Elementary principles

LUSAKA, Zambia—In Zambian high schools, students are learning their ABCs all over again. That's Abstinence, Being faithful to one partner, and Condom use.

Abstinence is becoming the preferred AIDS preventative, even as condoms remain the most touted. The retooling is part of an aggressive, multipronged approach to educating youths about the dangers of AIDS, a disease infecting 1.2 million Zambians.

With U.S. delegates gathering this month in Anaheim for the annual AIDS conference, attention again will focus largely on Africa, where 28 million people are living with AIDS and 20 million have already died. But in Zambia there may be good news. According to the latest United Nations global report on HIV/AIDS, Zambia could become the second country in Africa (after Uganda) to reverse its AIDS crisis.

The report said Zambia's HIV prevalence-a measure of how many people already have the virus that causes AIDS-has fallen for urban and rural women ages 15 to 29. That matches a new study showing that urban men and women are reporting less sexual activity, fewer multiple partners, and more consistent use of condoms.

Kenneth Ofosu-Barko, UNAIDS country program adviser, said that the drop in HIV is due to a variety of factors, ranging from more widespread education on the disease to increased use and availability of condoms to the strength of religious faith. But he said that, among teenagers, lowered infection rates are probably due to a rise in condom use more than a drop in the sex rate. "If it doesn't appear that the act of having sex has changed significantly, then chances are that people are using condoms," he said. High-school students, according to his anecdotal surveys, are still having sex at a young age.

Yoram Siame disagrees. "The reduction [of AIDS infection rates] has been mostly due to a delay in sexual debut and abstinence," said Mr. Siame, project manager for Youth Alive, an organization that promotes family values. In the last five years, he said, the abstinence message has gained prominence because young men and women have wanted to learn more about how they can abstain from sex-and nongovernmental organizations have responded.

"If, for instance, four years ago people did a workshop on AIDS, they would say abstinence is the best method of prevention. That would be all and they would spend the next hour talking about condoms and how to use them." Now, he said, abstinence is gaining ground as at least an equally acceptable method of prevention.

The new attention to abstinence has prompted billboards with verses reading, "Roses are red, Violets are blue, Abstinence is for me, How about you?" Television commercials carry the slogan, "Say No to Sex, Virgin Power, Virgin Pride!" A government leaflet-titled "When 'NO' Means 'NO!'"-also informs students of ways to cope with peer pressure and control their sexual desires. However, promiscuous sexual behavior is so ingrained in Zambian culture that most AIDS workers say it is too early to say confidently that abstinence is catching on.

According to the 2000 Zambia Sexual Behavior Survey, unmarried men and women have reduced their number of sexual partners. Between 1998 and 2000, the number of men abstaining from sex increased from 53 percent to 62 percent, while the number of women abstaining increased from 62 percent to 73 percent. Only 39 percent of men and 33 percent of women said they used a condom with a nonregular partner at their last sexual encounter.

According to the National AIDS Council, Zambians are using condoms more consistently. But many believe they are not effective, and even when condoms are used, they may not be used correctly-compounding their 5 or 6 percent failure rate. Even so, the Zambian government supplies 18 million condoms a year to health clinics and for free distribution.

Despite the failure rate of condoms, John Mambo, regional superintendent for the Church of God in Zambia, favors preaching condom use along with abstinence. He argues that the scale of the AIDS crisis means those who cannot abstain from extramarital or premarital sex should be instructed to use a condom to protect themselves. He said the church's newfound willingness to discuss AIDS has contributed to the drop in HIV prevalence. "The church has broken the silence," he said. "There's a lot more now said in the pulpit. We've embraced sufferers of HIV/AIDS, even if they are admittedly teachers and clergy."

Mr. Ofuso-Barko said churches in general have been slow to accept condom use as a means of AIDS prevention. "We're saying abstinence is the best method-if people can do it," he said. But he adapts the parable of the lost sheep to justify a more pragmatic approach. "Our message is the 99 that are in the fold are OK, they will abstain. But that one sheep that has strayed from the fold, the wolf is out there and that wolf is AIDS. Before the wolf can get him, we say, let's protect him."

Not everyone in the Christian AIDS relief community finds that approach satisfactory. Etambuyu Imasiku said under such instruction she was "safe in the condom" when she dated and had sex with a man for two years. She later discovered she was pregnant-and HIV positive. She disagrees with AIDS workers who say churches should allow nonmarital condom use.

"They want us to package the abstinence message with the condom message, but they contradict themselves," said Ms. Imasiku, now a Christian AIDS counselor. "We are not forcing people to abstain, but we are offering it as an alternative. The message is the message of truth. If you tell people the truth, they're better equipped to make the right decision."

"The whole problem of AIDS is a moral issue. The UN is trying to make it an amoral issue," said Happy Ngoma, pastor of Riverside Chapel. "When we say abstinence is the answer, we are saying the person first needs to have the fear of God before his eyes. My own opinion is that hospitals should have pictures of people with STDs [sexually transmitted diseases]. The sight of a person infected with an STD is enough of a deterrent."

Three-fourths of the world's AIDS sufferers live in Africa. Of 3 million AIDS deaths worldwide in 2000, 2.4 million were in Africa. While promiscuous homosexual activity is the leading form of transmission in the United States, in Africa heterosexual sex is the primary mode of transmission. The disease is also transmitted from mother to child. Up to 110,000 people ages 15 to 49 died of AIDS last year in Zambia, according to the UN. There are now about 572,000 AIDS orphans in the country.

Without urgent attention to the AIDS epidemic, other attempts to jumpstart development in Africa could flounder. The New Partnership for Africa's Development, or NEPAD, is the latest, touted last week at the new UN General Assembly session in opening remarks by Secretary General Kofi Annan as well as U.S. Secretary of State Colin Powell.

NEPAD is an Africa-led strategy to attract foreign investment, as opposed to begging direct foreign aid, for long-term development. The United States has already pledged to increase foreign assistance by 50 percent to "developing nations that are governed wisely and fairly," Mr. Powell told UN delegates. Mr. Annan stated and Mr. Powell reiterated that AIDS "has become the greatest threat to Africa's development." Heavily infected countries stand to lose up to 20 percent of GDP due to the disease as overall life expectancy rates drop, breadwinners die, and public spending on health care rises.

"The Bible does not say the problems of this world will finish in the here and now," said Mr. Ngoma. "They will only come to an end with the new heaven and earth. We help those who are victims and give them the hope of the gospel of Jesus Christ."

It's a hope that Ms. Imasiku found when she learned she was HIV positive.

"If I wasn't a Christian I don't know what would have happened to me," she said. "I was suicidal. I need to go on. I need to warn other people of the dangers."

-Ms. Abraham is a World Journalism Institute fellow