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.)
“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.
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.
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.
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.
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.