A quarterly international newsletter on sexuality, sexual health, and sexuality education.
Volume 3, Issue 1 - Spring/Summer 2004
SIECUS President Travels to Africa
In March,Tamara Kreinin, SIECUS president and CEO, traveled to Africa to attend a conference and meet with a number of our international partners. Tamara's trip took her to Nigeria, South Africa, and Uganda. Making the Connection recently sat down with Tamara so that we could share what she learned with our readers.
Making the Connection: In this issue we talk a lot about the U.S. Strategy which will provide HIV/AIDS funding to many African nations. As the articles explain, however, this funding is quite restrictive. What was the reaction to this funding among the organizations you met with?
Tamara Kreinin: Organizations had very mixed feelings about it.The reactions I heard were actually very similar to those of state-based organizations when the Title V abstinence-until-marriage money first became available in the United States. Organizations could not decide whether this money was a blessing or a curse.
The organizations in Africa were very eager for the treatment dollars. As for the prevention money, much of which is dedicated to abstinenceuntil- marriage programs, many organizations were torn. On the one hand, they desperately need the resources, while on the other hand they do not feel that restrictive abstinence-onlyuntil- marriage programs will work in their communities or that this was the best use of much-needed funds.
Many organizations were questioning whether to take the money, and some had already decided that they would not.
At the same time, however, many people working in HIV prevention felt that they had already seen signs of programs changing their focus in an effort to qualify for the U.S. funds.This is a very disturbing trend, and I met a number of people who fear that this turn toward unproven abstinence-untilmarriage programs will reverse any progress that African countries have made in slowing HIV transmission.
MTC: You mentioned abstinence-untilmarriage programs.These were a part of the "ABC campaign" in Uganda that has been credited with reducing HIV transmission rates.There has been a lot of controversy, however, over which aspects of this campaign really worked. After visiting a number of organizations in that country, what were your impressions of the "ABC" approach?
TK: I was very interested in going to Uganda because there has been so much excitement over that country's progress in reducing HIV transmission, and at the same time so much disagreement over how and why "ABC" worked.
As most readers probably know, "ABC" stands for abstain, be faithful, and use condoms. Since the results were publicized, many people, both in the U.S. and abroad, have tried to isolate one factor as the primary reason for success. Unfortunately, this is often based on a political or ideological agenda rather than facts and research.
My impression from my brief trip is the same reached by the researchers- that no one aspect can be pointed to as the magic bullet. Rather, it was the level of intensity with which the country focused on their AIDS epidemic which really brought about change.Throughout the country everybody was talking about AIDS, about the important roles individuals could play in reducing transmission, and about the various methods of prevention.These messages were heard from a number of sources including high level public officials, educators, and health care providers. In addition, some prominent people went public with their HIV status which did a lot to reduce the stigma attached to the disease.
I think that the lesson the rest of the world should learn from Uganda is the importance of multi-faceted approaches that work to increase dialogue around this issue and to truly change social norms. Abstinence was an important component in Uganda's success in reducing HIV prevalence, but it was just one piece of a much larger picture. Our own government has a great deal to learn in this regard.
MTC: Why do you think a multi-faceted approach is so important?
TK: I think that when we focus on one issue, such as HIV prevention, we often forget how many issues individuals have to deal with in their everyday lives. For example, I met with one peer educator in Uganda who is working at the University to educate young people about abstinence and safer sex. She said that abstinence is a very hard message to give young women in particular, because many young women are in relationships with older men as a way to get money for their education.
She explained that these young women are often even unable to negotiate condom use within these relationships because there is a stigma attached to women who suggest using condoms-men see them as prostitutes.
This conversation once again reminded me of how important it is to look at sexuality and sexual behavior in a cultural context that takes all aspects of individuals' lives into account.The role that gender plays in sexual health behaviors, for example, was apparent throughout my trip. In many relationships, including marriages, women are not in a position to refuse sexual behavior or negotiate safer sexual practices like condom use. This once again suggests to me that the abstinence- onlyuntil- marriage approach is not valid because marriage alone will not protect women from HIV, in fact in some places married women are the most vulnerable.
I think that to be successful, any prevention program must simultaneously address reproductive health issues, women's rights, and the myriad of other issues facing individuals throughout the world.
MTC: Do you have any closing thoughts that you would like to share with us?
TK: What became very clear to me is how the AIDS pandemic in Africa has had both a positive and negative impact on how individuals and countries address sexuality. On the one hand, the pandemic has literally forced many governments and individuals to focus on sexuality-related issues which had previously been ignored or considered too taboo to discuss.
At the same time, many programs, governments, and funding sources now focus exclusively on HIV/AIDS.This has meant that other important reproductive health issues, such as STDs and unintended pregnancy, have been pushed aside.
People I met also expressed concern that the AIDS pandemic has lead to a widespread negative view of sexuality. One program director in Uganda explained,"We are demonizing sex and love."
I think it is very important that HIV/AIDS-prevention and treatment are used as an opportunity to focus on all sexual and reproductive health issues, as well as an opportunity to educate young people and adults about the many positive aspects of sexuality.
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