Sex education

JOHANNESBURG, 6 March 2007 (IRIN) - Alarming figures released by a South African provincial education department indicate that schoolgirl pregnancies have doubled in the past year, despite a decade of spending on sex education and AIDS awareness.

It is only when we have an Africa where sexuality discourse is not a taboo that we will manage Aids, unsafe abortion, maternal mortality and sexually transmitted infections and prevent future catastrophes. Dr Uwemedimo Esiet spoke to Jane Godia on the way forward for Africa.

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 Implementers 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.

African countries have failed to meet prevention targets agreed upon in 2001 at the United Nations General Assembly's Special Session on HIV/AIDS (UNGASS), according to a statement issued recently by over 80 representatives of African civil society.

Educators feel condom distribution will undermine abstinence messages.

South Africans are so concerned with HIV and AIDS that they pay little attention to other sexually transmitted infections (STIs), according to the 2003 Durex Global Sex Survey. The online survey, which was released on Tuesday, polled nearly 4 000 South Africans on their sexual habits. The survey found 64 percent of South African respondents saw HIV and AIDS as the most important sexual health issue. Only five percent were concerned about STIs. This is in contrast with the global trend where 29 percent of respondents saw STIs as the most important sexual health issue, while HIV and AIDS and contraceptive use ranked joint second. South Africans were however taking measures to protect themselves from HIV and AIDS and STIs, with 68 percent of those surveyed having only one sexual partner. On the other hand, 19 percent of the respondents were still prepared to have unprotected sex with a new partner. Those surveyed were not getting their information about sex from experts such as doctors. Instead South Africans turned to magazines (22 percent), books (21 percent) and friends (17 percent). Sex expert Dr Elna McKintosh told reporters the research was important as it created awareness of safer sex, added to sex education and put across the message that sex can be fun. In South Africa we have this message that sex equals AIDS equals death, she said, adding that this created many sexual problems. More than 150 000 people from 34 countries took part in the worldwide survey.(Source: SAPA, 25 November 2003) Link //\// http://www.durex.com/index.html The 2003 Global Survey is the largest research project undertaken by Durex. Now in its seventh year, the survey has tripled in size since its launch and now covers 34 countries. This is the second year that the research has been carried out via the durex.com website with more than 150,000 people completing this youth-focused survey.

Religious conservative elements in the Republican party have forced amendments to the United States Global HIV/AIDS bill that will require one-third of all prevention funds given to African countries to be used in promoting sexual abstinence. The bill was passed by the US House of Representatives on May 1, and will go to the Senate for consideration within the next month. The bill will provide $3 billion a year for five years, 55% of which is to be spent on treatment. It aims to reach 2 million people with anti-retroviral treatment, prevent 7 million new infections, and provide assistance to 10 million HIV-infected individuals and children orphaned by the disease. The initiative focuses on 12 African countries - Botswana, Ivory Coast, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia - as well as Guyana and Haiti in the Caribbean. The bill also earmarks $1 billion in 2004 for the Global Fund to Fight AIDS, TB and Malaria providing that the US contributes no more than one-third of the Fund’s budget in that year. However, this sum will have to be approved by the House and Senate Appropriations Committees, which may decide that the allocation, more than President Bush asked for, is too generous. (Source: Keith Alcorn, Aidsmap, 2 May 2003)

One third of $15 billion US AIDS budget must be spent on abstinence education. Religious conservative elements in the Republican party have forced amendments to the United States Global HIV/AIDS bill that will require one-third of all prevention funds given to African countries to be used in promoting sexual abstinence. The bill was passed by the US House of Representatives on May 1, and will go to the Senate for consideration within the next month. The bill will provide $3 billion a year for five years, 55% of which is to be spent on treatment. It aims to reach 2 million people with anti-retroviral treatment, prevent 7 million new infections, and provide assistance to 10 million HIV-infected individuals and children orphaned by the disease. The initiative focuses on 12 African countries - Botswana, Ivory Coast, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia - as well as Guyana and Haiti in the Caribbean. The bill also earmarks $1 billion in 2004 for the Global Fund to Fight AIDS, TB and Malaria – providing that the US contributes no more than one-third of the Fund’s budget in that year. However, this sum will have to be approved by the House and Senate Appropriations Committees, which may decide that the allocation, more than President Bush asked for, is too generous. The bill’s prevention component specifies that money should be spent on programmes modelled on Uganda’s HIV prevention campaign, which is argued to have reduced prevalence and incidence dramatically over the past ten years. The programme emphasises three forms of behaviour change: abstinence, sexual fidelity and use of condoms. However, Republicans have insisted that abstinence should be emphasised, with an amendment that requires such campaigns to be funded, regardless of the wishes of local people. Vice President Dick Cheney lobbied House members in support of the amendment, proposed by Republican Representative Joe Pitts of Pennsylvania. Organisations which oppose condom use on religious grounds will now be able to receive funding to run prevention activities that accord with their religious beliefs. Whilst the bill does forbid HIV prevention money to be spent on abortion counselling and services, it does not prevent organisation that provide such services from receiving money – but they must be kept separate. (Source: aidsmap 2 May, 2003)

A former World Health Organization researcher has said Uganda's ABC strategy to combat HIV/AIDS --Abstinence, Be faithful, use Condoms, in that order -- could cut HIV infections by 80 percent if expanded across Africa, according to a feature in today's Washington Times. International aid workers have rebuffed the policy, calling it a cover for a right-wing agenda. Since Uganda launched the strategy in 1986, HIV/AIDS rates there have steadily declined, while infection rates in much of the rest of Africa have skyrocketed. Under the program, HIV prevalence among pregnant women -- a common yardstick for assessing HIV transmission in a population -- dropped in Uganda from 21 percent in 1991 to 6 percent in 2001. Some experts said the key to the program's success has been in changing Ugandans' sexual behavior by focusing on sexual fidelity, something international aid workers reportedly were doubtful about. According to epidemiological data, the focus on faithfulness may be the most important ingredient in the overall program's success. Women had to take responsibility for their own lives, said Sophia Mukasa Monico, a Ugandan who is a senior AIDS program officer for the Global Health Council. Wives told their husbands to be faithful, use a condom, even in marriage, or there would be no sex. Many women in Uganda had celibate marriages or moved out on their own, she said, adding that today, 60 percent of Ugandan women live on their own or are self-sufficient. The number of men reporting two or more sexual partners plummeted from more than 70 percent in 1989 to 15-20 percent in 1995. Among women, that figure dropped from 18 percent in 1989 to 2.5 percent last year. According to the Washington Times, Ugandan President Yoweri Museveni began the program after almost one-third of his top military officers tested positive for the virus during a trip to Cuba in 1986. Later that year, Cuban President Fidel Castro reportedly took Museveni aside and told him, Brother, you've got a problem. Uganda mobilised as if it were World War III, said Elaine Murphy, a global health specialist at George Washington University. They did this without donor money, on their own. At the time, the AIDS establishment laughed at him. ... But Museveni was right, said Norman Hearst, an epidemiologist at the University of California, San Francisco. I've had people tell me that the only reason they were successful in Uganda is that there were no European or American experts there. A more common international approach that relies heavily on condom distribution has been deemed largely a failure by some. There really is not any clear evidence that condom promotion by itself has been able to roll back the AIDS epidemic in any country where there is widespread transmission, Hearst said. The historical approach to HIV has been little A, little B and big C. The public health community at large did not believe in abstinence, but Africans were far ahead of the worldwide public health community on this, said Anne Peterson, a U.S. Agency for International Development global HIV/AIDS official. The core of Uganda's success story is big A, big B and little C. But U.S. HIV/AIDS workers have reportedly been reluctant to implement ABC-style programs, which have been endorsed by President George W. Bush and many faith-based organizations, for fear ABC is a cover for an abstinence-only policy. Hearst said that those who oppose ABC are just as religious in their beliefs as missionaries, and no more constructive. They are willing to let Africans die rather than embrace something that goes against their way of life. The Washington Times reports that ABC may be gaining more acceptance. ABC programs launched in Senegal and Zambia are reportedly showing positive results, and AID in December embraced ABC. Thinking people have to ask the question, 'What works? What saves lives?' said Murphy (Source: Washington Times, March 13).