On November 21, the Joint United Nations Program on AIDS (UNAIDS) released its annual update on the global AIDS epidemic.1 The report indicates that, although some promising developments have been made in the fight against the global HIV/AIDS epidemic, including scaling up the availability of anti-retroviral treatment in some of the world's poorest countries, little progress has been made overall in reducing the spread of the AIDS in Africa or Asia.
The report documents that the number of people living with HIV, as well as the number of deaths from AIDS, continues to grow.2 The region still hardest hit by this epidemic is sub-Saharan Africa which contains nearly two-thirds (63%) of all adults and children living with HIV. The number of HIV cases in sub-Saharan Africa continues to grow and increases have also been seen in Eastern Europe, East Asia, and Central Asia where the number of people living with HIV is 21% higher than in 2004.
The report includes data from behavioral trend surveys in the hardest hit African, Asian, and Caribbean countries, including the 15 focus countries of the President's Emergency Plan for AIDS Relief (PEPFAR).3 Results of these surveys revealed that a lack of sexuality education, a lack of comprehensive knowledge of HIV, as well as a lack of knowledge about condoms and low condom usage is contributing to an increase in HIV infections.
“While disheartening, this information does not come as a surprise to many advocates,” said William Smith, vice president for public policy for SIECUS. “Current PEPFAR prevention strategies place a disproportionate focus on abstinence-until-marriage and be-faithful programming that, in many instances, results in the exclusion of any prevention programming focused on correct and consistent condom use.”
The report notes several examples of the effects that the lack of knowledge about and low usage of condoms is having on HIV rates. In Haiti, knowledge and use of condoms is particularly low. At least 20% of sexually active students ages 14-25 reported not knowing what condoms are and only 50% of students who know about condoms also report using them regularly.4 Uganda provides one of the more striking examples of the relationship between lack of condom use and increase in HIV rate. Uganda, which had shown marked decrease of their epidemic during the 1990s, is now seeing a reversal of that trend with HIV incidence increasing in rural areas. In Uganda, knowledge and practice regarding condom use has become erratic with only half of Ugandans reporting using a condom the last time they had sex.5 Uganda had been held up as a model of the ABC approach (abstain, be-faithful, and condom use) to HIV prevention. This data, however, once again calls into question this approach.
According to the report, lack of comprehensive knowledge of HIV is also a contributor to the increase in new cases. In some of the PEPFAR focus countries, knowledge among youth remains particularly low. In Botswana, for example, only one out of three young people ages 15-24 could both correctly reject misinformation about HIV and identify proper means of preventing the sexual transmission of the disease.6 Likewise, in Vietnam, where approximately 40,000 people are infected with HIV each year, less than 50% of young people have a comprehensive knowledge of HIV.7
“The information compiled by UNAIDS for this report is concrete evidence that in order to reduce the spread of HIV/AIDS, young people need to have access to comprehensive sexuality education,” continued Smith. “Unfortunately, comprehensive sexuality education is not what youth in the 15 focus countries are getting from PEPFAR funded HIV prevention programs.”
Although PEPFAR purports to promote a balanced ABC approach to HIV prevention (abstinence-until-marriage, be faithful, and correct and consistent condom use), the program requires that all countries spend a minimum of 1/3 of all prevention funding on abstinence-until-marriage programs.
A recent Government Accounting Office (GAO) report found that this funding requirement, along with PEPFAR's preference for an abstinence-until-marriage and be-faithful (AB) approach, has hindered promotion of a comprehensive prevention campaign and has impeded staff working within PEPFAR countries to respond to specific epidemiologic, social, and cultural needs.8 This strategy, as indicated by the UNAIDS report, of promoting ideology and morality over evidenced-based prevention policies ignores the real needs of young people in Africa and Asia and does little to halt the spread of HIV.
The UNAIDS December 06: AIDS Epidemic Update can be accessed at: http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf .
For more information on PEPFAR and SIECUS' recommendations for improving the program, see PEPFAR Country Profiles.
- December 06: AIDS Epidemic Update , (New York: UNAIDS, 2006), accessed 22 November 2006, <http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf>.
- Ibid, 3.
- The 15 PEPFAR focus countries are: Botswana, Cote D'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia
- Ibid., 45.
- AIDS epidemic update , 18.
- Ibid., 14.
- Ibid., 31.
- “Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding Under the President's Emergency Plan for AIDS Relief,” Government Accounting Office, April 2006, GAO-06-395.