Why is Kenya's AIDS rate plummeting?

[Guest guest]

Why is Kenya's AIDS rate plummeting?

By Celia W. Dugger The New York Times

THURSDAY, MAY 18, 2006

NAIROBI Kenya, along with Uganda and Zimbabwe, is a rarity in Africa,

a nation where experts say the AIDS epidemic shows signs of easing. So

this land of safaris has become a hunting ground of a different sort,

attracting researchers looking for keys to slowing the relentless

spread of AIDS elsewhere on the continent.

The trends here are heartening. The number of new HIV infections has

plummeted over the last decade from an estimated peak of more than

200,000 a year to fewer than 90,000.

And changes in sexual habits seem to be contributing to the decline.

Men say they are having sex with fewer partners and women report

losing their virginity later. Many teenagers, once sexually active,

say they are abstaining entirely.

Such shifts, documented in large- scale surveys, suggest that

abstinence programs championed by U.S. congressional Republicans have

some chance of success. But the evidence also suggests its

limitations. Official guidelines for the Bush administration's AIDS

plan do not permit teaching children in school about condoms until

they are 15, but 1 in 7 Kenyan girls and 3 in 10 boys have had sex by

that age.

Kenyan health officials frankly acknowledge that evidence is lacking

on effectiveness of programs that promote condoms or abstinence.

According to the United Nations AIDS agency, Kenya, Uganda and

Zimbabwe are the sub-Saharan countries with documented declines in HIV

prevalence. Researchers agree that the fall is partly because AIDS

deaths have reduced the population of HIV-positive people. But they

also say it is likely that behavior change has helped.

Health officials here say the spread of knowledge about how to prevent

infection and a rising tide of death have been catalytic. Three out of

four Kenyans now know someone who has become sick or died from AIDS,

up from 40 percent a decade ago.

" That is a shock treatment, " said Godfrey Baltazar, an epidemiologist

who oversees monitoring of the Kenyan government's AIDS programs.

As donors have ratcheted up financing of anti-AIDS programs, the

landscape for prevention has changed. Since President W. Bush's

global AIDS plan was enacted in 2003, the United States has become the

dominant donor in Kenya, spending $208 million this year to combat

AIDS, more than all other donors combined.

Paradoxically, the feverish drive for diagnosis of AIDS and treatment

of infected people here, which consumes more than half the AIDS money,

may be Washington's most important contribution to preventing spread

of the disease.

Once people know that AIDS is not a death sentence, they are more

willing to be tested, and once they know their HIV status they can

protect themselves and their sexual partners.

This knowledge is critical in light of the experts' judgment that more

than half the new infections in Kenya are in couples in which one

partner is HIV- positive.

The build-up of testing and treatment has been explosive. The number

tested in Kenya, with a population of 32 million, has more than

tripled since 2003 to 1.5 million last year. The number of AIDS

victims receiving drug treatment has rocketed to 70,000 from less than

10,000 in 2003.

The United States is also paying for programs aimed at changing

behavior. This year, it will spend $15.7 million on programs that

promote abstinence and faithfulness, and $7.8 million to prevent

sexual transmission of HIV, including condom distribution to high-risk

groups.

Seen from Kenya, the debate that rages in Washington over AIDS and sex

sometimes seems more a reflection of American culture wars than

African realities.

Conservative Republican leaders in the House of Representatives

successfully included a provision in the 2003 law requiring that a

third of AIDS prevention money go to programs that promote abstinence.

Under the guidelines, U.S. funds can be used in schools to educate

children 14 and younger about abstinence and faithfulness, with condom

education only for those 15 and older.

But the clear lines drawn in Washington can get blurry on the ground.

With U.S. financing, Population Services International, or PSI, is

organizing abstinence clubs for 10- to 15-year-olds here. Following

U.S. policy, PSI does not teach the children about condoms, but they

ask many questions about them.

Terry Mathenge, 19, a PSI volunteer in a Nairobi school, gave the

example of a 10-year-old girl who is slapped by a parent for asking

about the condoms she has seen in her home, then repeats the question

at a club meeting.

" It's better to tackle it head on, " Mathenge said, adding, " Speak the

truth and the truth will set you free. "

But she also said abstinence was important. " In the past, the voice of

condoms was louder than the voice of abstinence, and I'm glad that's

changing, " she said.

Among those listening to her one recent afternoon in Nairobi was

Gerson, an evangelical Christian who is a close adviser to

Bush. He told the young people assembled for a talk that the U.S.

debate was polarized between those who favor abstinence only and those

who say the promotion of abstinence alone is naïve.

" It seems like you're saying it's neither, " he told Mathenge.

Gerson later said the best programs set an ideal of sexual behavior,

but were realistic about human nature " and deal with young people

where they are, and sometimes that includes condoms. " The

congressional earmark on abstinence money was needed to correct an

overemphasis on condoms, he said.

Dr. Lawrence Marum, who heads the global AIDS program in Kenya for the

U.S. Centers for Disease Control and Prevention, said abstinence

programs help give girls the confidence to resist pressure for sex.

Since teenage girls are six times more likely to be HIV-infected than

boys, these programs are needed " to save their lives, " he said.

Scholars say much work remains to be done to figure out whether

programs that emphasize abstinence, fidelity and use of condoms are

effective. " We don't know what works, " said Kremer, an

economics professor at Harvard who is helping evaluate the programs,

" and it's not at all obvious. "

NAIROBI Kenya, along with Uganda and Zimbabwe, is a rarity in Africa,

a nation where experts say the AIDS epidemic shows signs of easing. So

this land of safaris has become a hunting ground of a different sort,

attracting researchers looking for keys to slowing the relentless

spread of AIDS elsewhere on the continent.

The trends here are heartening. The number of new HIV infections has

plummeted over the last decade from an estimated peak of more than

200,000 a year to fewer than 90,000.

And changes in sexual habits seem to be contributing to the decline.

Men say they are having sex with fewer partners and women report

losing their virginity later. Many teenagers, once sexually active,

say they are abstaining entirely.

Such shifts, documented in large- scale surveys, suggest that

abstinence programs championed by U.S. congressional Republicans have

some chance of success. But the evidence also suggests its

limitations. Official guidelines for the Bush administration's AIDS

plan do not permit teaching children in school about condoms until

they are 15, but 1 in 7 Kenyan girls and 3 in 10 boys have had sex by

that age.

Kenyan health officials frankly acknowledge that evidence is lacking

on effectiveness of programs that promote condoms or abstinence.

According to the United Nations AIDS agency, Kenya, Uganda and

Zimbabwe are the sub-Saharan countries with documented declines in HIV

prevalence. Researchers agree that the fall is partly because AIDS

deaths have reduced the population of HIV-positive people. But they

also say it is likely that behavior change has helped.

Health officials here say the spread of knowledge about how to prevent

infection and a rising tide of death have been catalytic. Three out of

four Kenyans now know someone who has become sick or died from AIDS,

up from 40 percent a decade ago.

" That is a shock treatment, " said Godfrey Baltazar, an epidemiologist

who oversees monitoring of the Kenyan government's AIDS programs.

As donors have ratcheted up financing of anti-AIDS programs, the

landscape for prevention has changed. Since President W. Bush's

global AIDS plan was enacted in 2003, the United States has become the

dominant donor in Kenya, spending $208 million this year to combat

AIDS, more than all other donors combined.

Paradoxically, the feverish drive for diagnosis of AIDS and treatment

of infected people here, which consumes more than half the AIDS money,

may be Washington's most important contribution to preventing spread

of the disease.

Once people know that AIDS is not a death sentence, they are more

willing to be tested, and once they know their HIV status they can

protect themselves and their sexual partners.

This knowledge is critical in light of the experts' judgment that more

than half the new infections in Kenya are in couples in which one

partner is HIV- positive.

The build-up of testing and treatment has been explosive. The number

tested in Kenya, with a population of 32 million, has more than

tripled since 2003 to 1.5 million last year. The number of AIDS

victims receiving drug treatment has rocketed to 70,000 from less than

10,000 in 2003.

The United States is also paying for programs aimed at changing

behavior. This year, it will spend $15.7 million on programs that

promote abstinence and faithfulness, and $7.8 million to prevent

sexual transmission of HIV, including condom distribution to high-risk

groups.

Seen from Kenya, the debate that rages in Washington over AIDS and sex

sometimes seems more a reflection of American culture wars than

African realities.

Conservative Republican leaders in the House of Representatives

successfully included a provision in the 2003 law requiring that a

third of AIDS prevention money go to programs that promote abstinence.

Under the guidelines, U.S. funds can be used in schools to educate

children 14 and younger about abstinence and faithfulness, with condom

education only for those 15 and older.

But the clear lines drawn in Washington can get blurry on the ground.

With U.S. financing, Population Services International, or PSI, is

organizing abstinence clubs for 10- to 15-year-olds here. Following

U.S. policy, PSI does not teach the children about condoms, but they

ask many questions about them.

Terry Mathenge, 19, a PSI volunteer in a Nairobi school, gave the

example of a 10-year-old girl who is slapped by a parent for asking

about the condoms she has seen in her home, then repeats the question

at a club meeting.

" It's better to tackle it head on, " Mathenge said, adding, " Speak the

truth and the truth will set you free. "

But she also said abstinence was important. " In the past, the voice of

condoms was louder than the voice of abstinence, and I'm glad that's

changing, " she said.

Among those listening to her one recent afternoon in Nairobi was

Gerson, an evangelical Christian who is a close adviser to

Bush. He told the young people assembled for a talk that the U.S.

debate was polarized between those who favor abstinence only and those

who say the promotion of abstinence alone is naïve.

" It seems like you're saying it's neither, " he told Mathenge.

Gerson later said the best programs set an ideal of sexual behavior,

but were realistic about human nature " and deal with young people

where they are, and sometimes that includes condoms. " The

congressional earmark on abstinence money was needed to correct an

overemphasis on condoms, he said.

Dr. Lawrence Marum, who heads the global AIDS program in Kenya for the

U.S. Centers for Disease Control and Prevention, said abstinence

programs help give girls the confidence to resist pressure for sex.

Since teenage girls are six times more likely to be HIV-infected than

boys, these programs are needed " to save their lives, " he said.

Scholars say much work remains to be done to figure out whether

programs that emphasize abstinence, fidelity and use of condoms are

effective. " We don't know what works, " said Kremer, an

economics professor at Harvard who is helping evaluate the programs,

" and it's not at all obvious. "

http://www.iht.com/articles/2006/05/18/news/aids.php

[Guest guest]

Why is Kenya's AIDS rate plummeting?

By Celia W. Dugger The New York Times

THURSDAY, MAY 18, 2006

NAIROBI Kenya, along with Uganda and Zimbabwe, is a rarity in Africa,

a nation where experts say the AIDS epidemic shows signs of easing. So

this land of safaris has become a hunting ground of a different sort,

attracting researchers looking for keys to slowing the relentless

spread of AIDS elsewhere on the continent.

The trends here are heartening. The number of new HIV infections has

plummeted over the last decade from an estimated peak of more than

200,000 a year to fewer than 90,000.

And changes in sexual habits seem to be contributing to the decline.

Men say they are having sex with fewer partners and women report

losing their virginity later. Many teenagers, once sexually active,

say they are abstaining entirely.

Such shifts, documented in large- scale surveys, suggest that

abstinence programs championed by U.S. congressional Republicans have

some chance of success. But the evidence also suggests its

limitations. Official guidelines for the Bush administration's AIDS

plan do not permit teaching children in school about condoms until

they are 15, but 1 in 7 Kenyan girls and 3 in 10 boys have had sex by

that age.

Kenyan health officials frankly acknowledge that evidence is lacking

on effectiveness of programs that promote condoms or abstinence.

According to the United Nations AIDS agency, Kenya, Uganda and

Zimbabwe are the sub-Saharan countries with documented declines in HIV

prevalence. Researchers agree that the fall is partly because AIDS

deaths have reduced the population of HIV-positive people. But they

also say it is likely that behavior change has helped.

Health officials here say the spread of knowledge about how to prevent

infection and a rising tide of death have been catalytic. Three out of

four Kenyans now know someone who has become sick or died from AIDS,

up from 40 percent a decade ago.

" That is a shock treatment, " said Godfrey Baltazar, an epidemiologist

who oversees monitoring of the Kenyan government's AIDS programs.

As donors have ratcheted up financing of anti-AIDS programs, the

landscape for prevention has changed. Since President W. Bush's

global AIDS plan was enacted in 2003, the United States has become the

dominant donor in Kenya, spending $208 million this year to combat

AIDS, more than all other donors combined.

Paradoxically, the feverish drive for diagnosis of AIDS and treatment

of infected people here, which consumes more than half the AIDS money,

may be Washington's most important contribution to preventing spread

of the disease.

Once people know that AIDS is not a death sentence, they are more

willing to be tested, and once they know their HIV status they can

protect themselves and their sexual partners.

This knowledge is critical in light of the experts' judgment that more

than half the new infections in Kenya are in couples in which one

partner is HIV- positive.

The build-up of testing and treatment has been explosive. The number

tested in Kenya, with a population of 32 million, has more than

tripled since 2003 to 1.5 million last year. The number of AIDS

victims receiving drug treatment has rocketed to 70,000 from less than

10,000 in 2003.

The United States is also paying for programs aimed at changing

behavior. This year, it will spend $15.7 million on programs that

promote abstinence and faithfulness, and $7.8 million to prevent

sexual transmission of HIV, including condom distribution to high-risk

groups.

Seen from Kenya, the debate that rages in Washington over AIDS and sex

sometimes seems more a reflection of American culture wars than

African realities.

Conservative Republican leaders in the House of Representatives

successfully included a provision in the 2003 law requiring that a

third of AIDS prevention money go to programs that promote abstinence.

Under the guidelines, U.S. funds can be used in schools to educate

children 14 and younger about abstinence and faithfulness, with condom

education only for those 15 and older.

But the clear lines drawn in Washington can get blurry on the ground.

With U.S. financing, Population Services International, or PSI, is

organizing abstinence clubs for 10- to 15-year-olds here. Following

U.S. policy, PSI does not teach the children about condoms, but they

ask many questions about them.

Terry Mathenge, 19, a PSI volunteer in a Nairobi school, gave the

example of a 10-year-old girl who is slapped by a parent for asking

about the condoms she has seen in her home, then repeats the question

at a club meeting.

" It's better to tackle it head on, " Mathenge said, adding, " Speak the

truth and the truth will set you free. "

But she also said abstinence was important. " In the past, the voice of

condoms was louder than the voice of abstinence, and I'm glad that's

changing, " she said.

Among those listening to her one recent afternoon in Nairobi was

Gerson, an evangelical Christian who is a close adviser to

Bush. He told the young people assembled for a talk that the U.S.

debate was polarized between those who favor abstinence only and those

who say the promotion of abstinence alone is naïve.

" It seems like you're saying it's neither, " he told Mathenge.

Gerson later said the best programs set an ideal of sexual behavior,

but were realistic about human nature " and deal with young people

where they are, and sometimes that includes condoms. " The

congressional earmark on abstinence money was needed to correct an

overemphasis on condoms, he said.

Dr. Lawrence Marum, who heads the global AIDS program in Kenya for the

U.S. Centers for Disease Control and Prevention, said abstinence

programs help give girls the confidence to resist pressure for sex.

Since teenage girls are six times more likely to be HIV-infected than

boys, these programs are needed " to save their lives, " he said.

Scholars say much work remains to be done to figure out whether

programs that emphasize abstinence, fidelity and use of condoms are

effective. " We don't know what works, " said Kremer, an

economics professor at Harvard who is helping evaluate the programs,

" and it's not at all obvious. "

NAIROBI Kenya, along with Uganda and Zimbabwe, is a rarity in Africa,

a nation where experts say the AIDS epidemic shows signs of easing. So

this land of safaris has become a hunting ground of a different sort,

attracting researchers looking for keys to slowing the relentless

spread of AIDS elsewhere on the continent.

The trends here are heartening. The number of new HIV infections has

plummeted over the last decade from an estimated peak of more than

200,000 a year to fewer than 90,000.

And changes in sexual habits seem to be contributing to the decline.

Men say they are having sex with fewer partners and women report

losing their virginity later. Many teenagers, once sexually active,

say they are abstaining entirely.

Such shifts, documented in large- scale surveys, suggest that

abstinence programs championed by U.S. congressional Republicans have

some chance of success. But the evidence also suggests its

limitations. Official guidelines for the Bush administration's AIDS

plan do not permit teaching children in school about condoms until

they are 15, but 1 in 7 Kenyan girls and 3 in 10 boys have had sex by

that age.

Kenyan health officials frankly acknowledge that evidence is lacking

on effectiveness of programs that promote condoms or abstinence.

According to the United Nations AIDS agency, Kenya, Uganda and

Zimbabwe are the sub-Saharan countries with documented declines in HIV

prevalence. Researchers agree that the fall is partly because AIDS

deaths have reduced the population of HIV-positive people. But they

also say it is likely that behavior change has helped.

Health officials here say the spread of knowledge about how to prevent

infection and a rising tide of death have been catalytic. Three out of

four Kenyans now know someone who has become sick or died from AIDS,

up from 40 percent a decade ago.

" That is a shock treatment, " said Godfrey Baltazar, an epidemiologist

who oversees monitoring of the Kenyan government's AIDS programs.

As donors have ratcheted up financing of anti-AIDS programs, the

landscape for prevention has changed. Since President W. Bush's

global AIDS plan was enacted in 2003, the United States has become the

dominant donor in Kenya, spending $208 million this year to combat

AIDS, more than all other donors combined.

Paradoxically, the feverish drive for diagnosis of AIDS and treatment

of infected people here, which consumes more than half the AIDS money,

may be Washington's most important contribution to preventing spread

of the disease.

Once people know that AIDS is not a death sentence, they are more

willing to be tested, and once they know their HIV status they can

protect themselves and their sexual partners.

This knowledge is critical in light of the experts' judgment that more

than half the new infections in Kenya are in couples in which one

partner is HIV- positive.

The build-up of testing and treatment has been explosive. The number

tested in Kenya, with a population of 32 million, has more than

tripled since 2003 to 1.5 million last year. The number of AIDS

victims receiving drug treatment has rocketed to 70,000 from less than

10,000 in 2003.

The United States is also paying for programs aimed at changing

behavior. This year, it will spend $15.7 million on programs that

promote abstinence and faithfulness, and $7.8 million to prevent

sexual transmission of HIV, including condom distribution to high-risk

groups.

Seen from Kenya, the debate that rages in Washington over AIDS and sex

sometimes seems more a reflection of American culture wars than

African realities.

Conservative Republican leaders in the House of Representatives

successfully included a provision in the 2003 law requiring that a

third of AIDS prevention money go to programs that promote abstinence.

Under the guidelines, U.S. funds can be used in schools to educate

children 14 and younger about abstinence and faithfulness, with condom

education only for those 15 and older.

But the clear lines drawn in Washington can get blurry on the ground.

With U.S. financing, Population Services International, or PSI, is

organizing abstinence clubs for 10- to 15-year-olds here. Following

U.S. policy, PSI does not teach the children about condoms, but they

ask many questions about them.

Terry Mathenge, 19, a PSI volunteer in a Nairobi school, gave the

example of a 10-year-old girl who is slapped by a parent for asking

about the condoms she has seen in her home, then repeats the question

at a club meeting.

" It's better to tackle it head on, " Mathenge said, adding, " Speak the

truth and the truth will set you free. "

But she also said abstinence was important. " In the past, the voice of

condoms was louder than the voice of abstinence, and I'm glad that's

changing, " she said.

Among those listening to her one recent afternoon in Nairobi was

Gerson, an evangelical Christian who is a close adviser to

Bush. He told the young people assembled for a talk that the U.S.

debate was polarized between those who favor abstinence only and those

who say the promotion of abstinence alone is naïve.

" It seems like you're saying it's neither, " he told Mathenge.

Gerson later said the best programs set an ideal of sexual behavior,

but were realistic about human nature " and deal with young people

where they are, and sometimes that includes condoms. " The

congressional earmark on abstinence money was needed to correct an

overemphasis on condoms, he said.

Dr. Lawrence Marum, who heads the global AIDS program in Kenya for the

U.S. Centers for Disease Control and Prevention, said abstinence

programs help give girls the confidence to resist pressure for sex.

Since teenage girls are six times more likely to be HIV-infected than

boys, these programs are needed " to save their lives, " he said.

Scholars say much work remains to be done to figure out whether

programs that emphasize abstinence, fidelity and use of condoms are

effective. " We don't know what works, " said Kremer, an

economics professor at Harvard who is helping evaluate the programs,

" and it's not at all obvious. "

http://www.iht.com/articles/2006/05/18/news/aids.php