Fairy-Tale Failure

Even in an administration famous for its contempt for science, the President's tortured case for abstinence stands out. He committed $1 billion to abstinence-only programs abroad without a shred of scientific evidence that they prevent disease. Casting about for justification, he and the virginity advocates who surround him latched on to one of the developing world's rare AIDS success stories: Uganda. In their fertile imaginations, the East African nation was a fairy-tale place where Christian morality had turned the epidemic around.

But their castle in the sky came crashing down in May, on the eve of a United Nations meeting on AIDS, when Uganda's AIDS commissioner announced that after years of decline, new HIV infections had almost doubled from 70,000 in 2003 to 130,000 in 2005. Devastating news.

Back in 1986, when Ronald Reagan had yet to make a single public speech about AIDS, Ugandan President Yoweri Museveni launched an ambitious HIV prevention campaign, which included massive condom distribution, explicit information about transmission, and messages about delaying sex and reducing numbers of partners. HIV rates dropped from 15 percent in the early 1990s to 5 percent in 2001.

But conservative think tanks and Christian right activists saw what they wanted to see. Uganda's balance of abstinence, being faithful, and condom use, or ABC, became abstinence, be faithful, with condoms “only as a last resort.” It was common to claim, as Focus on the Family's James Dobson did in 2002, that, “Uganda has made great progress against AIDS by emphasizing abstinence, not condoms.”

This rewrite became a mantra in Washington, as a third of Bush's global prevention money was set aside only for abstinence. Soon, players among Bush's evangelical base, from Franklin Graham's Samaritan's Purse to Anita Smith's Children's AIDS Fund, began to rake in millions in federal grants to spread the abstinence-only message in Uganda. (Smith's proposal was rejected by a scientific review committee, but the head of USAID intervened.) Martin Ssempa, a local minister known for staging public condom burnings, joined the U.S. money train. Museveni himself began to sing the new tune. At the 2004 International AIDS Conference, he disparaged condoms as an “improvisation, not a solution.” Uganda released a new HIV prevention plan based on A and B only, while Museveni's evangelical wife proposed a national census of virgins.

The coup de grace arrived in October 2004, when flaws in Uganda's leading condom brand spurred a recall. Supplies dropped from about 120 million a year to 30 million in 2005. The recall is over, but tens of millions of condoms now languish in warehouses awaiting government rebranding to convince the public of their safety. Meanwhile, government officials refuse to make a public statement reaffirming condom efficacy. “I've spoken with many young people who have tested positive,” said Beatrice Were, a prominent Ugandan AIDS advocate, “and the health centers simply have no free condoms to give them.”

The Lancet, a British medical journal, recently attributed Uganda's surge in new infections to the condom shortage and the Musevenis's campaign to remove the “C” from ABC. “There is no question in my mind,” said Stephen Lewis, the U.N.'s Africa envoy, 10 months into the shortage, “that the condom crisis in Uganda is being driven and exacerbated by … the extreme policies that the administration in the United States is now pursuing in the emphasis on abstinence.”

Uganda's AIDS commissioner, Kihumuro Apuuli, is careful to support the Musevenis's AIDS work. But outside the May U.N. meeting, he told the Prospect that while new infections are down among teenagers, they are rising among those over 20. “These are people who are not going to abstain,” he said. “There must be evidence-based strategies—not moral strategies—if we are to break the cycle of infections.” Were, who, like many Ugandan women, was infected with HIV though she was abstinent until marriage and faithful to her husband, said the collapse of sound HIV prevention will be difficult to reverse. “Uganda's new morality-based approach has unleashed a wave of stigma against condom use, because now, if you ask for a condom, it must mean you have failed to abstain or be faithful,” she said. “It is a terrible shame that the U.S. government has exported programs to Africa that have been proven to fail.”

Bush's response? He rewarded Smith and others responsible for the Uganda debacle with seats on his delegation to the U.N. session on AIDS.

Esther Kaplan is a contributing editor at POZ, the national AIDS magazine, and author of With God on Their Side: George W. Bush and the Christian Right (New Press, 2005).