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The Less They Know, the Better: Abstinence-Only HIV/AIDS

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The Less They Know, the Better: Abstinence-Only HIV/AIDS Human Rights Watch March 2005 Vol. 17, No. 4 (A) The Less They Know, the Better Abstinence-Only HIV/AIDS Programs in Uganda I. Summary ..................................................................................................................................... 1 II. Recommendations ................................................................................................................... 6 To the Government of Uganda.............................................................................................. 6 To the Government of the United States ............................................................................. 8 To the U.S. Congress ........................................................................................................... 8 To the Presidential Emergency Plan for AIDS Relief (PEPFAR) country team in Uganda ................................................................................................................... 10 To the Office of the Global AIDS coordinator (OGAC) of the U.S. government.......................................................................................................................... 11 To all other donors to Ugandan AIDS programs, including the Global Fund and U.N. agencies ................................................................................................................... 11 III. Methods................................................................................................................................. 12 IV. Background ........................................................................................................................... 13 Young people and HIV/AIDS in Uganda.......................................................................... 13 The human right to HIV/AIDS information .................................................................... 16 Uganda and the U.S. Global AIDS Initiative ..................................................................... 18 V. Findings on Abstinence Education in Uganda.................................................................. 24 Uganda’s official “AB” policy............................................................................................... 25 Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) ................................................................................................................................. 29 PIASCY in primary schools.............................................................................................. 29 PIASCY in secondary schools.......................................................................................... 37 Abstinence programs out of school (including after-school programs)......................... 41 Faith-based organizations promoting abstinence .............................................................. 43 Uganda Youth Forum........................................................................................................ 44 Makerere Community Church.......................................................................................... 46 Family Life Network.......................................................................................................... 48 VI. Especially Vulnerable Persons............................................................................................ 49 Sexually active young people................................................................................................. 49 Orphans and children affected by AIDS............................................................................. 52 Refugees, internally displaced persons, and children affected by conflict ..................... 55 Discrimination based on sexual orientation........................................................................ 57 VII. Restrictions on Condoms.................................................................................................. 61 VIII. Arguments For and Against Abstinence-Only Programs........................................... 67 Distortion of Uganda’s HIV prevention efforts ................................................................ 68 Studies discrediting abstinence-only approaches in the U.S............................................. 72 IX. Government Response........................................................................................................76 X. Conclusion .............................................................................................................................. 77 Acknowledgments....................................................................................................................... 79 I. Summary With funding coming in now, for any youth activities, if you talk about abstinence in your proposal, you will get the money. Everybody knows that. —A teenager working with youth in Kampala We don’t think abstinence is really working in our communities. We work with children in primary five through seven who are engaging in sexual activities. We always come with the message to delay sexual debut. But for most children here, this is not enough. —Youth leader in Kabarole Widely hailed as a leader in the prevention of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), Uganda is redirecting its HIV prevention strategy for young people away from scientifically proven and effective strategies toward ideologically driven programs that focus primarily on promoting sexual abstinence until marriage. Although endorsed by some powerful religious and political leaders in Uganda, this policy and programmatic shift is nonetheless orchestrated and funded by the United States government. Pioneered in the United States in 1981, “abstinence until marriage” programs (also known as “abstinence only” programs) teach that abstaining from sex until marriage is the only effective method of HIV prevention and that marriage between a man and a woman is the expected standard of human sexual behavior. Numerous U.S.-funded studies have shown these programs to be ineffective at changing young people’s sexual behaviors and to cause potential harm by discouraging the use of contraception. The effect of Uganda’s new direction in HIV prevention is thus to replace existing, sound public health strategies with unproven and potentially life-threatening messages, impeding the realization of the human right to information, to the highest attainable standard of health, and to life. Despite a reported dramatic drop in HIV prevalence in Uganda in the 1990s, from an estimated 15 percent nationally in 1992 to 6 percent in 2002, Ugandans of all ages continue to face a high risk of HIV infection. Ugandans tend to start having sex at an early age and with little sex education. Demographic and health surveys show that over half of Ugandan girls have had sex by age seventeen, usually with someone older. Among girls who marry before the age of eighteen, most marry men who have been sexually active for several years, often without having used condoms. These and other factors make it vitally important to educate young people about HIV and to caution girls at an early age about the risks of HIV infection in marriage. Abstinence-until-marriage 1 HUMAN RIGHTS WATCH, VOL. 17, NO. 4 (A) programs fail on both of these counts. Not only do they fail to offer young people information about condoms and safer sex on the grounds that this would undermine the goal of abstinence, they additionally promote marriage to young people while withholding information on its inherent risks. Uganda’s increasing embrace of abstinence-only approaches is manifest on many levels, from the office of the president to the halls and classrooms of the nation’s primary and secondary schools. In November 2004, the Uganda AIDS Commission (UAC) released a draft “Abstinence and Being Faithful (AB)” policy to guide the implementation of abstinence-until-marriage programs throughout the country. Intended as a companion to the country’s existing strategy on the promotion of condoms, the policy in fact undermines condoms as an HIV prevention measure and suggests that promoting condoms alongside abstinence messages would be “confusing” to youth. The document contains virtually the same definition of “abstinence education” as in legislation governing abstinence-only programs in the United States, suggesting that Uganda’s programs will replicate programs that have been proven ineffective in numerous U.S. states. As an HIV prevention strategy for married people, the document proposes compulsory HIV testing for all couples intending to marry—a strategy that not only infringes on the right to informed consent but, as discussed further below, fails to address the ongoing risk of HIV faced by married women. In 2001, the Government of Uganda launched an ambitious program to expand HIV prevention education to all of the country’s primary and secondary schools. Funded by the United States and known as the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY), the program provides abstinence-until-marriage messages through a series of assembly messages, classroom activities and youth rallies. PIASCY materials were developed through a series of stakeholder meetings in Uganda that included public health experts, experienced HIV/AIDS educators, community and faith-based organizations, and others. Numerous participants observed that religious groups exercised an effective veto over the inclusion of objective
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