Sunday, August 28, 2005

The Global Fund to Fight Aids: Is Yet Another Blogger Bringing An Important Moral/Financial Scandal to Light?

Cheat Seeking Missiles has uncovered a story that I hope has legs: the Global Fund to Fight AIDS is penalizing a demonstrably successful African AIDS program because it emphasizes abstinence. The analysis by this fine blog's author, Laer Pearce, is thorough and professional, and raises some very interesting questions.

What's The Issue?

Here's an excerpt to whet your appetite:

A review of 122 news releases issued by the Global Fund to Fight AIDS, Tuberculosis and Malaria dating back to the beginning of that organization in 2001 reveals that no country except Uganda has had its grant funds suspended due to concerns about financial mismanagement -- even though the fund gives money to a rogue's gallery of corrupt governments. . . .

The cuts follow sharp criticism of Uganda's program -- not because it is failing; it is one of Africa's most successful -- but because it puts morality (monogamy and abstinence) first and condoms second.

No other country has ever been sanctioned by Global Fund in this manner for financial mismanagement.
The AP story Laer cites contains this interesting tidbit:

[T]he head of the AIDS control project in the Ugandan Anglican church, the Rev. Sam Rutaikara, said that he has seen some success with the abstinence message among young people.

"Abstinence has pushed the age of the first sexual contact to 17.5 years for boys and 16.5 for girls from an average of 13," he said.

One wonders how many other countries receiving Global Fund assistance can boast of such success. Acording to the CIA World Factbook, Uganda is 66% Christian.

I wanted to know more about Uganda's government before taking a strong position on this. The Factbook does not paint a pretty picture, but the profile of the place looks about the same as a dozen other African countries. AIDS is a huge problem for Uganda. The Factbook states:

note: estimates for this country explicitly take into account the effects of excess mortality due to AIDS; this can result in lower life expectancy, higher infant mortality and death rates, lower population and growth rates, and changes in the distribution of population by age and sex than would otherwise be expected (July 2005 est.)
It is telling that only 2.2% of Uganda's population survives beyond the age of 65.

If you are squeamish about expressing concern over Uganda because of its government, keep in mind that The Democratic Republic of the Congo and Zimbabwe are also Global Fund grant recipients. The Congo looks terrible in the CIA Factbook. (In 2003 I was involved in helping a Congolese Assemblies of God minister receive asylum in the U.S. He and his family had been the victim of horrific torture at the hands of the government there.) Zimbabwe, of course, has been a poster child for governmental reform for a decade now.

Uganda's relative merits as a nation aside, from what Laer has exposed it seems that the Global Fund's action says this: If you are a corrupt government and manage our funds in a questionable manner, we'll let that go; but your administration of our funds had better not smack of Christian theology, or we'll cut you off!

I hope Hugh Hewitt, InstaPundit, and other big blogs pick up Laer's story. It would be great to see some spotlights shining on the Global Fund's decision.

UPDATE: The Story Gets Noticed

Hugh has picked up the story and linked to Laer and to us. Thanks, Hugh!

UPDATE 2: The U.N. Pops Its Head Up, With A Predictable Silly Position

According to Reuters via Breitbart.com, the United Nations weighed in today:

The U.S. government's emphasis on abstinence-only programs to prevent AIDS is hobbling Africa's battle against the pandemic by downplaying the role of condoms, a senior U.N. official said on Monday.
Stephen Lewis, the U.N. secretary general's special envoy for HIV/AIDS in Africa, said fundamentalist Christian ideology was driving Washington's AIDS assistance program known as PEPFAR with disastrous results, including condom shortages in Uganda.
Okay, I am ready to be convinced. What are the "disastrous results" to which Lewis refers? A few paragraphs later the Reuters story notes that "Uganda had been praised for cutting HIV infection rates to around 6 percent today from 30 percent in the early 1990s, a rare success story in Africa's battle against the disease."

This is apparently not good enough for Mr. Lewis, who says, "I think the administration and PEPFAR [the Washington AIDS assistance program] have to come to their senses ... to impose dogmatic policies is doing great damage to Africa."

Is he really worried about damage to Africa, or about damage to the conventional wisdom on how best to fight AIDS?

UPDATE 3: Scholarly Review of Uganda's Success

Thanks to commenter mightcan, we know about Avert.org, which describes itself as "an international HIV and AIDS charity based in the UK, with the aim of AVERTing HIV and AIDS worldwide." The Avert web site offers a scholarly, well-documented discussion entitled "Why is Uganda interesting?" Here's the introduction:

Uganda is one of the few African countries where HIV prevalence rates have declined, and it is seen as a rare example of success in a continent facing a severe AIDS crisis. Uganda's policies are credited with having brought the HIV prevalence rate down from around 15% in the early 1990s to 5% in 2001. At the end of 2003, the government and the UN say that only 4.1% of adults had the virus. The country is seen as having implemented a well-timed and successful public education campaign.1

More and more money is being channelled into Africa, especially by the US which has pledged $15 billion to fight AIDS in resource-poor countries. Uganda is lucky enough to be one of the countries on President Bush's list and many other countries are being urged to follow its example.

But the results seen in Uganda don't have a simple recipe, and with so many lives and such large sums of money at stake, it is important to look carefully at what has been done there.

Uganda, as we now know, is the most successful African country by far in combating AIDS. It is also the country whose funding The Global Fund to Fight Aids has cut off because of Uganda's excessive emphasis on abstinence. Can someone please explain this?

5 Comments:

Anonymous Anonymous said...

I tried to send this to Pierce - it's from Drudge - the UN weighs in: http://www.breitbart.com/news/2005/08/29/MTFH68612_2005-08-29_17-08-24_BAU961689.html 

Posted by Steve Neely

Monday, August 29, 2005 11:46:00 AM  
Anonymous Anonymous said...

I'm not sure that I understand what you understand. The Ugandan program has always been ABC - abstinence, be faithful, use condoms. Its always been a three legged stool, not one above the other. But, I could be wrong...


from http://www.avert.org/aidsuganda.htm:
Why was Uganda's response so effective?

The approach used in Uganda has been named the ABC approach - firstly, encouraging sexual Abstinence until marriage; secondly, advising those who are sexually active to Be faithful to a single partner or to reduce their number of partners; and finally, especially if you have more than one sexual partner, always use a Condom. A number of factors helped to encourage people to take up these strategies.
Communication

It seems that the message about HIV and AIDS has been effectively communicated to a diverse population by the government and by word of mouth. Ugandan people have themselves to thank, in part, for the reduction in the HIV prevalence rate. Much of the prevention work that has been done in Uganda has occurred at grass-roots level, with a multitude of tiny organisations educating their peers, mainly made up of people who are themselves HIV+. There was considerable effort made towards breaking down the stigma associated with AIDS, and frank and honest discussion of sexual subjects that had previously been taboo was encouraged. There is a high level of AIDS-awareness amongst people generally.
Community action

Very early in the course of the epidemic, the government recruited the Ugandan people to help themselves in the fight against HIV/AIDS. One of the first community-based organisations to be formed was TASO, the AIDS Support Organization founded in 1987, a time when there was still a great deal of stigmatisation of people with HIV.

"The founders met informally in each other's homes or offices to provide mutual psychological and social support. Cohesion among these individuals was strengthened by the fact that they were either directly infected with HIV or implicitly affected because their very close familial associates were infected".25

TASO now provides emotional and medical support to people who are HIV positive and their families. It also works with other smaller organisations to educate the public about discrimination and about the dangers of HIV/AIDS.
Fear

A Cambridge University study in 1995 showed that 91.5% of Ugandan men and 86.4% of women knew someone who was HIV positive, and that word of mouth was the method by which most people were informed about HIV prevention. This indicates that one of the main reasons for people's behaviour change was their alarm about the risks and the extent of the epidemic. Many villages are experiencing several deaths each month, houses stand empty, and grandparents are looking after their orphaned grandchildren. Put simply, people are more likely to avoid risky behaviour if they know people who have died of AIDS-related illnesses.
Simple messages

In the early stages of the epidemic, the government responded swiftly, giving out simple messages about abstaining from sex until marriage, staying faithful to one's spouse, and using condoms. The key message was "Zero Grazing", which instructed people to avoid casual sex. More complicated messages about risky behaviour and safer sex were not spread until later, when there had already begun to be a decline in HIV figures.
Political openness

Since 1986, when Uganda's health Minister announced that there was HIV in the country, there has always been political openness and honesty about the epidemic, the risks, and how they might best be avoided. In that same year, the President toured the country, telling people that it was their patriotic duty to avoid contact with HIV. This was a brave approach, as many politicians are reluctant to talk openly about sexual issues, but the openness paid off.

The president encouraged input from numerous government ministries, NGOs and faith-based organisations. He relaxed controls on the media and a diversity of prevention messages - including 'zero-grazing' - spread through Uganda's churches, schools and villages. This frank and honest discussion of the causes of HIV infection seems to have been a very important factor behind the changes in people's behaviour that allowed prevalence levels to decline.

This contrasts sharply with countries like South Africa, which have lacked this political leadership in the fight against the epidemic. Uganda's entire population was mobilised in the fight against HIV and were made aware of the consequences that risky behaviour could have for their country. It is largely due to the Ugandan people, motivated by their leaders, that the epidemic appears to have been so well addressed. 

Posted by mightcan

Monday, August 29, 2005 2:00:00 PM  
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