The last decade has seen huge funding increases for the international fight against HIV. Increased funding has effectively reduced deaths from AIDS. But despite this progress, approaches to preventing HIV based in belief, not fact, remain and continue to hamper HIV prevention. Policies promoted by Christian right groups from the U.S. have been detrimental on two fronts: They limit the use of proven and effective prevention methods, and they oppose the human rights of women and gay people worldwide. Anti-gay bias and stigma help drive the epidemic both in the U.S. and internationally. Christian right groups fuel existing stigma to achieve their ideological goals. The U.S. Christian right emboldens anti-gay local leaders with their backing. They give them the credibility to oppress gay people and other groups at high risk for HIV.
Gender inequality is a key force driving the HIV epidemic. Women and girls are particularly at risk for HIV because they are often deprived of the rights to make decisions about their own bodies and economic well being. According to UNAIDS, half of all people in the world with HIV are female, and in sub-Saharan Africa they account for 59% of all cases. The Christian right continues to oppose key international efforts to protect women's rights since they view these efforts as promoting abortion and prostitution while contradicting traditional values.
The U.S. Christian right is a social movement working to impose so-called traditional values into public policy. The term describes a variety of right-wing Christian organizations whose membership is concentrated among evangelical Protestants. The groups that make up this movement vary in theological beliefs but share concerns about specific social issues and support conservative social and political values. The movement originated in the 1970s and its most prominent areas of focus were opposition to sex education, homosexuality, and abortion.
Although the various sectors of the Christian right agree on these three points, they also have internal political divisions. In recent years, the leadership of the Roman Catholic Church hierarchy has led efforts by the Christian Right and has been at the forefront of pushing to ban abortion, fight sex education, and oppose legal equality for LGBT people. The evangelical-Catholic alliance against gays is ironic. While they are united on this issue, they actually have serious religious conflict. Many evangelical Protestants consider Roman Catholicism pagan idolatry. White evangelicals, Hispanic evangelicals, and Catholics disagree on immigration reform. On issues including war and peace, torture, and welfare policy, the evangelical right is often at odds with Catholic leaders.
Some of the leading Christian right groups based in the U.S. are Concerned Women for America, Focus on the Family, the Family Research Council, the Traditional Values Coalition, and leaders of the Southern Baptist Convention.
U.S.-based Christian right groups have a large impact on HIV prevention efforts. They promote policies that ignore scientific proof on what HIV prevention methods work. They prioritize their religious beliefs over what works on the ground. These groups provide incorrect information and discredit prevention methods that work, such as condom use.
The U.S. Christian right has fought contraception and family planning efforts as well as science-based HIV prevention around the world for decades. Its moral position was codified as long ago as the Reagan administration in the "global gag rule," which prevented U.S. funding to be used toward accessing abortions. Organizations receiving funds for family planning or women's health were severely limited in providing services and could not provide abortion or information about access to abortion services. Christian right groups have fought contraception and family planning efforts, as well as science-based prevention. President Clinton rescinded this gag rule, only to see it reinstituted by the second President Bush. President Obama has once again rescinded the rule. Additionally Bush-era abstinence-only restrictions on HIV prevention funding were weakened in 2008 when the global AIDS relief program was reauthorized.
Another concern is the sole focus on heterosexuals in HIV prevention messaging. Currently only heterosexual people are portrayed in information about risks for HIV. This has led homosexually active men in Kenya, Uganda, and elsewhere to believe they are not at risk for HIV.
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has been the primary U.S. response to the global epidemic. This program started under President Bush in 2003 and provides funding abroad. PEPFAR targets countries with high HIV prevalence, primarily in Africa. This initiative has increased funding, successfully lowered death rates from AIDS, and expanded access to medication. PEPFAR funding provides antiretrovirals to nearly 2 million people in Africa. One study shows that the plan has averted an estimated 1.2 million deaths from AIDS. The same study, however, found that PEPFAR has not lowered rates of HIV infection. While successful at lowering AIDS death rates, the prevention portion is not working.
PEPFAR's prevention efforts fail mainly because of their basis in religious dogma rather than proven facts. It allows ideology to direct HIV prevention while ignoring scientific evidence. Studies repeatedly show that abstinence-only prevention education does not work. Yet until 2008 PEPFAR required that fully one-third of prevention funds be directed toward such programs. This is partly due to the strong influence of the Christian right. The abstinence-only component of PEPFAR was by far the most ineffective.
While changes have been made, problems remain. Even after the 2008 reauthorization, funding is still determined by ideological positions. PEPFAR requires the Office of the Global AIDS Coordinator to monitor the funding of non-abstinence programs. If organizations use more than half of their HIV prevention funds for non-abstinence prevention, they must inform Congress.This rule discourages organizations from having comprehensive prevention programming for fear of losing funding.
There are also other PEPFAR funding requirements that have a negative impact on HIV prevention. Organizations are required to pledge opposition to prostitution and sex trafficking publicly. This provision creates difficulties for organizations doing prevention work by limiting their ability to work effectively with individuals involved in sex work -- a population already marginalized and at high risk for HIV. The pledge limits provision of prevention, care, and treatment services for this vulnerable population.
PEPFAR was amended in 2008 to improve HIV prevention among men who have sex with men (MSM) by calling for HIV prevention efforts designed specifically for them. It also calls for more research to understand HIV among MSM better in the global epidemic.
Under PEPFAR, religious groups with little or no public health experience have landed lucrative federal grants. These funds support the provision of AIDS education, prevention, and services in Africa, Vietnam, and the Caribbean. The following is a profile of some of the main Christian right recipients of PEPFAR AIDS education funding.
Religious right groups like the Mormon World Family Policy Center, Focus on the Family, and Concerned Women for America closely monitor U.N.-sponsored international gatherings, paying particular attention to meetings focused on women. They actively promote their religious agendas and oppose homosexuality, abortion, and contraception. To their credit, some are active in efforts to prevent human trafficking.
Anti-gay groups pressure the U.S. government to oppose sexual orientation nondiscrimination resolutions at the U.N. They have also lobbied against the candidacy of gay rights groups for membership in the U.N. Economic and Social Council (ECOSOC). United Families International, a Christian right group, has ECOSOC status, giving it a formal role in U.N. deliberation.
Several religious right groups got together at the United Nations High Level Meeting on AIDS in June 2008. This forum included "ex-gay" groups, including the Catholic Family and Human Rights Institute and Families Watch International. Also present were the National Association for Research and Therapy of Homosexuality and Jews Offering New Alternatives to Homosexuality (JONAH). Speakers portrayed equal rights for LGBT people as a threat to "family rights." They argued that all same-sex relationships are promiscuous and high risk. Speakers also contended that homosexuality is a choice and argued that people can become heterosexual through therapy and religious conversion.
According to the World Health Organization (WHO), AIDS is the leading cause of death and disease among women of reproductive age in low- to middle-income countries, particularly in Africa. Women and girls in these countries are particularly at risk for HIV infection, since they face both gender-based inequalities and biological factors that make them more susceptible. According to UNAIDS, economic and social dependence on men often limits women's power to refuse sex or to ask for condoms. In unprotected sex, heterosexual women are twice as likely as men to acquire HIV, and this is particularly so in girls, whose genital tracts are not fully mature.
The inequalities faced by women and girls are evident across the world in deeply embedded discrimination. Women often have unequal access to education and information that would help them learn about how to avoid infection. They can face violence or may lack the right to make decisions that affect their own bodies. WHO reports that the most important risk factors for death and illness among women are lack of contraception and unsafe sex. These factors result in unwanted pregnancies, unsafe abortions, complications with pregnancy and childbirth, and sexually transmitted diseases, including HIV.
Christian right groups have blocked U.S. ratification of other important international treaties. They opposed the United Nations Convention on the Rights of the Child, which sets out the civil, political, economic, social, and cultural rights of children. It requires nations to respect, protect, and fulfill the rights of children. The Heritage Foundation opposes it as a "potential infringement of U.S. sovereignty." President Clinton signed the treaty in 1995, but the U.S. has still not ratified it. The U.S. and Somalia are the only countries in the world that have not ratified this convention.
Concerned Women for America is particularly active in promoting its agenda at the U.N. "I believe abortion, pornography, premarital sex, and homosexuality are schemes of the devil," said its founder Beverly LaHaye. The group has a budget of nearly $8.5 million, claims 500,000 members, sends delegates to the U.N., and seeks to impose its beliefs worldwide. CWA's agenda includes:
Opposition to efforts to ensure equal rights for women is particularly troubling given the harsh realities faced by women and girls in places where they are particularly at risk for HIV. Violence against women continues to be a problem -- during times of war, or even peace, women can be victims of rape and violence. In places such as the Congo, Sierra Leone, and Sudan, rape and beatings have been used as tools of war. Displaced populations are particularly at risk, and by some estimates, in Africa alone there are up to 6 million refugees and 15 million internally displaced persons.
In the Middle East and in parts of South Asia and Africa, women who are seen as having brought dishonor to the family can be killed by any man in the family. Honor killings happen even in countries where they are officially illegal, as is the case in India, Pakistan, and Egypt. They also sometimes occur in migrant communities in western countries such as France, Germany. and the U.K. Typically these women are perceived as having crossed the limits of social behavior. Offenses include refusing the sexual advances of their husbands, refusal to accept arranged marriages, unacceptable dress, adultery, and in some cases having been raped.
Studies have shown that better educated young girls start having sexual relations later. Unfortunately, in many parts of the world, cultural and social conditions prevent women from receiving education, and many girls are denied the right to inform themselves about their sexual and reproductive rights and options. By opposing comprehensive sex education, contraception, and reproductive rights on the international level, the Christian right contributes to the disempowerment of women. Lack of empowerment fuels the spread of HIV. Youth are under the control of adults, and girls in particular tend to have sex with people older than themselves. Due to the power inequalities between young girls and adult men, it is hard for youth to negotiate safer sex. This is why societies have age-of-consent laws.
A number of groups address gay issues:
In 2009 Ugandan Parliament member David Bahati introduced the Anti-Homosexuality Bill of 2009. Under current Ugandan law, homosexual acts are a crime punishable by a prison term of up to 14 years. The proposed legislation raises that to life in prison. In addition, anyone who fails to report the identity of any lesbian, gay, bisexual, or transgendered person faces serious consequences. Failing to make such a report within 24 hours can result in a jail term of up to three years. Most disturbingly, the bill creates a new offense: aggravated homosexuality -- defined as one partner being a minor, HIV positive, or a serial offender (a repeat homosexual). The sentence for this offense is death.
Mr. Bahati has close ties to U.S.-based Christian right organizations. So do most of the Ugandan legislators involved in writing this bill. International media have exposed these connections. The Times of London and The New York Times reported that politicians in Uganda, including Mr. Bahati, are connected to a Christian right organization called The Family, a secretive U.S.-based group of influential politicians and business leaders that actively promotes the objectives of the Christian right movement. The Family acts both within the U.S. and internationally. Its members include prominent politicians from both major U.S. political parties, and international decision makers are also included in its ranks. Other groups involved in stirring up homophobic sentiment in Uganda include Exodus International and FOF. There is no claim that these groups actually wrote the proposed legislation, but they have been known to exploit existing homophobia and fear to further their political goals.
This draft bill has obvious implications for HIV treatment and prevention efforts in Uganda. Its provisions would further stigmatize HIV. It would also impede efforts to implement HIV prevention programming with MSM. In response to this legislation, Uganda stands to lose a chance to host a major research institution. Currently the African AIDS Vaccine Programme (AAVP) is based in Geneva, Switzerland. On December 14, 2009, the U.N. and Ugandan health officials announced that AAVP headquarters would be moved to Uganda. UNAIDS chief scientific advisor for UNAIDS Catherine Hankins, however, has made clear that "Criminalizing adult consensual sex is not only a human rights issue ... .[I]t goes against a good HIV strategy. If the bill passes, UNAIDS and WHO would have to decide what happens to see whether this is an appropriate place."
In a December 2009 speech at Georgetown University, U.S. Secretary of State Hillary Clinton decried the bill, stating, "Governments should be expected to resist the temptation to restrict freedom of expression when criticism arises, and be vigilant in preventing law from becoming an instrument of oppression, as bills like the one under consideration in Uganda to criminalize homosexuality would do." Secretary Clinton has called President Museveni directly to express the profound concerns of the U.S. about the proposed law.
U.S. Christian right organizations initially refused to use their influence in Uganda to stop passage of this harmful legislation. Finally, after weeks of pressure that brought international attention to their connection with Ugandan groups behind the bill, politicians and leaders in The Family and other organizations spoke out against the proposed legislation. They even wrote letters to the Ugandan President Yoweri Museveni urging him to stop its passage. Exodus International, an ex-gay organization affiliated with FOF, sent a letter to President Museveni on November 16, 2009, that said: "The Christian church ... must be permitted to extend the love and compassion of Christ to all. We believe that this legislation would make this mission a difficult if not impossible task to carry out."
In January 2010, President Museveni came under pressure from international leaders. He responded to the advice of the President of the United States, the Prime Ministers of Canada, and leaders from Australia and the United Kingdom. He expressed his opinion that the bill had become a foreign policy issue and urged his cabinet to take into account Uganda's foreign policy interests when considering the bill.
The Ugandan anti-homosexuality bill provides two crucial lessons. It shows the influence of Christian right groups on an international scale, and demonstrates how their ideological approaches obstruct effective HIV prevention. The reauthorization of PEPFAR made important changes: "abstinence-only" requirements were weakened. Groups particularly prone to HIV infection, such as MSM, were included. These steps show progress. The removal of the global gag rule by President Obama was also a huge milestone. But we are still not truly efficient at using limited HIV prevention funding. To do so, international HIV prevention efforts must fully fund and utilize proven prevention methods. They must also defund approaches and groups that continue to emphasize disproven methods and approaches.
Sean Cahill is Managing Director, Public Policy, Research and Community Health, and Lyndel Urbano is Manager of Government Relations in the Public Policy Department at GMHC.