More HIV Funds to Promote Abstinence; Researchers Call Policy Misguided

In fiscal 2006, effective Oct. 1, 66 percent of U.S. international aid to prevent sexually transmitted HIV "must be used for activities that promote abstinence before marriage and fidelity," reads a directive from the office overseeing President George W. Bush's Emergency Plan for AIDS Relief. A copy of the directive, "Key Policy Changes for Fiscal Year '06 Country Operation Plans," was released to the Baltimore Sun by a federal AIDS official who believes it will weaken global HIV prevention efforts. The official asked to remain anonymous.

Office of Global AIDS Deputy Coordinator Dr. Mark Dybul said the change is based on good science, would rectify a strategic "condoms only" disparity, and would adhere to congressional requirements. In passing the assistance bill in 2003, Congress required at least one-third of prevention monies to be spent on "abstinence-until-marriage programs." This year, such programs accounted for about one-quarter of prevention funding. Allocating two-thirds of the sexual transmission funding to abstinence will ensure that the agency meets the law's original one-third requirement, Dybul said.

Dybul denied the policy document was an inflexible imperative, calling it a "guidance" designed to highlight a goal. But the source for the document, a senior HIV advisor who has worked on government AIDS programs for years, said officials at his agency are treating it as an inflexible order in the region for which he is responsible.

The rule could do the most harm in countries where the epidemic is not yet widespread and still largely affects sex workers, injecting drug users and gay men, some researchers say. Drug users are often infected through needle sharing and will likely infect their partners if condoms are not used. For sex workers, who necessarily engage in risky sexual behavior, "the whole notion of abstinence and fidelity doesn't make a lot of sense," said Thomas Coates of the University of California-Los Angeles.

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