Abstinence and Being Faithful: Futile Strategies in PEPFAR HIV programming?

Certain cultural factors in resource limited settings pose significant challenges to prevention efforts and must be addressed to make it possible for people (especially youth) to adopt behaviours such as abstinence, being faithful, and correct and consistent condom use (ABC) according to several presentations at the 2006 PEPFAR Implementer’s Meeting held mid-June in Durban, South Africa. Some PEPFAR-funded prevention programmes are attempting to change cultural norms around polygamy, cross-generational sex, male attitudes towards women, sexual coercion and violence, taboos surrounding discussing sex, economic pressures and social expectations to have sex. Failure to confront these challenges could lead to the failure of prevention programmes, and could also have extremely negative unintended consequences — including, potentially, the rape of girls known to be abstinent. This issue was addressed during both plenary talks on prevention. “When communities set expectations about the sexual behaviour of young people, they must also create an environment where that behaviour is possible,” said David Stanton, a clinical epidemiologist at USAID.

“Although the ABC approach is an important strategy, there are a number of challenges to this approach,” said Dr Dorothy Mbori-Ngacha of CDC Kenya. “The reality is that for many women, these strategies are hard to implement, and fail to offer real options that [fit] into their daily reality.” “For example, abstinence is meaningless when women and girls feel they must resort to sex as a matter of survival, or when sexual activity is coerced. “Likewise, being faithful is an effective strategy, only if both partners are faithful and none of them is infected. Condoms, though effective, are a male decision, with women having very little power to negotiate their use due to their dependency on their male partners.” “And finally, most women have limited access to female controlled methods that will enable them to control their own sexual health. We therefore need to recognise these limitations and make sure that our prevention programmes use the ABC approach as a platform to incorporate other prevention strategies.”

The continued debates around ABC and its failure to address women's and girl's concerns in the context of the HIV/AIDS pandemic are beginning to equate the sounds of a scratched record - each scratch and screech finer the next time round !!! PEPFAR and other notable donors may carry their own political intentions forward with the ABC preaching - and of course as a Baha'i I fully support the ABC strategy thoroughly - BUTTTTTTTTTT its simply not currently feasible, we have no structures, no mechanisms and in majority of instances we have not won over the minds, beliefs and attitudes of the masses and those that control social survival. The justifications also seem to be changing goal posts ever so regularly....SO where are the actions, and with the upcoming XVI International AIDS Conference in Toronto, Canada 13-18 August 2006...whose theme is "Time To Deliver", my question remains....WHEN will the delivery become a reality?

To those of us who shall be in Toronto - especially all Women of Africa - Women of Substance - lets drive the agenda and Demand A Delivery.......