World Health Day: Orthodox ABC strategy falls short in Aids fight

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World Health Day: Orthodox ABC Strategy Falls Short in Aids Fight

Inter Press Service (Johannesburg)

April 7, 2005

Posted to the web April 7, 2005

Niko Kyriakou

United Natons

More resources are being poured into campaigns against HIV/AIDS than

ever before, even as an unprecedented number of advocates demand new

treatment and prevention strategies to address the skyrocketing

number of women becoming infected with the virus.

Debrework Zewdie, director of the World Bank's Global HIV/AIDS

Programme, told the Commission on Population and Development (CPD) on

Monday that between 1996 and 2004, the international community

boosted funding for HIV/AIDS programmes from 300 million to 6 billion

dollars annually.

While commending this increase, she said that not only was twice the

funding needed to successfully deal with the disease, but that to be

effective, HIV/AIDS strategies needed to make a long overdue gender-

sensitive paradigm shift.

" We need programmes that simultaneously address HIV and reproductive

health, " she said. " ly, I don't know what we're waiting for. "

Women's health is also the focus of World Health Day Thursday, with

experts from the United Nations and World Health Organisation

complaining that maternal mortality and other problems are just not a

high enough priority for many governments and the international

community.

In the past, AIDS prevention has focused on the ABC approach --

Abstain, Be Faithful, and use Condoms. This approach is successful in

some places, but according to UNAIDS, it has failed in parts of the

world where women lack the social power to negotiate fidelity and

condom use among their partners, and where rape is common.

Zewdie called abstinence programmes a " non-starter " , saying that

young people who choose not to have sex don't really need help. " I

don't know that abstinence used to cost money, until recently, " she

said.

Globally, the proportion of HIV/AIDS cases among women has climbed

from 41 to 50 percent since 1997, and has reached 75 percent among 15-

to 24-year-olds in Sub-Saharan Africa.

About 6,000 young women in this age group die every day of AIDS. In

Russia, according to Thoraya Ahmed Obaid, executive director of the

United Nations Population Fund (UNFPA), women accounted for 24

percent of HIV/AIDS cases in 2001, but account for nearly 40 percent

today.

For a disease that started out exclusively in high-risk groups like

intravenous drug users, sex workers, and men who have sex with men,

these statistics are staggering evidence the disease is shifting

towards women. For most in the field, this shift demands a

corresponding shift in strategy. But some donors, including the U.S.,

still cling to the ABC formula.

There are many reasons for the feminisation of AIDS, but according to

Human Rights Watch, the primary factors are rape, physical

vulnerability to infection, lack of access to information and

services, fear of testing due to cultural stigmas, and an inability

to force fidelity and condom use among their partners and husbands.

Integrating the vast network of reproductive health facilities and

those dealing with the AIDS virus is a colossal task, but not a new

idea.

The need for this paradigm shift was discussed at U.N. conferences

throughout the 1990s, is mentioned in the U.N. Millennium Development

Goals to reduce poverty and disease, and was pinpointed in a

Commitment signed by governments, multilateral agencies, U.N. and NGO

leaders at the Rockefeller Foundation in New York last year.

The Commitment reasons that HIV/AIDS and sexual and reproductive

health programmes should combine their efforts because, " the

overwhelming majority of HIV infections are sexually transmitted or

associated with pregnancy, childbirth and breastfeeding. "

It also notes that " both HIV/AIDS and sexual reproductive ill-health

are driven by many common root causes, including gender inequality,

poverty and social marginalisation of the most vulnerable

populations. "

Gita Sen, a professor at the Indian Institute of Management in

Bangalore India, says that merging the reproductive health and AIDS

fields must be handled delicately because many NGOs and other groups

do not want to be overrun.

" We should be careful not to threaten anyone that they are going to

get integrated into one another, " she said at a meeting called by

several U.N. agencies and NGOs this week. " Rather, identify and

prioritise lists of services and programmes that both need to be

working on together. "

Some countries are leading the way. The director general of India's

National AIDS Control Organisation, S.Y. Quraishi, spoke in detail

about both existing and envisioned Indian programmes that move

towards the new paradigm.

India's new government coalition plans to increase the health

services budget significantly Quraishi said, and Prime Minister

Manmohan Singh, who spoke about " aggressively " promoting condom use

in his first speech to the nation, has promised to expand AIDS

programmes to all government ministries.

Of the 5.1 million AIDS cases in India, 45 percent involve women, and

Quraishi expects the number to reach 50 percent in the next five

years. The local factors propelling this shift are familiar --

widespread ignorance of the disease, a preference among Indian men

for younger partners, myths that sleeping with a virgin can cure

AIDS, and a refusal among men to use a condom because, in their

opinion, " they don't get pleasure " .

Quraishi said India has plans to scale up the voluntary testing and

counseling centers from 700 to 24,000. He said 170 universities in

India now have student-run AIDS education programmes which use

innovate methods like street theatre.

Another 60,000 lower schools have AIDS education programmes, with a

target of 150,000 in the next two years.

" We must catch them young before AIDS catches them young, " Quraishi

said.

He also had some innovative ideas to promote safe sex.

" The condom has been portrayed as anti-sex. It needs to be recast as

increasing pleasure, " he said. He suggested making condoms

called " All Night " and publicising the message that " if you are

carefree, you do it better " to encourage use by Indian men.

A recurrent mantra among HIV/AIDS workers is that " prevention is

cheaper than cure, " and International Labor Organisation (ILO)

studies have proven this fact. In 2000, the ILO found that the cost

of Africa's increased mortality from AIDS is about 15 percent of the

continent's GDP.

By 2020, the ILO anticipates the labour force will be reduced by 5 to

35 percent in 38 countries due to the disease. In terms of teacher

shortages, the World Bank estimates this will add 450 to 550 million

dollars per year to the cost of achieving universal primary education

in 33 low-income African countries by 2015, a U.N. Millennium

Development Goal.

Advocates also emphasise that more is needed than integration of

reproductive health services. The new strategy must involve men and

boys in AIDS education and programmes, increase availability of

contraceptives, including the female condom, expand sex education for

young people, and widen access to counseling and treatment

facilities, especially those focusing on testing, family planning,

and preventing mother-to-child transmission of the disease.