Shortly after the turn of the 21st century, when it seemed the condom wars would never end, the AB message received an enormous boost with the onset of the President Bush’s Emergency Plan For AIDS Relief (PEPFAR), based entirely on what is known as “The Uganda Model” for stopping the spread of the virus.
PEPFAR infuriated the UN-based public health community. In 2005, Dr. Ruben DelPrado, the Uganda coordinator for UNAIDS was asked to leave the country because of his vociferous objection to a public health policy that reduces an emphasis on condoms and for lobbying for homosexual rights in a nation where homosexuality is illegal. Speaking from his office in Geneva after l
eaving the country, Dr. DelPrado told me, “That government is making a huge mistake. There’s no way an ideology can be used to fight an epidemic.”
“By ideology, you mean marriage?” I asked.
“Yes. Marriage. Being faithful. It is against human nature,” DelPrado stated. “You cannot stop promiscuity in that culture. The only way to fight the spread of AIDS there is to provide condoms.”
The idea for PEPFAR was introduced in 2003 largely on the results of research undertaken for USAID by Harvard’s Edward C. (Ted) Green, Dr. Rand Stoneburner and Dr. Norman Hearst. In a presentation before the Medical Institute for Sexual Health in Austin, TX to Ambassador Randall Tobias, the Global AIDS Coordinator and approximately 35 appointees of the Bush Administration from the White House and the Department of Health and Human Services, Green stated that worldwide, 8,000 people die of AIDS every day, the equivalent of 20 fully-loaded Boeing 747s crashing, killing everyone on board, day after day, year after year. He told how, at the urging of USAID, more than 100 developing countries had completed the formulation of strategic AIDS plans by December, 2002.
Heralded as one of the most objective presentations on dealing with the AIDS pandemic, participants dealt only with statistical fact, openly avoiding issues such as “Is my personal or corporate ideology or time-honored presupposition threatened? Is my personal or corporate prestige threatened? Is my person or corporate financial future threatened? Was a program developed by me or my group of our friends?” The purpose of the presentation was to answer the question: “Is there one place in the world, shown by scientific study, to have reversed a generalized HIV epidemic for an extended number of years?” The answer was yes. Uganda. As Rand Stoneburner stated: “Uganda is the only country in the world where HIV prevalence in a heterosexual population has undergone such a dramatic and sustained decline (a decrease of HIV prevalence in pregnant women from 30% to less than 6% 1990-2000)
Norman Hearst, Professor of Epidemiology and Biostatistics at the University of California, San Francisco School of Medicine reported: “There is no known example of a country that has turned back a generalized heterosexual epidemic of HIV primary through condom promotion. Contrary to popular belief, there is little evidence to show that all this condom promotion we’ve been doing all these years in African countries with generalized epidemics has made any difference.
“Fortunately for Uganda, there weren’t a lot of foreign experts then telling them how to do things in the late 1980s and early 1990s,” he added. “So they did things their own way. That’s when Museveni was going around with his bullhorn telling people about Zero Grazing and, in the circles I travel (the so-called AIDS experts), everybody thought he was a clown, a buffoon. Everybody made fun of him. Well, it turns out he was exactly right and we were all wrong.”
Soon after this conference, President George Bush launched PEPFAR as a $15 billion fund to support an abstinence-first education effort in seven African nations. The program was ultimately expanded to include many Caribbean countries. Deemed successful by USAID, the President proposed doubling the size of the program in 2007. The funding at last gave Uganda and other countries the tools and techniques they needed to present its case in as bold a fashion as the condom providers.
Comments