AFRICA: AIDS Profiteering
Serious Concerns Raised Over Use of FundsBy Sue Ellin Browder
WASHINGTON, D.C., JUNE 30, 2008 (Zenit.org).- Pressing the Senate to rubberstamp $50 billion in global spending on AIDS, malaria and TB, AIDS activists marched on the White House last week bearing signs with slogans like "Now or Never."
But this week, a Anglican priest from Uganda opened more serious dialogue about the bill, saying that "condom promotions have failed in Africa" and AIDS "profiteers" have subverted African fidelity and abstinence programs in order to sell commodities for a profit.
"AIDS is no longer simply a disease; it has become a multibillion-dollar industry," Reverend Sam Ruteikara, co-chair of Uganda's national AIDS-prevention committee, wrote today in the Washington Post.
Stalled for months in the Senate, the reauthorization for the President's Emergency Plan for AIDS Relief (PEPFAR) would more than triple program spending from $15 to $50 billion over five years. But Ruteikara told ZENIT that if the money is misspent, it won't stop the spread of AIDS in sub-Saharan Africa, and it could even raise HIV rates.
President George Bush wants the bill passed before the G-8 summit in Japan next week. But in a March 31 letter to Senate Republican leader Mitch McConnell, seven senators led by Senator Tom Coburn of Oklahoma urged delay, saying the bill has "serious problems."
Among other concerns, the senators said the new initiative costs too much and would fund "morally dubious" activities such as needle-exchange programs for drug addicts.
Further, the letter expressed major concerns about the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The senators wrote, "The [Global] Fund has serious policy problems, drug quality problems, administrative corruption, and [it] operates programs not bound by U.S. laws on abortion, needle exchange, prostitution/trafficking policy and others."
Over five years, the new PEPFAR bill would give the Global Fund $10 billion -- a quarter of the fund's budget. But the U.S. has only one vote out of 20 on how the money is spent.
The senators also want to reinstate wording from the original PEPFAR bill specifying that 55% of AIDS monies will go for treatment.
Prevention first
An AIDS-prevention authority on the frontlines in Africa, Ruteikara agreed the Global Fund has serious problems that merit more U.S. oversight, but he questioned whether 55% of AIDS monies should be spent on treatment.
"HIV-testing and treatment are good, but they won't stop the pandemic," Ruteikara said. "With six Africans becoming infected for every person who gains access to treatment, we can't treat our way out of this tragedy. Effective prevention must come first."
Coburn, a physician, and others have argued that anti-retroviral treatment will do more than just prolong lives; it will prevent new AIDS cases by making the HIV virus less infectious and, therefore, less likely to be transmitted.
But in The Lancet, a leading British medical journal, James Shelton of USAID called this theory a "myth" unsupported by science. Shelton observed that as people become healthier on anti-retroviral treatment, they're likely to become more sexually active, creating further chances for the virus to spread.
Physician Norman Hearst of the University of California, San Francisco, agreed that "treatment is important, but it's not prevention."
"In sub-Saharan Africa, prevention must be linked to sexual behavior, because that's what fuels the pandemic," Hearst explained. Whereas most Westerners are monogamous -- one sex partner at a time -- many Africans, even when married, have one or two long-term lovers on the side. In a young-adult survey in Botswana, where one-third of the population carries the HIV virus, 43% of men and 17% of women reported having two or more regular lovers.
"The latest evidence shows it's these long-term, overlapping multiple partnerships that drive the pandemic," Hearst said. "This new scientific understanding that the African pandemic is fueled by people having more than one current sex partner explains why public-health campaigns urging sexually active adults to be faithful have worked so well in Africa."
ABC
Between 1991 and 2002, Ugandans lowered the proportion of the population infected with HIV from 21% to 6% with their famous ABC (Abstain, Be faithful, or use a Condom) campaign -- with "B" as the pillar. "We promoted fidelity for sexually active people, abstinence for young people, and condoms only as a last resort," Ruteikara said.
In response to the campaign, the number of Ugandan men embracing monogamy shot up from 59% to 79% -- and the number of faithful women rose from 79% to 91%. Rates of new HIV infections fell by two-thirds.
"Uganda provides the clearest example that HIV is preventable if populations are mobilized to avoid risk," Cambridge University researchers Rand Stoneburner and Daniel Low-Beer wrote in Science magazine. They likened Uganda's plunge in casual sex to the equivalent of an AIDS vaccine that's 80% effective.
What's more, prevention advocates say, sexual behavior change is a bargain. "HIV treatment costs an estimated $1,000-per-patient per added year of life. Uganda's successful prevention campaign cost less than 30 cents per person per year," says Edward Green, head of Harvard's AIDS Prevention Research Project.
"Because we knew what to do in our country, we succeeded," Ruteikara wrote in the Post. But he said that when "international AIDS experts" arrived in Uganda, they came with their own "casual-sex agendas," which they forced on Africans -- even to the point of rewriting Uganda's National Strategic Plan, which guides how PEPFAR money is spent.
Ruteikara reported that he and his fellow Ugandans would repeatedly put abstinence and fidelity into the National Strategic Plan. "Repeatedly, foreign advisors erased our recommendations. When the document draft was published, fidelity and abstinence were missing." Meanwhile, a suspicious statistic blaming most HIV infections on marriage appeared. Repeated requests for the source of the statistic have gone unanswered, the priest said.
"As fidelity and abstinence have been subverted, Uganda's HIV rates have begun to tick back up," Ruteikara wrote. "The Western media have been told this renewed surge of HIV infection is because there are 'not enough condoms in Uganda,' even though we have many more condoms now than we did in the early 1990s, when our HIV rates began to decline."
Off course
Green said that Western "sexual freedom ideologies" have caused successful AIDS-prevention strategies to be derailed in Africa, perhaps costing millions of lives.
"If AIDS prevention is to be based on [scientific] evidence rather than ideology or bias, then fidelity and abstinence programs need to be at the center of programs for general populations. [...] What the churches are inclined to do anyway turns out to be what works best in AIDS prevention," Green and his Harvard colleague Allison Herling Ruark wrote in the April issue of First Things.
In a 2004 "common ground" statement in The Lancet, 150 global AIDS-prevention leaders agreed fidelity should be the first-line prevention strategy for population-wide epidemics like those in sub-Saharan Africa.
The Senate bill mentions fidelity, but not as a central priority. Instead, the initiative, if passed, will fund a wide array of commodities and services to combat AIDS indirectly -- from HIV tests and Chlamydia treatments to female condoms. The latter are more expensive than male condoms -- and so unpopular in Africa that Uganda has stopped importing them.
Only 20% of funds in the new PEPFAR bill would go for prevention. Ruteikara would like to see that percentage doubled until the pandemic is under control.
The only hint of a spending requirement for fidelity in the current bill is a clause stating that in the event a country chooses to spend less than half its prevention funding on fidelity and abstinence programs, a report must be sent to Congress.
The bill also calls for preventing 12 million new HIV infections worldwide, but doesn't specify how.
Calling for HIV/AIDS profiteers to "let [his] people go," Ruteikara wrote, "We understand that casual sex is dear to you, but staying alive is dear to us. Listen to African wisdom, and we will show you how to prevent AIDS."
Green said, "This is a challenging moment for Congress to unite behind objective scientific evidence, and do the right thing. If Congress puts fidelity promotions at the center of our AIDS response, billions of tax dollars will be effectively spent and millions of African lives will be saved."
--- --- ---
On the Net:
"Let My People Go, AIDS Profiteers": http://www.washingtonpost.com/wp-dyn/content/article/2008/06/29/AR2008062901477.html
________________________________
WASHINGTON, D.C., JUNE 30, 2008 (Zenit.org).- Pressing the Senate to rubberstamp $50 billion in global spending on AIDS, malaria and TB, AIDS activists marched on the White House last week bearing signs with slogans like "Now or Never."
But this week, a Anglican priest from Uganda opened more serious dialogue about the bill, saying that "condom promotions have failed in Africa" and AIDS "profiteers" have subverted African fidelity and abstinence programs in order to sell commodities for a profit.
"AIDS is no longer simply a disease; it has become a multibillion-dollar industry," Reverend Sam Ruteikara, co-chair of Uganda's national AIDS-prevention committee, wrote today in the Washington Post.
Stalled for months in the Senate, the reauthorization for the President's Emergency Plan for AIDS Relief (PEPFAR) would more than triple program spending from $15 to $50 billion over five years. But Ruteikara told ZENIT that if the money is misspent, it won't stop the spread of AIDS in sub-Saharan Africa, and it could even raise HIV rates.
President George Bush wants the bill passed before the G-8 summit in Japan next week. But in a March 31 letter to Senate Republican leader Mitch McConnell, seven senators led by Senator Tom Coburn of Oklahoma urged delay, saying the bill has "serious problems."
Among other concerns, the senators said the new initiative costs too much and would fund "morally dubious" activities such as needle-exchange programs for drug addicts.
Further, the letter expressed major concerns about the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The senators wrote, "The [Global] Fund has serious policy problems, drug quality problems, administrative corruption, and [it] operates programs not bound by U.S. laws on abortion, needle exchange, prostitution/trafficking policy and others."
Over five years, the new PEPFAR bill would give the Global Fund $10 billion -- a quarter of the fund's budget. But the U.S. has only one vote out of 20 on how the money is spent.
The senators also want to reinstate wording from the original PEPFAR bill specifying that 55% of AIDS monies will go for treatment.
Prevention first
An AIDS-prevention authority on the frontlines in Africa, Ruteikara agreed the Global Fund has serious problems that merit more U.S. oversight, but he questioned whether 55% of AIDS monies should be spent on treatment.
"HIV-testing and treatment are good, but they won't stop the pandemic," Ruteikara said. "With six Africans becoming infected for every person who gains access to treatment, we can't treat our way out of this tragedy. Effective prevention must come first."
Coburn, a physician, and others have argued that anti-retroviral treatment will do more than just prolong lives; it will prevent new AIDS cases by making the HIV virus less infectious and, therefore, less likely to be transmitted.
But in The Lancet, a leading British medical journal, James Shelton of USAID called this theory a "myth" unsupported by science. Shelton observed that as people become healthier on anti-retroviral treatment, they're likely to become more sexually active, creating further chances for the virus to spread.
Physician Norman Hearst of the University of California, San Francisco, agreed that "treatment is important, but it's not prevention."
"In sub-Saharan Africa, prevention must be linked to sexual behavior, because that's what fuels the pandemic," Hearst explained. Whereas most Westerners are monogamous -- one sex partner at a time -- many Africans, even when married, have one or two long-term lovers on the side. In a young-adult survey in Botswana, where one-third of the population carries the HIV virus, 43% of men and 17% of women reported having two or more regular lovers.
"The latest evidence shows it's these long-term, overlapping multiple partnerships that drive the pandemic," Hearst said. "This new scientific understanding that the African pandemic is fueled by people having more than one current sex partner explains why public-health campaigns urging sexually active adults to be faithful have worked so well in Africa."
ABC
Between 1991 and 2002, Ugandans lowered the proportion of the population infected with HIV from 21% to 6% with their famous ABC (Abstain, Be faithful, or use a Condom) campaign -- with "B" as the pillar. "We promoted fidelity for sexually active people, abstinence for young people, and condoms only as a last resort," Ruteikara said.
In response to the campaign, the number of Ugandan men embracing monogamy shot up from 59% to 79% -- and the number of faithful women rose from 79% to 91%. Rates of new HIV infections fell by two-thirds.
"Uganda provides the clearest example that HIV is preventable if populations are mobilized to avoid risk," Cambridge University researchers Rand Stoneburner and Daniel Low-Beer wrote in Science magazine. They likened Uganda's plunge in casual sex to the equivalent of an AIDS vaccine that's 80% effective.
What's more, prevention advocates say, sexual behavior change is a bargain. "HIV treatment costs an estimated $1,000-per-patient per added year of life. Uganda's successful prevention campaign cost less than 30 cents per person per year," says Edward Green, head of Harvard's AIDS Prevention Research Project.
"Because we knew what to do in our country, we succeeded," Ruteikara wrote in the Post. But he said that when "international AIDS experts" arrived in Uganda, they came with their own "casual-sex agendas," which they forced on Africans -- even to the point of rewriting Uganda's National Strategic Plan, which guides how PEPFAR money is spent.
Ruteikara reported that he and his fellow Ugandans would repeatedly put abstinence and fidelity into the National Strategic Plan. "Repeatedly, foreign advisors erased our recommendations. When the document draft was published, fidelity and abstinence were missing." Meanwhile, a suspicious statistic blaming most HIV infections on marriage appeared. Repeated requests for the source of the statistic have gone unanswered, the priest said.
"As fidelity and abstinence have been subverted, Uganda's HIV rates have begun to tick back up," Ruteikara wrote. "The Western media have been told this renewed surge of HIV infection is because there are 'not enough condoms in Uganda,' even though we have many more condoms now than we did in the early 1990s, when our HIV rates began to decline."
Off course
Green said that Western "sexual freedom ideologies" have caused successful AIDS-prevention strategies to be derailed in Africa, perhaps costing millions of lives.
"If AIDS prevention is to be based on [scientific] evidence rather than ideology or bias, then fidelity and abstinence programs need to be at the center of programs for general populations. [...] What the churches are inclined to do anyway turns out to be what works best in AIDS prevention," Green and his Harvard colleague Allison Herling Ruark wrote in the April issue of First Things.
In a 2004 "common ground" statement in The Lancet, 150 global AIDS-prevention leaders agreed fidelity should be the first-line prevention strategy for population-wide epidemics like those in sub-Saharan Africa.
The Senate bill mentions fidelity, but not as a central priority. Instead, the initiative, if passed, will fund a wide array of commodities and services to combat AIDS indirectly -- from HIV tests and Chlamydia treatments to female condoms. The latter are more expensive than male condoms -- and so unpopular in Africa that Uganda has stopped importing them.
Only 20% of funds in the new PEPFAR bill would go for prevention. Ruteikara would like to see that percentage doubled until the pandemic is under control.
The only hint of a spending requirement for fidelity in the current bill is a clause stating that in the event a country chooses to spend less than half its prevention funding on fidelity and abstinence programs, a report must be sent to Congress.
The bill also calls for preventing 12 million new HIV infections worldwide, but doesn't specify how.
Calling for HIV/AIDS profiteers to "let [his] people go," Ruteikara wrote, "We understand that casual sex is dear to you, but staying alive is dear to us. Listen to African wisdom, and we will show you how to prevent AIDS."
Green said, "This is a challenging moment for Congress to unite behind objective scientific evidence, and do the right thing. If Congress puts fidelity promotions at the center of our AIDS response, billions of tax dollars will be effectively spent and millions of African lives will be saved."
--- --- ---
On the Net:
"Let My People Go, AIDS Profiteers": http://www.washingtonpost.com/wp-dyn/content/article/2008/06/29/AR2008062901477.html
________________________________
Independent.ie
A Recent Reflection upon "Humanae Vitae" & Contraception
By Mary Kenny
Saturday June 28 2008
I was recently asked to give a re-assessment of a document first published 40 years ago, which made a great splash at the time.
The document was called 'Humanae Vitae', and I had, of course, condemned it when it appeared in July 1968. My generation's reaction to it was the Catholic equivalent of the Bob Dylan ballad The Times They Are A-Changin.
The 1968 headlines summed up the papal encyclical with a pithy dismissal: "Pope Slams Birth Control." That was it. Silly old Pope Paul VI. He hadn't cottoned on to the idea, at all, that the times they were a-changing.
So, when asked to re-assess it, 40 years on, I actually read the encyclical from start to finish, which I had never deigned to do before.
It begins -- "Humanae Vitae tradendae munus gravissimum ... " The English goes: "In their function of transmitting human life a married couple freely and responsibly collaborate with God. Though many hardships may ensue, their task is also one of joy."
As I read on, the text struck me as lyrically poetic and idealistic. One commentator had called it "the triumph of theory over practice". But theories and ideals we also must have.
"The love between the couple is faithful unto death, as both the bride and bridegroom know, the day they freely make their vows to keep the marriage bond.
"To live by this is difficult but not impossible, and from it flows a wealth of dignity."
Surprisingly, the encyclical is in parts progressive. It condemns coercive sex -- what we would now call marital rape. "Intercourse is not an act of love once it is demanded regardless of the partner's state or feelings. Such a demand goes right against the moral order that should reign within a couple's close relationship."
It is sensitive to such issues as women's changing roles, and concern about over-population: " ... the rapid growth of births, and growing fear that human life may far outstrip the means of its survival." It affirms the "right use of reason" in the exercise of "responsible parenthood" and accepts that issues can be multi-faceted.
It doesn't claim -- contrary to legend -- that couples should have as many children as possible, and allows that there may be good reasons for family limitation.
But still, there at the heart of the matter is that which begat the worldwide headlines: Pope Slams Birth Control.
It concedes that procreation is not the be-all and the end-all in the conjugal relationship. "Procreation is a goal ... but not for each and every act of love." But it still affirms that conjugality must "stay destined towards a chance of life".
And here's the corker: "Human procreation is not a thing a couple can decide upon just as they please, without a thought for our Creator's plan." This is where the encyclical belongs to a way of thinking that has almost passed away: we now think we can decide upon anything just as we please.
The encyclical supposes all kinds of ideas that have now disappeared: for example, taking for granted that sexual relations are only licit between a married couple. Indeed, taking for granted that the fruitfulness of sexual relations means that only heterosexuality represents the natural law.
Humanae Vitae is not as black-and-white as it was painted in the media at the time. (And how critical it was of the media! "Mass media today can be abused, by putting over dirt and deprivation." Prettier in the Latin -- "communicationis instrumentis sensus commovet dissolutosque mores".)
Yet it recommends an ideal that most people can never match -- and admits as much. "Steady self-control" is required in matters of love and family life: and sometimes "you have to be an ascetic" to master this. It recommends the "rhythm method" of natural fertility because "such discipline requires a constant effort ... and helps a married grow in grace."
Even those who disagreed with its findings at the time (many Catholics, including the Pope's own Papal Commission, said that sensible family planning should have been given the green light) were also too idealistic. Even the dissenters believed that the conjugal life of most couples was dedicated to a perfection of holy matrimony.
If only! Much of holy wedlock consists of two persons in mortal emotional combat for dominance and power. Holy matrimony is also bickering, fights, walk-outs, petty jealousies, sulks, grievances, dark resentments, and being driven demented by hearing a spouse's repeated old jokes. Factor cat-and-dog domesticity into the equation, Papal Commission!
An Irishwoman, a mother of 10, upon hearing a celibate priest preach on the ideals of marriage and parenthood in Humanae Vitae, was said to have sighed: "I wish I knew as little about it as he does!"
And yet for all that, it remains a fascinating historical document, conjuring up a high-minded vision of a gentle and considerate Christian couple finding rapture and fulfilment through the sunny uplands of the right moral order.
email: mkenny@independent.ie
The document was called 'Humanae Vitae', and I had, of course, condemned it when it appeared in July 1968. My generation's reaction to it was the Catholic equivalent of the Bob Dylan ballad The Times They Are A-Changin.
The 1968 headlines summed up the papal encyclical with a pithy dismissal: "Pope Slams Birth Control." That was it. Silly old Pope Paul VI. He hadn't cottoned on to the idea, at all, that the times they were a-changing.
So, when asked to re-assess it, 40 years on, I actually read the encyclical from start to finish, which I had never deigned to do before.
It begins -- "Humanae Vitae tradendae munus gravissimum ... " The English goes: "In their function of transmitting human life a married couple freely and responsibly collaborate with God. Though many hardships may ensue, their task is also one of joy."
As I read on, the text struck me as lyrically poetic and idealistic. One commentator had called it "the triumph of theory over practice". But theories and ideals we also must have.
"The love between the couple is faithful unto death, as both the bride and bridegroom know, the day they freely make their vows to keep the marriage bond.
"To live by this is difficult but not impossible, and from it flows a wealth of dignity."
Surprisingly, the encyclical is in parts progressive. It condemns coercive sex -- what we would now call marital rape. "Intercourse is not an act of love once it is demanded regardless of the partner's state or feelings. Such a demand goes right against the moral order that should reign within a couple's close relationship."
It is sensitive to such issues as women's changing roles, and concern about over-population: " ... the rapid growth of births, and growing fear that human life may far outstrip the means of its survival." It affirms the "right use of reason" in the exercise of "responsible parenthood" and accepts that issues can be multi-faceted.
It doesn't claim -- contrary to legend -- that couples should have as many children as possible, and allows that there may be good reasons for family limitation.
But still, there at the heart of the matter is that which begat the worldwide headlines: Pope Slams Birth Control.
It concedes that procreation is not the be-all and the end-all in the conjugal relationship. "Procreation is a goal ... but not for each and every act of love." But it still affirms that conjugality must "stay destined towards a chance of life".
And here's the corker: "Human procreation is not a thing a couple can decide upon just as they please, without a thought for our Creator's plan." This is where the encyclical belongs to a way of thinking that has almost passed away: we now think we can decide upon anything just as we please.
The encyclical supposes all kinds of ideas that have now disappeared: for example, taking for granted that sexual relations are only licit between a married couple. Indeed, taking for granted that the fruitfulness of sexual relations means that only heterosexuality represents the natural law.
Humanae Vitae is not as black-and-white as it was painted in the media at the time. (And how critical it was of the media! "Mass media today can be abused, by putting over dirt and deprivation." Prettier in the Latin -- "communicationis instrumentis sensus commovet dissolutosque mores".)
Yet it recommends an ideal that most people can never match -- and admits as much. "Steady self-control" is required in matters of love and family life: and sometimes "you have to be an ascetic" to master this. It recommends the "rhythm method" of natural fertility because "such discipline requires a constant effort ... and helps a married grow in grace."
Even those who disagreed with its findings at the time (many Catholics, including the Pope's own Papal Commission, said that sensible family planning should have been given the green light) were also too idealistic. Even the dissenters believed that the conjugal life of most couples was dedicated to a perfection of holy matrimony.
If only! Much of holy wedlock consists of two persons in mortal emotional combat for dominance and power. Holy matrimony is also bickering, fights, walk-outs, petty jealousies, sulks, grievances, dark resentments, and being driven demented by hearing a spouse's repeated old jokes. Factor cat-and-dog domesticity into the equation, Papal Commission!
An Irishwoman, a mother of 10, upon hearing a celibate priest preach on the ideals of marriage and parenthood in Humanae Vitae, was said to have sighed: "I wish I knew as little about it as he does!"
And yet for all that, it remains a fascinating historical document, conjuring up a high-minded vision of a gentle and considerate Christian couple finding rapture and fulfilment through the sunny uplands of the right moral order.
email: mkenny@independent.ie
- Mary Kenny
_____________________________________________________________________________________________________
"The protection of human life [at all its stages] is the "rock solid and inviolable" foundation upon which all other human rights are based." - Benedict XVI
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