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Last Updated: Monday, 12 July, 2004, 13:57 GMT 14:57 UK
Bush's affair with abstinence
By Clare Murphy
BBC News Online

The foreign forays of the Bush administration have rarely been without controversy, and the president's global Aids initiative is no exception.

A pledge of abstinence ring
Bush has thrown his weight behind the US abstinence movement

It may be the most expensive effort ever mounted by a government to fight Aids internationally, but the $15bn programme comes with strings attached - notably in diverting a third of the funds to faith based groups which preach abstinence.

Its critics see this provision as thinly disguised Christian moralism which is at best paternalistic, and at worst a sure-fire way of endangering lives by failing to place sufficient emphasis on condoms.

But to its proponents, pushing abstinence is the only way to tackle the disease in a continent like Africa where, as they see it, campaigns promoting the use of condoms have failed to halt the disease.

Home and Away

The US - in theory at least - practises what it preaches.

Under Mr Bush, who is himself a born-again Christian, a multi-million dollar fund has been established for abstinence-only education to teenagers.

Under the terms of the fund, schools and other groups may not use the money for classes which also promote the use of other forms of birth control.

If contraception is mentioned, it can only be done in reference to its likelihood to fail both in terms of protection from pregnancy and sexually transmitted diseases.

While disparaged by some, the decision to sponsor such education has on the whole prompted little controversy in the US, and indeed has been embraced by social conservatives - a key element of Mr Bush's electorate.

But efforts to export this policy - whose efficacy in preventing both pregnancy and disease is debatable - have proven more contentious.

Aids patient in Bangkok, Thailand
There are doubts about the effectiveness of abstinence promotion

Some sexual health workers contend that trying to change sexual behaviour in African societies that have long been promiscuous and polygamous is a waste of time; people can however be persuaded to use condoms, they argue, rendering that approach an altogether more effective one.

Yet supporters of abstinence programmes have leapt on the example of Uganda as evidence that its promotion can work.

Uganda has waged one of the world's most successful battles against the spread of Aids - bringing the infection rate down from 30% in the 1990s to around 6% last year.

The country's president, who has been credited with the decline, puts it down to the government's so-called "ABC" method - which stresses abstinence first, followed by fidelity and lastly, condom use.

Don't shout

The Bush Aids fund does however also make provision for the distribution of condoms.

While some liberal Democrats fought against the abstinence-only approach when the fund was approved by Congress last year, many were satisfied that the legislation acknowledged that condoms had a role to play in preventing disease.

In fact, according to research cited in the New York Times, the US will supply more than 550 million condoms to the developing world this year.

"We've more than doubled condom availability during this [Bush] administration, primarily for HIV/Aids," said Dr E Anne Peterson of the Agency for International Development.

"Before it was a mix of family planning and Aids, but the big increase is for Aids prevention."

The paper noted that Mr Bush had done little to advertise this fact.

However the president prompted some controversy in recent weeks when he suggested at a rally in Pennsylvania that condoms could be an effective weapon in the fight against Aids.

Having reportedly upset some social conservatives, it would appear that when it comes to condoms, Mr Bush must step carefully. Especially in an election year.

The BBC's Kylie Morris
"There is little evidence that abstinence campaigns reduce infection rates"

Uganda turns back the Aids tide
02 Dec 03  |  Africa
The power of the ring thing
22 Jan 04  |  This World

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