Condom campaigns

It doesn’t seem unreasonable to expect nations to consider foreign policy decisions in the context of the wishes of their allies abroad. However, globalization and ever-increasing cash flow have brought international oversight to all aspects of domestic policy in countries that receive large sums of aid. In Uganda, foreign aid accounted for 50 percent of the government budget in 2012, and these contributions are evident when you look at correlations between things such as the U.S. presidency and policy decisions in this small East African nation 8,500 miles away.

Uganda’s recent history reveals no impressive effort against corruption or poverty. In spite of this, the nation emerged as a leader amongst African nations in the early 1990s with an incredibly successful campaign against AIDS. Championing the cause, the Ugandan president, Yoweri Museveni, promoted an ABC plan: abstinence, being faithful and condom use. Approximately 30 percent of the nation tested HIV positive in the 1980s, but by the mid-90s that number was brought down to 5 percent. Policy that promotes condom use—and not just to high-risk groups like sex workers and truck drivers—is striking in a country that is 42 percent Roman Catholic and, in fact, 84 percent Christian, but the efforts of Museveni and the support of traditional leaders were enough to overcome circumstances that would normally be barriers to pro-condom campaigns. Uganda saw progress where other African nations struggled to keep rates from rising further.

This success story drew donors from left and right. Countries and organizations flocked to support the glowing example in Africa, and, under George W. Bush’s presidency, millions more in U.S. dollars were earmarked for investment in Uganda, only this time supporting an abstinence and fidelity campaign. The first lady, Janet Museveni, rose to the occasion: Parades were held celebrating virgins and abstinence, a census sought to ascertain the number of virgins in Uganda and billboards that displayed colorful packets of condoms and read “don’t get it, don’t spread it,” were replaced by billboards showing the crested crane, Uganda’s national bird and a species that mates for life.

Looking at the research, it’s hard to argue for abstinence-only sex education anywhere. The relative rates of unwanted pregnancy and STD transmission between individuals who were in abstinence-only curricula and those who were in programs that taught FDA-approved methods of contraception speak strongly in favor of the latter. Teenagers in abstinence-only programs wait no longer than individuals in more comprehensive programs to begin having sex, but they are 50 percent more likely than their counterparts to become pregnant as teenagers.

Despite this fact, however, federal funding for abstinence only programs was the norm during the 20th century in the U.S. It was only in the past couple years that North Carolina passed the Healthy Youth Act, requiring schools to teach FDA-approved methods of contraception. My middle school and high school health classes occurred before its passage and were limited to absurd and uninformative role-playing, practicing turning down the scripted propositions of other eighth graders.

The consequences of these practices are even more damaging in Uganda, where HIV prevalence rates are so high. Even considering married couples, lack of awareness and availability of condoms is a serious public health threat; 65 percent of new HIV transmissions are between husband and wife. These discordant couples—couples who enter marriage with one HIV positive and one HIV negative partner—fall into the category of individuals who are allowed by all social and religious standards to have sex, but are unlikely to have access to condoms or educational material on methods of birth control based on newer anti-contraception momentum. Nobody is telling these individuals they should be abstinent, nor are they hearing that they should be using contraception. The result is often transmission.

A year ago, Uganda was one of two African nations where infection rates for HIV were rising, as evangelical ministers burned condoms on university campuses and AIDs education was removed from some schools curricula. The impetus for this about-face, after years of success, is programs like those funded by the Bush administration. There are a lot of problems with aid and development work, but often they take the form of indirect damage, such as inefficiency or negligence. Yet when foreign aid dollars lead to the imposition of a donor’s value system, they can not only stagnate progress, but actually undo successes and advances previously achieved.

International aid is tricky and can be a useful tool in accomplishing human rights ends when domestic governments fail to respect their people. But the enforcement of American norms and American standards abroad is incredibly hard to justify when there are basic health facts that determine these standards to be harmful. When it comes down to it, aid programs must be constantly examined and critiqued to ensure that money is spent wisely.

Lydia Thurman is a Trinity junior. Her biweekly column will run every other Tuesday. Send Lydia a message on Twitter @ThurmanLydia.