NYT/Kristof: When Prudery Kills

[Guest guest]

http://www.nytimes.com/2003/10/08/opinion/08KRIS.html

The New York Times

Op-Ed

October 8, 2003

When Prudery Kills

By NICHOLAS D. KRISTOF

JOHANNESBURG

Here on the ground where President Bush's big anti-AIDS program is

supposed to unfold, it looks as if the program was drafted more to win

American votes than to save African lives.

" We have the opportunity to save millions of lives abroad from a

terrible disease, " Mr. Bush told the nation in his State of the Union

address. But we're busy missing that opportunity.

Mr. Bush was happy to bask in the praise that his announcement of the

AIDS program attracted. But now he is delaying some of that spending,

holding back $1 billion in the first year, at a time when three

million people die of AIDS annually and five million are newly

infected.

In fairness, Mr. Bush is doing more about AIDS in Africa than

President Bill Clinton ever did. But one can hail these advances and

still recognize that administration officials are taking only baby

steps.

" They've been in office three years, and they've done almost nothing

to get the sick and dying on treatment, " said Sachs, a

Columbia University economist and expert on public health. " Despite a

lot of talk and one famous speech, and one plan that isn't in

operation, they've essentially accomplished nothing. "

" It's utterly inexcusable, " Mr. Sachs added, " that 7.5 million people

in Africa have died on their watch, and they've not yet reached even

500 Africans on treatment in U.S.A.I.D.-supported programs. They've

talked and procrastinated and dissembled while millions of

impoverished people have died. Ultimately, history will judge them

very severely. "

In his State of the Union comments on AIDS - which were deservedly

praised - Mr. Bush pledged $15 billion for AIDS in Africa and the

Caribbean over five years. But instead of $3 billion for the first

year, Mr. Bush backtracked to just $2 billion (much of it already in

the pipeline). He's also trying to cut urgently needed contributions

to the Global Fund, an international partnership to fight AIDS.

The administration is also fumbling the AIDS initiative by requiring

that one-third of AIDS prevention funds do nothing but encourage

sexual abstinence until marriage. This is the kind of stipulation set

by people who sit in Washington and have never actually set foot in an

African village.

In fairness, there is a growing body of evidence that promoting

conservative religious and social mores can reduce the scourge of

AIDS. But the only religion that does this effectively is Islam.

Muslim parts of African countries like Nigeria tend to have much less

promiscuity and much less AIDS than Christian parts.

Somehow I doubt that the lesson that conservatives will take from this

is that we should buy veils, encourage stonings and build

fundamentalist mosques across Africa.

ly, it's going to be very hard to change sexual mores, and pious

lectures aren't enough. Countries like Uganda and Thailand that have

enjoyed some success in preventing AIDS suggest that abstinence

campaigns can be effective, but only in conjunction with straight talk

about condoms - not with the administration's approach of beginning

and ending the conversation with abstinence.

Restricting funds to abstinence, and nothing more, looks as if the

administration is more interested in showing that it shares the

Christian Right's sexual squeamishness than in fighting AIDS. And all

over Africa you see heartbreaking evidence both that sex kills, and

that so does this kind of blushing prudishness.

Incredibly, young men in Botswana pay more to play Russian roulette:

several prostitutes there told me that the basic price for sex is

$6.50 with a condom or $11 without.

One study found that only 42 percent of at-risk Africans can easily

get condoms. As Dr. Marlin McKay, a Johannesburg AIDS doctor,

describes the need to promote condoms as well as abstinence: " This

isn't condoning sex. It's condoning life. "

Sibulele Sibaca, a 20-year-old AIDS orphan from Capetown, put it this

way: " I don't think that wasting a lot of money on abstinence is going

to work. It's like saying, `AIDS kills.' So what? The government had

billboards saying, `AIDS kills,' and AIDS just went up and up. "

After he announced his AIDS initiative, Mr. Bush was praised as a

humanitarian. But unless he delivers on his promises, then it will all

look like the most cynical of gestures - using the great health

tragedy of our age as a cheap photo-op to drape the White House with

compassion.

Copyright 2003 The New York Times Company