia's school system is designed to filter out those deemed less promising, and even those with an education cannot find employment not because of sloth, but because the jobs do not exist. Others engage in sex work sporadically, often because they simply had no money for food that month. This is sex for the purposes of attaining life's basic necessities when nothing else around can provide it.
A single group is doing the outreach in Kafue to both schools and to the sex workers. It does so on a relative shoe-string and outside of the PEPFAR-funded prevention efforts in Zambia. This small NGO's workers are out each evening in Kafue's bars and on the streets where truckers are openly negotiating with women.
Finding a condom in Kafue is often an exercise in futility. They can be purchased in some of the bars, but purchasing condoms for a girl or women who is engaging in sex work in the first place to buy food is a stretch in logic that is the reality of life in Kafue. This single organization is the only presence on the streets, each night, doing a yeoman's job of trying to meet demand with free condoms and urging people to go for testing and counseling. Since the collapse of Planned Parenthood of Zambia's Success condom brand - a collapse facilitated in large part by that group's principled refusal to sign the U.S. global gag rule - free condoms are tough to come by in Kafue. This organization stocks designated boxes with free condoms in some of Kafue's bars but they simply cannot meet demand. Supplies fully stocked the day prior were empty by the time we got there.
Save this one group and a couple of brave others, "condom flight" is pervasive among NGO's doing HIV prevention work in Zambia. One PEPFAR grantee described the country situation as "AB Silent-C." In Kafue, the "Silent C" reality, coupled with the prostitution pledge, has left Kafue's women and girls vulnerable to infection.
PEPFAR's onerous policies have created an important, but politically safe and insufficient portfolio for preventing the sexual transmission of HIV in Zambia. Good prevention work is happening here with PEPFAR funding, but it is as far from a comprehensive approach as one can imagine.
The PEPFAR reauthorization proposals in the House and Senate have some language that might hold out hope for Kafue's women and girls. That hope, however, hinges on an election and an incoming administration that is more concerned with evidence than ideology. But both proposals maintain the prostitution pledge which, like it or not, is interpreted here on the ground as an explicit direction from the United States government that prevention with sex workers is a risky business if you want grant money. Safer to stick to the A and B which is exactly how it has played out here in practice.
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