Earlier this year, the Bush Administration
persuaded Congress to authorize $15 billion over the next five
years to fight the AIDS pandemic in Africa and the Caribbean. The
U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 is a bold legislative effort. About 42 million people
worldwide are dying of AIDS or are infected with the HIV virus that
causes the disease. Of these individuals, 29 million live in
Africa. In addition, Africa is home to a staggering 11 million
orphans who have lost their parents to AIDS.
These facts carry political as well as
moral implications: Failure to confront the pandemic in nations
ravaged by AIDS is a recipe for economic decline and social
Bush Administration is basing its AIDS initiative on the success of
Uganda, which has experienced the greatest decline in HIV
prevalence of any country in the world. Studies show that from 1991
to 2001, HIV infection rates in Uganda declined from about 15
percent to 5 percent. How did Uganda do it?
best evidence suggests that the crucial factor was a national
campaign to discourage risky sexual behaviors that contribute to
the spread of the disease. Beginning in the mid-1980s, the Ugandan
government, working closely with community and faith-based
organizations, delivered a consistent AIDS prevention message:
Abstain from sex until marriage, Be faithful to your partner, or
use Condoms if abstinence and fidelity are not practiced.
effect was to create what researchers call a "social vaccine"
against HIV: a set of cultural values that encouraged more
responsible sexual attitudes and behaviors. Uganda's "ABC" approach
is now widely acknowledged as being linked to the dramatic
reduction in the nation's HIV/AIDS rate. Based on the best research
data available, several lessons can be drawn from Uganda's
- High-risk sexual behaviors can be
discouraged and replaced by healthier lifestyles.
- Abstinence and marital fidelity appear to
be the most important factors in preventing the spread of
- Condoms do not play the primary role in
reducing HIV/AIDS transmission.
- Religious organizations are crucial
participants in the fight against AIDS.
White House correctly insists that U.S. AIDS policy be based on
these lessons and the best available research about effective
prevention and treatment programs. "The Ugandan model has the most
to teach the rest of the world," says Dr. Edward Green, a senior
research scientist at Harvard and author of Rethinking AIDS
Prevention. "This policy should guide the development of programs
in Africa and the Caribbean funded under the President's
initiative." Jeff Spieler, chief of the research division in the
U.S. Agency for International Development's population office,
says: "It just happens to be where the evidence is pointing."
Congress should follow the evidence as
well. Although it has approved the President's initiative, Congress
is still debating whether to follow Uganda's ABC approach.
Lawmakers should be guided by good data, not ideology, in the
upcoming appropriations and confirmation debates.
President's AIDS initiative faces profound challenges. First, most
of the African continent lacks the health care infrastructure
required to treat HIV/AIDS and other deadly diseases effectively.
Second, many African governments are either unprepared to face
their AIDS crisis seriously or too corrupt and unaccountable to
mount effective treatment campaigns. Finally, international AIDS
organizations and activists continue to ignore the success of
Uganda while promoting flawed approaches to disease prevention.
promote the most effective AIDS policy for developing nations,
effective prevention policy by insisting that AIDS funding uphold
the ABC program emphasis on abstinence and marital fidelity;
that programs for high-risk groups, such as commercial sex workers
and drug addicts, make rescue and recovery a major program
non-governmental organizations (NGOs) while protecting their right
to fight AIDS without compromising their moral and religious
limit the U.S. contribution to international AIDS
organizations until their policies reflect the best AIDS prevention
and treatment programs available; and
that the President's nominee for Global AIDS Coordinator fully
endorse the ABC prevention model.
Bush Administration's AIDS initiative is a bold and ambitious plan
to tackle a pandemic that is ravaging the lives of millions of
people across Africa and the Caribbean. The White House seems to
understand that the favorite solution of Western public health
elites--a "condom airlift" for the continent--would be a medical
and moral disaster. It was precisely this approach that was roundly
rejected by Ugandan President Yoweri Museveni. "We made it our
highest priority to convince our people to return to their
traditional values of chastity and faithfulness or, failing that,
to use condoms," Museveni told drug company executives during a
June meeting in Washington. "The alternative was decimation."
Critics of the Administration's AIDS
policy for Africa should meditate long and hard on that
is the William E. Simon Fellow in Religion and a Free Society
at The Heritage Foundation and the author of Seducing the
Samaritan: How Government Contracts Are Reshaping Social Services
(Boston: The Pioneer Institute, 1997). John D. Pitts, Jr., a former
intern at The Heritage Foundation, served as a research assistant
for this paper.