U.S. Focus on Abstinence Weakens AIDS Fight, Agency Finds

By CELIA W. DUGGER

Published: April 5, 2006

Insistence by Republican Congressional leaders that American money to fight the spread of AIDS globally be used to emphasize abstinence and fidelity is undercutting comprehensive and widely accepted aid models, the Government Accountability Office said in a report released Tuesday.

The report by the G.A.O., an investigative arm of Congress, examines the effect of a mandate from Congress that at least a third of United States money to prevent the spread of AIDS worldwide be devoted to sexual abstinence and fidelity programs.

It found that the provision had limited the reach of broader strategies to fight AIDS that include the use of condoms — a conclusion strongly contested by a senior Bush administration official.

The report also said the requirement had meant that officials in some countries have had to reduce spending on programs to prevent the transmission of H.I.V. from women to their newborn babies, as well as other prevention strategies.

"It is hampering their ability to implement key elements of the widely accepted model of H.I.V./AIDS prevention — the ABC approach," said David Gootnick, the main author of the report. ABC stands for abstain, be faithful or use condoms.

The new emphasis on abstinence and fidelity emerged in 2003 from the House International Relations Committee as it debated President Bush's $15 billion, five-year AIDS program. Since then, financing for AIDS prevention programs has increased sharply, from $207 million in 2004 to $322 million this year.

The report is based on interviews with United States officials carrying out American-financed AIDS programs in 15 countries, mostly in Africa. They were guaranteed anonymity to encourage candor.

American officials told Congressional investigators that the guidelines were at times ambiguous and confusing. The rules on abstinence and fidelity, they said, have made it more difficult for them to tailor programs to local needs.

Some officials said that although activities to promote condom use have been restricted, they did not understand the distinction between condom education and condom promotion, "causing uncertainty over whether certain condom-related activities are permissible," the report stated.

Dr. Mark R. Dybul, the deputy coordinator of the federal AIDS program, strongly disagreed. He said the program was carrying out a balanced effort that includes all the elements of ABC, a strategy that successfully reduced H.I.V. infection rates in Uganda. The guidelines are generally clearly spelled out, he said.

More broadly, he said, Congress's requirement has brought about what he called a needed shift of emphasis to include abstinence and fidelity, saying that earlier programs had been overly focused on condoms.

But condoms have not been neglected, he said. The number distributed at United States expense has risen during Mr. Bush's years in office, to 429 million last year from 348 million in 2001, federal figures show.

In a statement on Tuesday, Representative Henry J. Hyde, the Illinois Republican who heads the House International Relations Committee, said no report was needed "to uncover the fact that country teams may be resistant to change, and that some adjustment time would be needed to implement new requirements."

Representative Tom Lantos of California, the ranking Democrat on the same committee, differed.

"While this was obvious to those of us who do not have ideological hang-ups, the reality was that only a compromise would fly," he said, referring to the 2003 debate in Congress.

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