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October 01, 2004

Abstinence and Ignorance: Dismissing Science in the Fight Against AIDS

by Joanne Csete

It seems to be a little known fact that HIV/AIDS is little understood, even in places where it has claimed many lives. In most countries, large percentages of people still believe that HIV is transmitted by casual contact: sharing utensils, shaking hands, or sitting in the same classroom with an HIV-positive person. This lack of awareness, which reflects underfunded or misinformed government educational campaigns on HIV and other sexually transmitted diseases, leaves people vulnerable to the virus and fuels the discrimination, stigma, and exclusion faced by people with AIDS.

Legal consensus on the human right to health is still evolving, but most people agree that access to information about important medical conditions is a key component of this right. Unfortunately, HIV/AIDS is proliferating at a time when political factors are undermining the right of all people to information about this lethal disease.

In the United States, for example, conservative groups have found allies in the Bush administration for dismantling sex and HIV/AIDS education in public schools. Insisting that sexual abstinence is the only completely effective way to prevent HIV and that sex education only leads to promiscuity, they have supported abstinence until marriage as the preferred “educational” strategy. Thanks to support from Congress and the White House, hundreds of millions of public dollars now fund this approach, despite extensive scientific evidence demonstrating the health benefits of teaching young people about safer sex, as well as calls for comprehensive sex education by medical professional organizations and the government’s own National Institute of Medicine.

It is one thing to undermine the right to information about sexually transmitted diseases and quite another to promote misinformation. Certain abstinence until marriage programs cited as models by the Bush administration exaggerate failure rates of condoms and instruct parents that telling their children about condoms may be putting those children in danger.

The United States is not alone in clinging to abstinence-only approaches despite evidence that they undermine efforts against HIV/AIDS. The government of India, dominated by the Bharatiya Janata Party until it was deposed by a Congress Party-led coalition in May 2004, also espoused keeping sex education out of the classroom. Even as the AIDS epidemic burgeoned in India, the former health minister told the press that condom use was “against Indian culture.” The new government restored television advertisements explaining the usefulness of condoms in fighting AIDS, but it will take a long time to undo the lack of awareness of the basic facts of HIV/AIDS in the population.

Despite this positive development, abstinence-based approaches are probably the best-funded HIV prevention programs in the world. The same political forces that have helped displace sex education in U.S. classrooms have ensured the export of abstinence programs as part of President Bush’s international initiative on AIDS. The June 2003 legislation authorizing funds for this initiative specifies that one-third of U.S. assistance for HIV prevention be allotted to abstinence until marriage programs. The U.S. Agency for International Development’s official HIV prevention strategy is to promote the “ABC message”: Abstain from sex before marriage, Be faithful to one sexual partner if you do not abstain, and use Condoms. The Bush administration has frequently shown its preference for A-only or AB messages.

As noted recently in the medical journal The Lancet, the cost of disparaging condoms can be measured in human lives. The obvious good health policy of ensuring that everyone who needs condoms has them in sufficient supply is being undermined by the unwillingness of key donors and other governments to provide free condoms. The Lancet and other sources note that greater availability and use of condoms is the only measure currently at hand that has the potential to turn the deluge of sexually transmitted HIV into a trickle.

Sadly, abstinence-only programs also reinforce discrimination against sexual minorities. Since same-sex marriage is not allowed by law in most places in the world, these programs effectively argue that homosexual sex has no legitimate context. At a time when persecution of gay men and criminalization of same-sex behavior are social scourges in too many countries, anything that contributes to the marginalization and stigma faced by gays is certainly bad HIV/AIDS policy and bad human rights practice.

For the last several years, annual state of the epidemic reports issued by the United Nations have suggested that we are losing the war against HIV/AIDS, which continues to infect about five million people per year. Every tool that can be brought to this crisis should be mobilized with utmost urgency. It is scandalous that ideology and political pandering seem to outweigh the human right to information—an essential part of the right to life and survival in the face of AIDS.

As published in Human Rights, Fall 2004, Vol. 31, No. 4, p.7.

Joanne Csete

Joanne Csete is the director of the HIV/AIDS program at Human Rights Watch.