* "Abstinence works if people can abstain, but I don't think people should die because they have sex" *
* "There is no doubt the condom crisis in Uganda is being driven by [US policies]," said Mr Lewis. "To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa." *
* "In reality, people have sex ... much as conservative evangelists in the US might prefer that they didn't," *
Sarah Boseley Thursday December 1, 2005 The Guardian
Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.
The statement, released for World Aids Day today, emphasises the fundamental importance of condoms, sex education and access to reproductive health services. "We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness," it says.
While the US is not named, there is widespread anxiety over the effect of its pro-abstinence agenda in countries such as Uganda, where statements by Janet Museveni, the president's wife, and alleged problems with supply have led to a serious shortage of condoms.
The US has pledged $15bn (£8.6bn) over five years to fight the disease, most of which is channelled through the President's Emergency Plan for Aids Relief (Pepfar). Pepfar grants come with conditions, however - two thirds of the money has to go to pro-abstinence programmes, and it is not available to any organisations with clinics that offer abortion services or even counselling. The US is also opposed to the provision of needles and syringes to drug users on the grounds that it could be construed as encouraging their habit.
But the statement from 22 EU member states, released at a meeting under the UK presidency in London yesterday, calls on developing world governments to use every prevention tool, from condoms to clean needles to sexual health clinics, in a bid to slow down the spread of HIV. UNAids' latest figures show 40 million people are now infected, and the rate is rising as fast as ever.
"We, the European Union, firmly believe that, to be successful, HIV prevention must utilise all approaches known to be effective, not implementing one or a few selective actions in isolation," it says.
The international development secretary, Hilary Benn, told the Guardian that the evidence had shown what worked, from tackling stigma to supplying condoms and clean needles. "It is very important that those messages are heard loud and clear by everybody," he said.
Asked whether the UK disagreed with the US emphasis on abstinence, he said: "Abstinence works if people can abstain, but I don't think people should die because they have sex. We need to make sure people have all the means [of prevention] at their disposal - condoms and clean needles. It includes education and access to sexual and reproductive health services. We are very clear about that."
In August the UN secretary general's special envoy for HIV/Aids in Africa, Stephen Lewis, accused the* *US of "doing damage to Africa" by cutting funds for condoms in Uganda while promoting abstinence. "There is no doubt the condom crisis in Uganda is being driven by [US policies]," said Mr Lewis. "To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa."
Only 35m condoms were distributed in Uganda between October 2004, when the government said there was a problem with the quality of the stock, and August this year, compared with 120m in previous years.
Uganda has historically been cited as one of the HIV/Aids success stories and experts generally agree it was partly the availability of condoms that brought the infection rate down. But Mrs Museveni has said condom distribution pushes young people into sex and recently equated condom use with theft and murder in an interview with the BBC World Service. The shift in government thinking is being linked within Uganda to Pepfar.
Aids activists in the UK were pleased by the EU stance. "Activists have been warning for years that the US prevention policy is reckless and could cost lives," said Fiona Pettit of the UK Consortium on Aids and International Development. "The relentless promotion of abstinence only is already having an impact in countries like Uganda. Abstinence only is an unrealistic policy in many communities and a one-size-fits-all approach simply won't work."
"In reality, people have sex ... much as conservative evangelists in the US might prefer that they didn't," said Andrew George, the Liberal Democrat spokesman on international development.