Abstaining from abstinence

Faith-based groups fighting AIDS have groused for months that they have seen only drips of U.S. funding meant for sexual abstinence and faithfulness programs. New spending figures show they were right. Teaching sexual responsibility was to be the major rampart of a $15 billion emergency plan launched by President George W. Bush. But in 2004-the first year of the plan-abstinence funding fell short of congressional benchmarks. When Congress passed a bill authorizing the plan two years ago, it stipulated that at least one-third of all funds devoted to prevention must go purely to abstinence-until-marriage programs. In 2004, such spending was only 27 percent-and that figure lumps abstinence and faithfulness programs together. That may seem like a slight shortfall, but the sheer size of the program means millions of dollars are not being used as intended. Last year, $193 million went to prevention, which includes medical measures such as stopping pregnant mothers from passing HIV to their babies. The 27 percent got fleeting attention during a congressional hearing on April 13, when the plan's director, Randall Tobias, testified before the House Committee on International Relations. For now his office can gloss over such low spending; it is only violating congressional intent in these first two years of the Bush plan. But if the trend continues, the fund's administrators will be in violation of the law; abstinence earmarks become mandatory in 2006. In many ways, life is not easy for Mr. Tobias, a Bush appointee who takes flak from the left for supporting abstinence and from the right for not doing enough to bolster it. Minutes into his Hill testimony, jeans-clad, college-age protesters rose and held up letter-sized sheets of printer paper emblazoned with slogans like "Stop AIDS." The four halted the hearing by chanting, "Marriage is not a vaccine! Abstinence only is just a dream!" until ranking Democrat Tom Lantos silenced them. Mr. Tobias paused patiently without bothering to turn and look at them. In addition to social nonconformists, Washington's public-health bureaucracy also is opposed to sexual responsibility programs-preferring prophylactic solutions like condom giveaways-all making the task of carving out funds for abstinence programs a challenge. But Mr. Bush pushed for abstinence and faithfulness because they have worked. Those with a track record follow the "ABC" acronym: abstinence, being faithful, and condom use for high-risk groups (such as prostitutes). The formula comes from Uganda, where it helped slash the country's HIV infection rate by more than two-thirds. Compromising on this approach is not only a political defeat; it means HIV rates worldwide could rise. Congressman Ted Poe (R-Texas), who pressed Mr. Tobias, asking for a percentage breakdown of funding going to each component of ABC, had in reply a flurry of statistics and caveats from Mr. Tobias. Mr. Poe later told WORLD, "It's obvious the money is going to C, and in my opinion it's the least effective method. I was alarmed and concerned that [I got] just excuses on why funding was low for A and B." A hike in HIV infections is what Ugandan pastor Martin Ssempa, another witness at the congressional hearing, is trying to avoid. An advisor to Ugandan First Lady Janet Museveni, Mr. Ssempa runs an abstinence program geared toward university and high-school students. Six months ago he told WORLD that U.S. abstinence funds were going to old-school family-planning programs in Uganda (see "Hooked on failure," Nov. 6, 2004). The campaign eventually brought him to Washington this month. "Today the abstinence messages are gone," Mr. Ssempa told the committee panel. "Gone are the 'AIDS kills' ads warning teenagers to abstain. Gone are the signs that once warned truck drivers to 'drive home to their wives.' The abstinence billboards have been replaced with new billboards advertising condoms with slogans like 'so strong, so smooth.' And the HIV/AIDS rate has begun to tick upwards." In Uganda, one global condom distributor, Population Services International, received funding to teach teenagers abstinence. What they produced was a safe-sex program dressed up with abstinence-friendly language. A comic-book series they published provided messages such as "True Love Waits" while reminding teens to use condoms. PSI also denied funding to Mr. Ssempa's own program because it was not promoting condoms-a move that is illegal under the law governing the emergency AIDS plan, which includes a conscience clause to protect faith-based groups. Mr. Tobias told lawmakers his office is now engaging external auditors to determine whether such groups are following U.S. policy. Once breaches are identified, he said, "appropriate action could include terminating the awards." Part of the problem is hair-splitting interpretations of the law. One-third of all prevention funds must go to abstinence-until-marriage programs, but not necessarily abstinence-only-until-marriage. That allows groups such as PSI to include cursory nods to abstinence in their safe-sex programs, which sometimes amounts only to rhetoric. And because the group mentions abstinence, Mr. Tobias's office can count funding for them toward the "A" in ABC. Mr. Ssempa explained that local officials are often helpless in the face of U.S. pressure to promote condoms. "In Uganda and in many other poor African countries more than half the revenues come from overseas donors with the U.S. being the primary donor," he said. "In addition, USAID and CDC fund individuals at international rates which are typically many times what these people would otherwise earn. Make no mistake about it, you and your in-country representatives are very, very influential." Will it take microscopic oversight to ensure abstinence funds go to the right groups? Not necessarily. One immediate and proven method is to require dollar-by-dollar accounting and progress on a public website, similar to one kept by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Sen. Sam Brownback (R-Kan.) intends to introduce such a measure for U.S. agencies in a larger bill before the end of this month. For Mr. Ssempa, who lost his brother and sister to AIDS, creating more accountability is welcome. He knows lives are at stake if it does not happen now.