ABC (Abstinence) Program Gets Mixed Reviews genre: Gaylingual & Little Red Ribbon-Hood & Six Degrees of Speculation

Comprehensive sex education

The Bush administration's ABC program...a plan to combat HIV that promotes abstinence until marriage, being faithful, and condoms if necessary is being met with mixed reviews at the XVI International AIDS Conference in Toronto. Thought Theater previously reported on the programs negative implications in Uganda and it appears that other African countries are expressing concerns about the program. The full Washington Post article can be found here.

More important, the evidence that ABC is changing behavior is quite spotty, with condom use appearing to be the most acceptable of the three forms of advice.

ABC is a centerpiece of the Bush administration's $15 billion, five-year plan to fight AIDS in 15 target countries, most of them in Africa.

The Bush program stipulates that one-third of the money spent on preventing sexual transmission of the virus must go for "abstinence until marriage" messages.

The interim evaluation of efforts in Botswana, supported by the U.S. Centers for Disease Control and Prevention, found that much of the ABC message was getting through, but that it was not making much of a difference.

While I'm not opposed to abstinence messages, I simply don't see such programs as an answer to HIV. Abstinence programs require 100% compliance to be successful...an unrealistic objective when it comes to sex. All too often such programs convey a moral judgment which makes the objective use of condoms more difficult. People often make poor decisions when they equate their behavior with a morally unacceptable activity. Instead of being thoughtful and deliberate, they often act impulsively...which is a dangerous way to confront HIV. Condom use has to be promoted without moral judgment in order to be effective...if using a condom is seen to be part of an immoral act; it is less likely to be employed. The reporting seems to support this argument.

The people who had been counseled were also twice as likely to have been tested for HIV in the previous year, and to have discussed that possibility with a sex partner. However, they were just as likely to have a partner outside marriage as the people who had not gotten a visit from a counselor, and they were no more likely to be using a condom in those liaisons.

"People who were exposed to the program had greater knowledge but were no more likely to be practicing ABCs," said Margarett K. Davis, director of the "BOTUSA" collaboration between the two countries.

A survey of 1,400 Kenyan teenagers found a fair amount of confusion about ABC's messages. About 15 percent of the girls and slightly less than half the boys had had intercourse.

Half of the teenagers could correctly define abstinence and explain why it was important. Only 23 percent could explain what being faithful meant and why it was important. Some thought it meant being honest, and some thought it meant having faith in the fidelity of one's partner. Only 13 percent could correctly explain the importance of a condom in preventing HIV infection. About half spontaneously offered negative opinions about condoms, saying they were unreliable, immoral and, in some cases, were designed to let HIV be transmitted.

Some studies in the U.S. suggest that the comprehensive ABC education has reduced the likelihood that sixth and seventh grade students would engage in sexual intercourse. The study data covers a two year period and the data suggested that only 48 percent of those given abstinence only messaging engaged in sexual intercourse compared with 61 percent of those given a comprehensive message that included condoms. Missing from the data I reviewed is how many of those who did engage in sexual intercourse practiced safer sex with the use of a condom. I contend that it is possible to use fear and moral judgments to reduce sexual activity (or the willingness to report having engaged in such activity)...but for how long and at what risk are the essential questions that are seemingly being ignored.

If the majority of the 48 percent abstinence only group that engaged in sexual intercourse did so without condoms while a majority of the 61 percent comprehensive message group (including condom education) that engaged in sexual intercourse did so with condoms, then clearly the latter group was better served and the likelihood of transmitting HIV or other sexually transmitted diseases...as well as the potential to become pregnant...were diminished in this group.

One of the prevailing problems with much of the current statistical data being generated is that it is conducted with bias by groups that are the beneficiaries of this type of government funding. Further, proving the outcome desired by the Bush administration assures that the programs continue regardless of the actual realities. Unless the research fully extracts all the facts, it is impossible to objectively evaluate the benefits or the shortcomings of these programs. In fact, to actually ascertain the benefits of an abstinence only program, one would need to track these children until they were married. At the same time, one single failure during the years until that happens may well prove deadly.

Ironically, the Bush administration understands and likes to say that the U.S. has to be right 100 percent of the time to prevent a terrorist success. They tout that fact to demonstrate the daunting task of protecting America and yet they are employing the same model...by choice...to protect America's youth. We may have to live with that reality when it comes to terrorism but with regards to the health and wellbeing of young Americans such a concession is unconscionable.

Daniel DiRito | August 15, 2006 | 9:43 AM
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