Terrance Heath

Bush's African Baby Boom

Filed By Terrance Heath | December 16, 2009 5:30 PM | comments

Filed in: Living, Politics
Tags: abstinence only education, baby boom, Bush administration, condom use, evangelical Christian, HIV/AIDS

Time and again, I’ve written about how the disastrous consequences of the Bush administration’s HIV/AIDS policy agenda in Africa.

Yes, Bush increased aid to Africa. Yes, the Bush administration’s global AIDS policy has been cited as a redeeming positive piece of his legacy; perhaps, even, the one aspect in which he may have done some good.

I beg to differ.

Back in November I blogged about Uganda losing ground in the battle against HIV as a resurgence of infections was reported. Earlier I blogged about an HIV prevention worker forbidden to mention condoms during a program in Uganda. This, at the same time that the country was experiencing a shortage of condoms and flooded with anti-condom propaganda from American fundamentalist groups, after the Bush administration weakened or eliminated restrictions to protect church-state separation and allow these groups to use tax dollars to run health care operations and spread their gospel on the side.

Just a couple of weeks before the Bush administration’s point man on abstinence-only abroad, Randall Tobias was outed as a patron of prostitutes, yet another report was published which spelled out what anyone who cared to already knew: abstinence-only education doesn’t work. Then we learned that abstinence-only education programs — funded by the Bush administration to the tune o f$176 million annually — are shot through with inaccurate information about condoms. (And that’s putting it mildly.)

You can see the entire nine minute documentary as well. But I think this woman’s story is compelling enough.

And that’s just from not know how to use a condom,because of never being told how and perhaps being misinformed about their effectiveness. But, really, I should say, deliberately misinformed, because we’ve known for years that abstinence-only doesn’t work. But some of don’t care. For them, it’s beside the point, as the post above indicated. As exemplified by the words of one American abstinence-only educator, they don’t are that it doesn’t work.

“People of God,” she cried, “can I beg you, to commit yourself to truth, not what works! To truth! I don’t care if it works, because at the end of the day I’m not answering to you, I’m answering to God!”

Later in the same talk, she explained further why what “works” isn’t what’s important—and gave some insight into what she means by “truth.” “Let me tell you something, people of God, that is radical, and I can only say it here,” she said. “AIDS is not the enemy. HPV and a hysterectomy at twenty is not the enemy. An unplanned pregnancy is not the enemy. My child believing that they can shake their fist in the face of a holy God and sin without consequence, and my child spending eternity separated from God, is the enemy. I will not teach my child that they can sin safely.”

In that sense, if you think about it, it works precisely because it doesn’t work. The only thing I’m not sure of is who’s more pleased over what happened to Juliet; God or the evangelical abstinence educator. One thing I am sure of, there’s a word for not only knowingly depriving people of information that might save their lives, but lying to them about it too. At least only one word I know.

I wrote that in 2007, about the HIV/AIDS epidemic in Uganda (yes, the country that is now seriously debating the death penalty for homosexuality, with the support of America’s religious right, denials notwithstanding and belated condemnation notwithstanding) as it related to the Bush administration’s abstinence-only policy. That same year Michelle Goldberg reported on similar circumstances.

Uganda’s initial response to AIDS addressed this, and urged partner reduction, or “zero grazing,” which was not the same as abstinence. Condoms played a role as well. “HIV infection rates fell most rapidly during the early 1990s, mainly because people had fewer casual sexual partners,” Epstein writes. “However, since 1995, the proportion of men with multiple partners had increased, but condom use increased at the same time, and this must be why the HIV infection rate remained low.”

Yet in a grotesque irony, PEPFAR funding has refashioned Uganda’s anti-HIV campaign to fit the distorted notions of American conservatives (and their allies among Uganda’s evangelical revivalists, who include First Lady Janet Museveni). “The policy is making people fearful to talk comprehensively about HIV, because they think if they do, they will miss funding,” says Canon Gideon, an HIV-positive Anglican minister from Uganda who has been a leader in the clerical response to the epidemic. “Although they know the right things to say, they don’t say them, because they fear that if you talk about condoms and other safe practices, you might not get access to this money.”

Today, Uganda’s infection rate is once again rising.

A few weeks before I came to Kenya, I spoke with Stephen Lewis, who until last year was the United Nations Secretary General’s Special Envoy for HIV/AIDS in Africa. I asked how he understood the balance between the harmful and the helpful aspects of Bush’s AIDS initiative. “It really is difficult to quantify,” he said. “The only thing one can categorically say is that the overemphasis on abstinence probably resulted in an unnecessary number of additional infections.” That this policy is celebrated as Bush’s greatest moral achievement shouldn’t be understood as praise.

And that’s not all the “overemphasis on abstinence” has caused.

Although it’s frequently portrayed as a continent decimated by epidemics, starvation and war, Africa is gripped by one of the greatest population explosions ever recorded. Over the past 60 years, while birth rates in the rest of the developing world declined by half, Africa’s population quadrupled to 1 billion, an epic baby boom that threatens to trap a generation of children in poverty and strangle economic progress across the world’s neediest continent.

Driven largely by low rates of contraception use and social pressures to have big families, sub-Saharan African women bear 5.3 children each on average, compared with 2.1 in the United States. The continent is producing a child every second, and by 2050 its population will reach 2 billion, projects the Population Reference Bureau, a demographic research center in Washington.

Nearly half of Africa’s people are 15 or younger, a youth bulge that will struggle to find jobs and support its own children, and perhaps condemn the continent to more disillusionment and violence.

In the sprawling slums of tin and mud that snake through Nairobi, the booming capital of Kenya, families of six, eight, even 10 or more children survive on one simple meal a day as jobless parents struggle to keep up with creeping food prices. Many days, they don’t eat at all.

And Africa’s “overemphasis on abstinence” is, at least in part, a result of the Bush administrations overemphasis on abstinence, and outright hostility to accurate information on condoms.

Under President George W. Bush, the United States withdrew from its decades-long role as a global leader in supporting family planning, driven by a conservative ideology that favored abstinence and shied away from providing contraceptive devices in developing countries, even to married women.

Bush’s mammoth global anti-AIDS initiative, the President’s Emergency Plan for AIDS Relief, poured billions of dollars into Africa but prohibited groups from spending any of it on family planning services or counseling programs, whose budgets flat-lined.

The restrictions flew in the face of research by international aid agencies, the U.N. World Health Organization and the U.S. government’s own experts, all of whom touted contraception as a crucial method of preventing births of babies being infected with HIV, the virus that causes AIDS.

The Bush program is widely hailed as a success, having supplied lifesaving anti-retroviral drugs to more than 2 million HIV patients worldwide.

However, researchers, Africa experts and veteran U.S. health officials now think that PEPFAR also contributed to Africa’s epidemic population growth by undermining efforts to help women in some of the world’s poorest countries exercise greater control over their fertility.

Let me put it this way. After years of the Bush administration’s global AIDS policy, we’re at a point where elephants have access to or are provided with contraceptives.

But for far, far too many people, this is not the case — in large part, because the U.S. bankrolled a policy that essentially ignored the reality that people will have sex, and which apparently rejected the notion that people don’t deserve to die for having sex, and thus information that could help them protect themselves and reduce risk for themselves and their partners shouldn’t be withheld from them.

A usual, when policy and policymakers are divorced from reality, people suffer. And they are suffering for it in Africa now.

That’s Bush’s legacy in Africa. And, sadly, ours.

As a former HIV/AIDS prevention educator, I know that the only way to do prevention education responsibly and effectively is to give people all the information they need so that they can make an informed decision. That includes abstinence, yes. If people chose that course then they should be supported and equipped with strategies for handling intimacy without compromising their decision regarding abstinence.

But it also means giving people all the information they need to protect themselves and their partners if they choose to be sexually active, so that no one becomes ill or dies because they didn’t know how to use a condom, or didn’t have access to them. It means not sitting in judgement on either decision, because people don’t deserve to die for having sex.

The religions right, the Bush base, doesn’t think this matters.

To understand why it doesn't matter, you only have to listen to abstinence-only advocates when they think that no one who opposes them is listening. Michelle Goldberg did that, and recounted it in Kingdom Coming: The Rise of Christian Nationalism; most strikingly in an excerpt that includes part of a speech by leading abstinence educator Pam Stenzel.

At Reclaiming America for Christ, Stenzel told her audience about a conversation she'd had with a skeptical businessman on an airplane. The man had asked about abstinence education's success rate--a question she regarded as risible. "What he's asking," she said, "is does it work. You know what? Doesn't matter. Cause guess what. My job is not to keep teenagers from having sex. The public schools' job should not be to keep teens from having sex." Then her voice rose and turned angry as she shouted, "Our job should be to tell kids the truth!"

"People of God," she cried, "can I beg you, to commit yourself to truth, not what works! To truth! I don't care if it works, because at the end of the day I'm not answering to you, I'm answering to God!"

Later in the same talk, she explained further why what "works" isn't what's important--and gave some insight into what she means by "truth." "Let me tell you something, people of God, that is radical, and I can only say it here," she said. "AIDS is not the enemy. HPV and a hysterectomy at twenty is not the enemy. An unplanned pregnancy is not the enemy. My child believing that they can shake their fist in the face of a holy God and sin without consequence, and my child spending eternity separated from God, is the enemy. I will not teach my child that they can sin safely."

Of course, as Goldberg points out, Stenzel isn't just teaching her child. She and others like her are teaching kids in Texas and across the country, as well as people in Africa where the AIDS epidemic has perhaps hit hardest. And, as in war, evidence doesn't matter for them. Evidence that kids are having more sex, have increased pregnancy rates, and are getting STDS more often doesn't matter.

But in fact, it's not beside the point. It's precisely the point. It's evidence of their success. To understand that, you have to turn Stenzel's statements around to understand the logic. AIDS is a victory. HPV is and a hysterectomy at twenty is a victory. An unplanned pregnancy is a victory. It adds up to victory because prevention is not the point.

It doesn't matter that proper condom use is proven to significantly reduce the chances of STD infection. It doesn't matter if teenagers are infected with HIV. It doesn't matter if more teenagers end up getting pregnant or getting others pregnant. It doesn't if it happens to anyone at all, because saving lives or preventing harm. It only matters that they are punished, and that they are not taught about how they might avoid the potential and possibly life-altering or even fatal consequences of sexual activity, because that would mean they can "sin without consequences." And that they must not do. Even if it means death.

But it does matter. It does. And it’s time we started acting like it does.


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The callousness and insanity of these abstinence-only zealots is continually astounding. Thanks for reminding us.

As I understand it, Uganda had already significantly reduced its HIV infection rate before HEPFAR ever came into the picture. Its strategy at the time was a scientifically-based program called "ABC" (Abstinence, Being faithful, Condoms).

Since all this has come under public scrutiny in the last month, I've wondered how history would regard Bush's efforts in this arena. My guess is that they will be seen as a well-intentioned humanitarian effort that went horribly wrong, just another huge administrative bungle like Katrina.

Christian conservatives have long prized pregnancy and sexually transmitted disease as punishments for sex outside of wedlock. When penicillin was discovered as a cure for syphilis, sermons were preached against it. Similarly, "The Pill" was vilified by Protestant clergy as well as Catholic.

Thank you, Terrance, for reminding us of these inhumane attitudes and how they affect both domestic and foreign policy. The quote by Pam Stenzel is truly frightening.

Yes, Bush's legacy in fighting HIV/AIDS in Africa was seriously compromised by his insistence on that 33% of the aid, 1 in every 3 dollars, be spent on abstinence education.

Just a small clarification re: Lynn David's comment: The original authorization of PEPFAR required that 33% of the 20% of funds recommended for prevention be directed to abstinence-only programs. While this was an enormous figure ($1 billion), it was only 6.67% of the total amount committed, not 1/3 of all PEPFAR funds.

I agree that critique of Bush-sponsored abstinence-only HIV prevention efforts is crucial (because they don't work, because they discourage access to family planning, etc.), but it's also important to be clear that the majority of PEPFAR funds go toward treatment and care for people living with HIV. It's a stretch to argue that these programs aren't an "aspect in which he [Bush] may have done some good." Ask some of the people who are alive because they are receiving ARVs paid for with PEPFAR funds if they think the program is doing "some good" or not.

I'm not suggesting that Bush's legacy on this issue is untainted or that PEPFAR hasn't been hobbled by ineffective, unsound and politically-motivated restrictions, but I do think it's important to acknowledge that the program has been instrumental in saving lives. Certainly we should demand that, in the future, funds are not wasted on the kinds of misguided efforts highlighted in this post.

Thank you for the correction. I am embarrassed to have gotten the figure wrong, but grateful for the better understanding.

Sorry, that should read "a small clarification re: Lynn Miller's comment"! Too hasty with the "submit" button...

Before we go castigating Bush for his policies in Africa, it needs to be said that the ABC program was also instituted here in the States too. It's not like he did anything there that he wasn't trying (or succeeding) to do here as well.

Was ABC initially part of Bush's African policy?

Terrance, thanks for pointing out the population spike resulting from church obstruction to condom use in Africa. It hasn't gotten much news coverage. Conservative Protestant groups are actually adopting the "no birth control" policy that used be typical only of Catholics.

It's disappointing (but not surprising) that Obama has done so little to limit "faith based" leverage on HIV/AIDS prevention in Africa. Under the new PEPFAR authorization, 50 percent of funds can still be used in "abstinence-only" type programs.

It's very disturbing to see the degree to which our new President is leveraged by these same people that leveraged Bush.