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Executive Summary #1692 on Africa

September 30, 2003

Executive Summary: The White House Initiative to Combat AIDS: Learning from Uganda

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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 chaos.

The 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?

The 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.

The 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 experience:

  • 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 HIV/AIDS.
  • Condoms do not play the primary role in reducing HIV/AIDS transmission.
  • Religious organizations are crucial participants in the fight against AIDS.

The 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.

The 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.

To promote the most effective AIDS policy for developing nations, Congress should:

  • Endorse effective prevention policy by insisting that AIDS funding uphold the ABC program emphasis on abstinence and marital fidelity;
  • Ensure that programs for high-risk groups, such as commercial sex workers and drug addicts, make rescue and recovery a major program goal;
  • Empower non-governmental organizations (NGOs) while protecting their right to fight AIDS without compromising their moral and religious beliefs;
  • Sharply limit the U.S. contribution to international AIDS organizations until their policies reflect the best AIDS prevention and treatment programs available; and
  • Insist that the President's nominee for Global AIDS Coordinator fully endorse the ABC prevention model.

The 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 alternative.

Joseph Loconte 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.

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