This morning we visited the Naguru teen center, a health education and treatment center just outside Kampala specifically catering to the youth populations. It was astonishing to listen to health service providers on the ground describe the impact of PEPFAR's (President's Emergency Plan for AIDS Relief ) strict abstinence versus condom use policy. Recently, Uganda has adopted the U.S. government approach of addressing prevention by emphasizing abstinence only discussions (opens in new tab). This shift is not only because U.S. directed funds have many strings attached (including the no-condom promotion) but is partly attributed to the influence of the Ugandan first lady, who is a born again Christian.
Since embracing the Bush policy in 2003, posters encouraging people to practice safe sex and use protection went down. Like I mentioned in an earlier blog, these cartoon messages are cheap, easy and powerful ways for the Ministry of Health to advocate for behavior change. They can target the entire population and because they rely less words even the illiterate can grasp the meaning. Around Kampala I saw no condom or protection posters, very strange in a country which has constantly engaged in honest, frank conversations about sex, etc.
The more I listened, the more I felt that this plan is actually cruel to women in Uganda because we know what to do but we aren't doing it. I'm my public health classes I've learned that medical research has proven condoms as very effective but instead we are advocating a policy with serious holes. Though I have read about the PEPFAR policy being shortsighted or just plain stupid in terms of being a public health strategy to cope with HIV prevention (opens in new tab)and treatment, today I felt enraged about the implications of this policy. Currently, America is not supporting the UNFPA and it seemed like sheer arrogance for us to further dictate moral values to Ugandans. In fact, instead of accomplishing its missions, I perceive that abstinence only policy is hurting the country by mandating PEPFAR and not supporting UNFPA work. UNFPA funding is different to PEPFAR because UNFPA funds come with no such strings so UNFPA programs can provide condoms and promote usage, based on the wants and needs of each country.
While PEPFAR can be attributed to lengthening many people's lives by providing access to lifesaving ARV drugs, it is completely missing the point of providing preventative services that work. Out of 1000 youth tested monthly at the Naguru center, 35-40 people are HIV positive. This is just one of several district health centers and furthermore, there are thousands who haven't been tested. Yes, abstinence has a strong place in the prevention education and should definitely be part of early youth awareness programs, just like promotion of being faithful, BUT condom use should also be equally stressed. The reality is most of Uganda are young adults and guess what, youth will always be engaged in sexual activity.
Not only should we be concerned about reducing new HIV infection rates, we need to also be concerned about teen pregnancy (opens in new tab). In many ways, condom use can promote safe motherhood by delaying pregnancy in teens with small pelvic bones.
Many of us in the delegation were completely blown away by how professional the teen health center is. We were also demoralized and angry about how a woman's access to a better life was being obstructed. Instead of supporting the Ugandan women to make choices about their futures and bodies, the American government (and by extension, the American people) are forcing them to lead lives which we ourselves find unacceptable. The U.S. and Uganda are both nations which currently support plans that don't work but the vast economic difference is the American advantage. In the US, women can get access to many services whether it is birth control, or the ability to put unwanted children up for adoptions. Perhaps our own luxuries make us blind to what global women are suffering from. What struck me the most is how the situation for women in American or in Uganda are truly not that different in the way the government chooses to address sex.
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