Dobson's World: ABC without the C, or, AIDS is a loving God's way of punishing sinners
The Governmental Accountability Office (GAO) maintains a Web site where it publishes numerous reports on various federal programs and is probably a much-underused resource for the blogosphere.
It discusses the effect of the Congressional-imposed "ABC" approach. GAO explains of the relevant law:
The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 authorizes the President’s Emergency Plan for AIDS Relief (PEPFAR) and promotes the ABC model (Abstain, Be faithful, or use Condoms). It recommends that 20 percent of funds appropriated pursuant to the act be spent on prevention and requires that, starting in fiscal year 2006, 33 percent of prevention funds appropriated pursuant to the act be spent on abstinence-until-marriage. (my emphasis)
Here is the general conclusion of the study:
OGAC's ABC guidance and the abstinence-until-marriage spending requirement, including OGAC’s policies for implementing it, have presented challenges for country teams. First, although most teams found the ABC guidance generally clear, two-thirds reported that ambiguities in some parts of the guidance led to uncertainty about implementing the model. OGAC officials told GAO that they plan to clarify the guidance. Second, although several teams told GAO that they value the ABC model and emphasize AB messages for certain populations, teams also reported that the spending requirement can limit their efforts to design prevention programs that are integrated and responsive to local prevention needs. Seventeen of 20 country teams reported that fulfilling the spending requirement, including OGAC’s policies implementing it, presents challenges to their ability to respond to local prevention needs. Ten of these teams (primarily those with smaller PEPFAR budgets) received exemptions from the requirement, allowing them to dedicate less than 33 percent of prevention funds to AB activities. In general, the nonexempted teams were effectively required to spend more than 33 percent of prevention funds on AB activities; as a result, OGAC should just meet the overall 33 percent spending requirement for fiscal year 2006. However, to meet the requirement, nonexempted country teams have, in some cases, reduced or cut funding for certain prevention programs, such as programs to deliver comprehensive ABC messages to populations at risk of contracting HIV. Finally, OGAC’s decision to apply the spending requirement to all PEPFAR prevention funds may further challenge teams’ ability to address local prevention needs.
In other words, the faith-based requirement to preach conservative Christian practices of abstinance that have never mixed well with human hormones, adolescent or adult, is getting in the way of medically useful education that actually helps people prevent disease. I know the Christian Right advocates of these kinds of things prefer to think of themselves as "pro-life". But "pro-disease" would literally be a better description of the "ABC" requirements.
Part of the practical consequence of the percentage spending requirement for abstinence education is that it creates strong pressure to "isolate funding for AB activities" from the more medically and pratically useful parts of the program.
Just to be clear: any medically responsible program would include practical discussions of abstinence and the risks of multiple sexual partners. That's what the ABC concept actually means. But the results of the faith-based approach in practice can actually force local teams to design some programs that provide unbalanced, exclusive focuses on the faith-based approach of "just say no", leaving some participants uninformed about safe sex procedures. It's just irresponsible and unethical. In effect, the faith-based requirement shifts money away from genuinely integrated ABC programs toward abstinence-only education.
Further complicating the situation is the implementation guidelines under which the programs function. For instance, education about condoms and "C-related activities" is allowed; promotion of condoms is not. In the field, it can produce results like this:
Several NGOs that receive PEPFAR funding expressed concern to us about crossing the line between providing information about condoms and promoting or marketing condoms. For example, representatives of a PEPFAR-supported organization that runs a youth camp for students (aged 15-17) told us that condom use is addressed during camp sessions only when youths ask specific questions. However, staff said that they feel “constrained” when they hear these questions, because they do not want to say more than is allowed under PEPFAR guidelines. Another implementing partner representative said that although the organization views condom demonstrations as appropriate in some settings, it believes that condom demonstrations, even to adults, are prohibited under PEPFAR. OGAC’s guidance also does not explain whether ABC approaches for broader audiences in a generalized epidemic may include condom social marketing. Although a senior OGAC official told us that broad condom social marketing is appropriate in certain situations, five focus country teams reported that, in their understanding, PEPFAR funds may not be used for broad condom social marketing,even to adults in a generalized epidemic. (my emphasis)
Another instance of real-world effects of faith-based medicine:
One country team stated that, because of the abstinence-until-marriage spending requirement, it had limited funding for comprehensive ABC messages to the general public. In this focus country, the AIDS epidemic is generalized but is largely fueled by populations determined to be most at risk of contracting HIV, such as commercial sex workers and truck drivers. Most of this country’s "other prevention" [i.e., "C-related" activities] funding is reserved for its most-at-risk populations. However, because one-third of prevention funding must be reserved for AB programs, the team had little sexual transmission prevention funding to deliver integrated ABC messages to those in the general population who, although at risk for contracting HIV, are not among the most-at-risk populations.
And another:
A focus country team told us that, to meet the spending requirement, it had to cut “other prevention” funding by 50 percent. Team members explained that, as a result, services for married discordant couples, sexually active youths, and commercial sex workers were reduced. In general, this team noted that allocating funding in accordance with the spending requirement is not appropriate for the country’s epidemic and has reduced the quality of the team’s prevention programming.
This is Dobson's World. Where rules that don't even work among priggish adult white folks in America are allowed to sidetrack useful anti-AIDS education. Where the idea that AIDS is God's way of punishing teenagers who make whoopie on a Friday night day is actually guiding policy combatting a very serious medical epidemic. This is part of what Republican Party theocracy looks like.
And to remind ourselves that much more is at stake here than Sunday School lessons for young adolescents, it's worth keeping in mind the real problem out there in the real world:
Each day, an estimated 13,400 people worldwide are newly infected with HIV; more than 20 million have died from AIDS since 1981. HIV is transmitted both sexually (through sexual intercourse with an infected person) and nonsexually (through the sharing of needles or syringes with an infected person; unsafe blood transfusions; or the passing of the virus from mother to child during pregnancy, childbirth, or breastfeeding). However, the majority of HIV infections worldwide are transmitted sexually. About two-thirds of the estimated 40 million people currently living with HIV/AIDS are in sub-Saharan Africa where, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), adult HIV prevalence averaged 7.4 percent in 2004.
HIV/AIDS is an urgent and growing health problem, driven by complex factors that present challenges to HIV prevention. The nature of the AIDS epidemic varies among the 15 PEPFAR focus countries, 12 of which are in sub-Saharan Africa ... . In addition, the groups most vulnerable to HIV infection vary among the focus countries. For example, while girls and young women are most vulnerable in some countries, populations typically considered high-risk groups, such as intravenous drug-users or commercial sex workers, are most vulnerable in others. Figure 1 shows that although the epidemic in some focus countries is concentrated in certain populations, in other focus countries it has spread among the general population.
