Category: public health

PEPFAR contributing to spread of AIDS

The Washington Post recently reported that the AIDS rate is rising in Uganda. Peter Piot, director of UNAIDS, attributes the increase (from 5.6 to 6.5 percent in rural men and from 6.9 to 8.8 percent in rural women) to “a period of ‘decreased credibility’ of condoms, the consequence of messages by some fundamentalist groups, a run of defective condoms and then a shortage of condoms.”

This article comes on the heels of the Global Fund’s rejection of a Ugandan grant proposal for $111 million to fight HIV/AIDS. Corruption and poor management ripple throughout Uganda’s handling of its HIV/AIDS programs — the last two years have been a recurring pattern of fraud, lies and incompetence. What concerns me even more, however, is the United States’ ineffectual response to a disease that is threatening to engulf the nation yet again.

A full thirty-three percent of the money USAID spends on HIV prevention goes towards abstinence. In 2004, the number of condoms provided by USAID’s PEPFAR (the President’s Emergency Plan for AIDS Relief) dropped by 60 percent, a decrease which coincided with the Ugandan government’s confiscation of all free health-center condoms due to concerns about their quality; the condoms were tested and proven to be perfectly usable but were never re-released. These two events triggered a shortage of condoms in the country and widespread doubt of their effectiveness from which Uganda has not yet recovered.

The U.S. attitude towards condoms is frightening. In an April 2005 meeting of the International Committee of the House of Representatives to review the U.S. response to the global AIDS crisis, Ted Poe (R-TX) 25% more effective than natural family planning (the method USAID is pushing with Janet Museveni).

Still, USAID is increasingly funding abstinence-only programs to the detriment of more comprehensive, more effective organizations: in November 2004, PEPFAR overrode the recommendations of their Technical Review Committee and funded an organization deemed unsuitable for grant money. The pro-abstinence organization, Children’s Aid Fund, has close ties to both the Bush administration and to Janet Museveni, which was seen as justification enough to fund their program. Furthermore, the U.S. has been steadily decreasing the amount of money it gives to international organizations that provide reproductive health services — in 2002, the government withdrew over $36 million from the World Health Organization and the UN Population Fund.

AIDS is making a comeback in Uganda, and U.S. efforts are doing little to stop it. USAID needs to get their act together and start providing factual, practical information about STDs, STD prevention and reproductive health instead of funding misguided projects that skirt the issues at hand.

plastic beads as birth control? how Janet missed the mark

Last week Ugandan First Lady Janet Museveni introduced a system of birth control called Moon Beads. Designed to help women track their menstrual cycles and, by doing so, avoid sex when fertile, the beads are part of a five-year family planning program sponsored by the United States Agency for International Development. Museveni encourages women to “work selflessly” to use the beads.

The Ugandan birth control system desperately needs a revision. Uganda is currently the fastest-growing country in the world, with a population that could exceed that of Russia or Japan by 2050. This population explosion threatens to permanently mire the nation in poverty, increasing conflicts over land and resources in an already unstable environment. One half of all pregnancies in Uganda are unintended, and one in four results in an abortion — almost twice the abortion rate in East Africa as a whole.

Over one third of all women have expressed their desire for contraception, but only one in five married women actually has access to it. Oral contraceptives cost approximately 8 cents per month — a price affordable for much of the Uganda population — but clinics are few and generally inaccessible, making this option unavailable to most women. Condoms are theoretically free — to men only — in clinics, but they are often poorly stored, causing them to expire before they can be distributed. In 2004 the government recalled all free health clinic condoms, citing concerns about their quality. The condoms were checked and determined to be fine, but the government did not redistribute them, causing a shortage that has raised prices for the remaining stock to nearly 20 cents per condom.

Though Mrs. Museveni’s plan recognizes the need for better family planning in Uganda, it is sorely misguided. The natural family planning method is intended for monogamous couples and requires the women to carefully observe her periods for three to six months before implementing the system (the Moon Beads are intended to be used immediately and do not account for varying menstrual cycles). Even then, the method is only 75-90% effective, as compared to 95-99% for oral contraceptives and 86-98% for condoms.

Furthermore, the reality is that over 25% of men and 13% of women in Uganda admit to having sex with more than one partner (this does not include rape statistics, which are especially high in the north). Moon Beads and other methods of natural family planning do nothing to prevent the spread of HIV and other STDs. What Uganda needs if it is to avoid unwanted pregnancies, further lower the prevalence of AIDS, curb its wild population growth and prevent the medical complications that over 80,000 women face each year as a result of abortions is not a string of colored beads but better access to both information about birth control methods and to the methods themselves. Instead of encouraging women to use a method that is often ineffective and can contribute to the spread of disease, Mrs. Museveni should campaign to open more clinics throughout the country and to make both condoms and oral contraceptives widely and easily available to women.