LATIN AMERICA: AIDS Threat Still Looming

By Emilio Godoy

MEXICO CITY (IPS) - The HIV/AIDS epidemic remains stable in Latin America and the Caribbean, mainly affecting high-risk groups like gay men and sex workers, according to the UNAIDS report for 2008, released Tuesday.

Last year, 140,000 new infections were reported in the region, bringing the total number of people living with HIV to 1.7 million, while 63,000 people died of AIDS-related causes in 2007.

César Núñez, UNAIDS (Joint United Nations Programme on HIV/AIDS) director for Latin America, said at the presentation of the report that "this is not a small, controlled epidemic," and recommended heavy emphasis on prevention measures.

The U.N. agency's 2008 Report on the Global AIDS Epidemic identifies Brazil and Mexico (Latin America's most populous countries) as having the largest number of cases: 800,000 and 200,000, respectively.

It also reports that the Central American and Caribbean regions have been hard-hit by the pandemic. In the Caribbean, where 20,000 new cases were reported and 14,000 people died of AIDS in 2007, there are 230,000 people living with HIV.

A majority of the 33 million people testing positive for HIV worldwide live in sub-Saharan Africa, according to the study presented simultaneously in Mexico City, New York, Geneva, Johannesburg and Bangkok just ahead of the 17th International AIDS Conference, to take place Aug. 3-8 in the Mexican capital.

The "AIDS 2008" conference is expected to draw 25,000 delegates from national and international bodies, experts and activists from 150 nations.

The Latin America section of the UNAIDS study says unprotected sex is common among men who have sex with other men in Mexico, Bolivia, Colombia, Ecuador and Peru.

It also warns that in countries like Bolivia and Peru, the spread of HIV is linked to the practice of unprotected sex and intravenous drug use without precautions.

In addition, the report points to a feminisation of the epidemic. "We have seen that the number of infected women has gone up in recent years, and we will see this to an even greater extent in the future," said Núñez.

More than 30 percent of people living with HIV in Latin America and the Caribbean are women. In Mexico alone, 40,000 women test positive for the AIDS virus.

"The visibility of the epidemic must be raised among women, in order to promote safe, protected sexual practices," said Linda Adechar, head of the non-governmental Fundación Vihdha.

Tuberculosis is still the biggest killer of people with HIV/AIDS. "The disease remains the main cause of mortality among vulnerable groups," said Philippe Lamy, the Pan-American Health Organisation’s representative in Mexico.

Núñez underscored the significant increase in prevention efforts and treatment in Latin America, where 390,000 people now receive antiretroviral medications.

However, 630,000 people in the region still lack access to the life-extending drugs, he said.

"The number of people receiving antiretroviral therapy has increased," said the UNAIDS official, who also stressed the importance of prevention.

"Measures like blood tests and increased use of condoms have provided an encouraging response," said Mauricio Hernández, deputy minister of prevention in Mexico’s health ministry.

The fight against HIV/AIDS has faced hurdles from the start because of stigma, discrimination, homophobia and ignorance.

A study of seven Latin American countries, sponsored by Brazil's International Centre for Technical Cooperation on HIV/AIDS (ICTC) and the German Agency for Technical Cooperation (GTZ), noted that, despite more and better government policies and laws, discrimination against people living with HIV and high-risk groups remains a major challenge.

The report, which was coordinated by the Latin American Faculty of Social Sciences (FLACSO) and will be presented at next week's conference in Mexico, says that one of the biggest efforts that countries must make to fight HIV/AIDS is to achieve social equality for vulnerable groups like gay men and prostitutes.

The study, to which IPS had access, notes that practically all of the constitutions in the region mention the right to non-discrimination, but without referring to people living with HIV or to members of the gay, lesbian and transgender communities.

Labour is one of the most problematic areas, since that is where laws that guarantee the right to non-discrimination are systematically flouted, a phenomenon that is hidden because of reforms that have ushered in more flexible labour relations and the difficulties in proving that someone was fired because of discrimination, says the report, which focused on Argentina, Chile, Colombia, the Dominican Republic, El Salvador, Mexico and Peru.

"In the case of HIV, discrimination is still very strong, because of prejudice and misinformation about how it is spread," José Aguilar, national coordinator of the Mexico City-based Democracy and Sexuality network, told IPS.

A National Survey on Discrimination carried out in 2005 showed that the two groups who feel the worst discrimination in Mexico are the disabled and homosexuals.

On average, nine out of 10 women, disabled persons, indigenous people, homosexuals, elderly persons and members of religious minorities responded that they have faced discrimination. In addition, one out of three people belonging to these groups say they have suffered discrimination at work.

Alejandra Gil, president of the Asociación en Pro Apoyo a Servidores, which provides support for sex workers in the Mexican capital, told IPS that the growing visibility of high-risk groups can help combat the stigma and discrimination.

Colombia, the Dominican Republic, El Salvador, Mexico and Peru have multidisciplinary agencies to deal with the HIV/AIDS epidemic, which is not the case in Argentina and Chile. But all of the countries studied have national action plans to tackle the problem.

The researchers found gaps and contradictions in laws on the right to non-discrimination in the countries studied.

While on one hand, governments try to combat the stigmatisation of people living with HIV, on the other they have laws and institutions that are themselves discriminatory against groups that are vulnerable to the disease, says the document.

"Stigma and discrimination are still major factors," said Núñez.

The FLACSO study found that while legislation in the region generally prohibits labour discrimination, such laws are usually not enforced.

"We need work places free of stigma and discrimination," said Adechar.

A study by the International HIV/AIDS Alliance, which will also be presented at the Mexico City conference, concluded that even though organisations fighting the epidemic in 10 Latin American nations have gained visibility and political influence, they have more limited financial resources for carrying out their projects.

Schools "encouraging "underage sex

by Kathleen Nutt and Julia Belgutay
www.timesonline.co.uk

SCHOOLS have been criticised for encouraging underage sex by giving pupils free condoms.

Teenagers at secondary schools in Edinburgh and West Lothian have received the contraceptives, in a bid to curb unwanted pregnancies and sexually transmitted diseases.

But parent groups and education campaigners say that the scheme encourages youngsters to have sex.

Broughton High School, in Edinburgh, North Berwick High School in East Lothian, Newbattle High School, in Midlothian and West Calder High School in West Lothian have given out contraceptives.

NHS Lothian was unable to say what age the pupils were who had received the contraceptives and whether they were over 16. The schools sexual health clinics also offer pregnancy tests and testing for sexually transmitted diseases.

Free condoms have also been handed out to pupils at Sandwick Junior High School in Shetland under a one-year pilot scheme which is set to be extended to the seven other secondaries on the islands.

A spokesman for Shetland Isles' schools said that parents' permission is not required if the pupils are aged over 16. He said that it was "extremely rare" for underage pupils to receive condoms.

Some school nurses in secondary schools in the Borders have also obtained permission to give out free contraceptives to pupils.

However, the local authority does not keep information on how many contraceptives have been issued.

"Handing out free contraceptives to school children simply encourages teenage sexual activity," said Nick Seaton, chairman of the Campaign for Real Education. "It is extremely worrying that condoms are being given out to pupils without the permission of their parents."

Stan Martin, one of the founders of Parents for Consultation, a group that wants parents to have more influence over sex education in schools, said: "Initiatives like these just sexualise children at an earlier and earlier age."

Scotland has one of the worst teenage pregnancy records in the world, with almost 30% of girls aged between 15 and 19 giving birth. In a league table of teenage pregnancy rates, produced by the children’s charity Bernardo, Scotland was 28th out of 31 countries. Only America, Mexico and Turkey had more teenage mothers.

Last year The Sunday Times reported that almost 5,000 underage girls, some as young as 11, were being prescribed the contraceptive pill.

Figures published last year revealed the number of cases of the sexually transmitted disease chlamydia rose by 4% cent, to 17,926. More than 70% of the patients suffering from the disease, which can cause infertility, were aged under 25.

Jim Reyner, quality improvement manager at Shetland Isles' schools service, said: "From our perspective we would rather condoms were available than kids were left ignorant. They are issued responsibly."

If any child under 16 asked for a condom, parents and child protection staff would be informed, he said.

A spokesman for Scottish Borders council said: "Contraceptives could be given out by school nurses in the drop-in sessions, but it is a private matter between the pupil and the school nurse. The sessions are confidential and designed to discuss all health issues."

Shona Robison, the public health minister, said: "It is important for local agencies to provide high-quality, consistent information in a range of settings. This includes easily accessible drop-in services, staffed by health professionals and youth workers, services we know young people respond well to.

"How these services are delivered is a decision for local health boards and local authorities to make in partnership with their sexual health strategy groups."

Making it big: Bravo Condoms aims product at sports, music scenes

By LAITH AGHA
www.montereyherald.com

In orchestrating his quickly growing business, Bravo Condoms, Zac Mazzotta figured out early that he is not just selling a product.

He is selling a name. He is selling packaging. And perhaps most importantly, he is selling an image.

In an industry that has traditionally focused on more general themes — safety and comfort — in its marketing, Mazzotta, a Stevenson School graduate and part-time Carmel Valley resident, is billing his product as the condom of youth culture, infiltrating the adventure sport and rock music crowds with an aggressive advertising campaign.

"We're becoming the Red Bull of condoms," said Mazzota, 28.

It is tailored toward a fast-paced lifestyle that craves convenience and lacks patience.

A cup of coffee is to be sipped. A Red Bull is "downed."

"These days kids buy image," said Bob Wecker, owner of The Wecker Group advertising design company in Monterey. "With a condom company, image and packaging is everything."

Most condoms come in three-dimensional boxes that must be ripped open. Bravo Condoms are sold in a flatter fold-open packet that borrows from Orbitz's gum packaging design. Flaps hook together to contain the contents.

While the typical condom package is easily identifiable, which can be embarrassing for those concerned about the stigma of buying or carrying condoms, Mazzotta said, Bravo's sleeker package design is less conspicuous.

The company's innovations appear within the packet, which, in addition
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to three condoms, contains a sticker of the Bravo logo — a lion's head with a flowing mane, an information booklet and a baggie for disposal purposes.

Starting a business in an established marketplace, with an industry leader, Trojan Condoms, that holds about 70 percent of the American market, "It's almost like, it's impossible to reinvent the wheel," Wecker said. "But there is always an opening."

The insurance industry, for instance, used to play it straight with its advertising, but once Aflac loosened the collar by featuring a comical duck in its commercials, "everyone else started do it," Wecker said.

Mazzotta saw a similar opportunity for the condom market.

"It's been a sleeping industry for 85 years," Mazzotta said.

The target consumer ranges from high school students to thirtysomethings, the age group most likely to use the product and to be involved in the sports and music scenes. But the company is not hyping sex to sell the product, Mazzotta said.

"We don't promote sex," he said. "We promote safe sex, and we promote condoms as a tool if you choose to do it."

And while the sales pitch is image-driven, the product retains the basic principals of its function.

"We're not just selling a mediocre product in nice packaging," Mazzotta said. "The goal was always to put out a phenomenal product in great packaging."

His company mantra, as well as his motivation to start the company, stems from personal experience.

Mazzotta's 4-year-old daughter is a blessing now, he said, but at the time he found he was going to be a father, Mazzotta was a 23-year-old race car driver living the fast-paced lifestyle that complements the profession. He hadn't planned to start a family for another decade, but he promised himself he would stop racing when he did start one because the risk of dying on the track was too great to be a responsible father, he said.

At the end of the 2003 racing season, a month before his daughter's birth, he retired early from the sport. Giving up the career and lifestyle to take care of a child — and learning how to be a father — was a major struggle, he said. Mazzotta learned first-hand the financial and emotional strains that can rise from an unplanned birth.

That was a major driving force in starting the company, Mazzotta said.

"It spawned in me a real passion to try and make options that gives someone the opportunity to keep that from happening to them," he said. "It's not easy for the adults. It's not fair to the kids."

He wanted to pursue something that inspired him more than pounding nails at construction sites, which he did for a while to make a living after racing.

Mazzotta moved to Santa Barbara from Carmel Valley in 2006 — he splits his time between the two places — and began researching for his new business idea the new-fashioned way, by Googling.

Selling the image can't happen without getting the word out, so Mazzotta is slapping the Bravo insignia on some very strategic surfaces.

The company sponsors 15 athletes in the adventure, or extreme, sports realm, starting with Mozzatta's brother, Hawk, a 26-year-old motorcycle racer from Carmel Valley who is competing in Sunday's American Motorcyclist Association Superbike race at Mazda Raceway Laguna Seca. Bull rider Tony Mendez, who competed in Wednesday's Professional Bull Riders tour event at the Salinas Sports Complex, signed with the company Thursday.

Bravo sponsors surfers, skateboarders, bicyclists and a daredevil.

Distribution is steadily increasing. Mazzotta started by stocking shelves of convenience stores and gas stations around the Monterey Peninsula and Santa Barbara. He expanded to businesses that cater to Bravo's target audience, such as surf and motorcycle shops. He has a deal with 7-Eleven stores in Hawaii.

But most of the company's volume has moved through online sales. More than 250,000 condoms have sold on the Web site, www.condomdepot.com, he said.

Mazzotta recently signed a product placement deal to put Bravo in several movies, including "Transformers 2" and "Old School 2," and the television shows "Entourage" and "The Office." And he is working out a deal with a distributor to have Bravo's logo placed on race cars in 11 NASCAR events next year.

After the label is on the race cars, Mazzotta said, he will be in a strategic position to approach major chain stores. If that door opens as Mazzotta hopes, the Bravo image could be sold across the country and, eventually, around the world.

"We're getting very close," he said.

Condom adverts should be screened before 9pm to tackle teenage pregnancies, Government advisers say

By Aislinn Simpson
www.telegraph.co.uk

The Teenage Pregnancy Independent Advisory Group (TPIAG) also called for the parents of children as young as four to be sent information packs about how to talk to their children about sex, relationships and contraception.

The group, which is made up of family planning advisers, medical experts and social workers picked by ministers, made its recommendations in its annual report published yesterday (Wed).

The report said: "TPIAG would like to see restrictive and outdated broadcasting standards reviewed and overhauled to ensure positive sexual health messages, including the advertising of condoms, are communicated effectively before the 9pm broadcast watershed."

Male fertility options growing

By Amy Crawford
www.chicagotribune.com


NEW YORK—Though they didn't look like much, the white specks squirming under a microscope in Debra Wolgemuth's lab could have a big impact in the world of controlling fertility, not for women but for men. The specks were sperm from mice that had been treated with a new contraceptive. The healthy, swimming cells showed that the new drug did not have a permanent effect once the mice had gone off it. For Wolgemuth, this was an important step toward testing the drug in men.

Wolgemuth and other researchers at Columbia University Medical Center were using the drug to block retinoid receptors—proteins that bond with vitamin A to turn on certain genes. The drug prevented sperm from developing normally.

"We demonstrated that the mice are infertile," Wolgemuth said. "We take them off the drug, and then after a certain period of time they're fertile again."

If the method works as well in humans, it could become a true contraceptive option for men.

In 1960, "the Pill" hit the market and changed the sex lives of millions of American women. By taking a tiny pill containing female hormones, they could take control of their bodies and prevent pregnancy. Today, 12 million women in the United States use oral contraceptives, and others use hormonal implants, transdermal patches or vaginal rings. For women who can't take hormones, there are copper intrauterine devices, female condoms, diaphragms and cervical caps.

Men, on the other hand, still have only two options.

"You have condoms, which are in the moment, and vasectomies, which are permanent, and nothing in between," said Elaine Lissner, founder of the not-for-profit Male Contraceptive Information Project.

But researchers around the world are working on new options for male birth control, including retinoid blocking, implants that could be removed when a man decides to become a father, and even special underwear that prevent sperm production. A new analysis of 30 studies done between 1990 and 2006 shows that male hormonal contraception might not be that far away.

"The initial work toward producing contraceptives focused on women, because women get pregnant," said Ronald Swerdloff, head of the endocrinology department at the UCLA Harbor Medical Center. "That attitude has changed with the changing attitudes of partners."

In a 2002 survey of 9,000 men on four continents, more than half said they would use male hormonal birth control. Methods like the Intra-Vas Device and RISUG would be ideal in developing countries, where access to pills or condoms is not always guaranteed, said Lissner.

FDA sets guidelines to ensure imported condoms hold up

By Elizabeth Lopatto
Bloomberg News-www.sltrib.com
No repeat shippers were listed as of June 17. A repeat offense will get a warning about manufacturing deficiencies. A bad shipment after that will lead to a full banfor example - before the shipment is freed.
Federal regulators urged steps to prevent a trickle of leaky condoms being shipped to the U.S. from becoming a flood.
One faulty sheath will cause a whole shipment to be detained, the U.S. Food and Drug Administration said Thursday in its final guidelines for the industry and agency employees. Measures were originally proposed in 2000. The FDA also posted guidelines for medical gloves, which like condoms are made of latex.
''Some foreign manufacturers and shippers repeatedly attempt'' to ship leaky articles, the agency said. Condoms, when they work, help prevent pregnancy and the spread of diseases such as AIDS, gonorrhea, and syphilis.
Leaky condoms have been shipped from China, India, Korea and Thailand, as well as the United Kingdom, Greece, Japan, Italy and Germany.
Condoms and latex gloves, according to the FDA, undergo what is known as the ''water leak test,'' set forth in a ''Compliance Policy Guide.'' If just one style of condom fails in a shipment that contains a variety - ''unlubricated, lubricated, spermicidally lubricated, ribbed, etc.'' - all must be detained and ''a separate style should be taken for each style that the field office wishes to test.''
Styles shouldn't be mixed in one sample.
The FDA has three levels of detention. First offenders have to show their products are safe - using an independent U.S. laboratory, for example - before the shipment is freed.
A repeat offense will get a warning about manufacturing deficiencies. A bad shipment after that will lead to a full ban. No repeat shippers were listed as of June 17.

Brazil legislators reject legalizing abortion

by Raymond Colitt
www.reuters.com/

A committee in Brazil's lower house of Congress voted down a bill on Wednesday that would have legalized abortion in the world's most populous Roman Catholic nation.

The Justice and Constitution Committee in the Chamber of Deputies voted 57-4 against a bill that had been stuck in Congress for 17 years, steeped in controversy. It is now likely to be shelved.

"This bill won't prosper in the Chamber," said Deputy Eduardo Cunha, committee leader.

Several ruling party legislators pushed the bill after Health Minister Jose Temporao last year all but endorsed legalizing abortion.

Church groups, which lobbied against the legislative proposal and witnessed the hearing, cheered and prayed in celebration after the vote.

Some deputies had placards hanging from their necks, showing pictures of aborted fetuses.

A few legislators supported the bill.

"You can't treat this issue on the basis of religion or belief. It's a public health issue," said Deputy Jose Genoino, who voted in favor of the proposal.

Temporao angered church groups by proposing a referendum on the legalization of abortion and backing increased use of contraceptives.

The government has begun distributing condoms in public high schools and in April launched its own factory to produce condoms made of rubber from Amazon trees.

Temporao has warned that the large number of women having illegal abortions was a serious public health issue because of often dangerous complications when they went awry.

Annually more than 200,000 women are hospitalized because of botched abortions, government statistics show. Based on those figures some experts estimate the number of abortions could be as high as around 1 million per year.

Many Brazilians believe it is mostly poor teenagers who abort. But a study co-sponsored by the University of Brasilia showed that most abortions were practiced by Catholic mothers, aged 20-29, with jobs, who used contraceptive devices and had steady sexual partners. (Reporting by Raymond Colitt, Editing by Cynthia Osterman)

Plan for spray-on condoms shelved

By Gary Fennelly, belfasttelegraph.co.uk

A German inventor has admitted that spray-on condoms may never hit the shelves after his team were unable to overcome technical problems.

Jan Vinzenz Krause of the German Institute for Condom Consultancy made headlines across the world when he announced his pioneering design in 2006.

Krause promised the spray-on condom would offer a better, safer fit for men of all sizes.

"We thought why not come up with a condom that fits the man rather than vice versa? This would represent a revolution in the condom market," said Krause.

"With our technology we could spray a condom on an erect elephant," he added.

Krause filed for a patent for the latex spraying system he invented and had hoped to have it on sale this year.

But the project hit problems and may never reach the market, according a statement on his website.

"Whether we can solve the technical problems, and whether the advancement of the idea is financially viable, remains uncertain," he wrote.

Spray-on condoms ignited a wave of online interest recently after being featured in the US forensics show CSI and getting a mention on the BBC's Friday Night with Jonathan Ross.

Demonstrating it on a model, CSI character Lindsay Monroe said: "Simply apply like so. Allow a few moments for maximum drying time and, boom. Instant condom."

Can You Hear Me Now?, the CSI:NY episode featuring the condom, was shown in the US in September 2007 but has not yet been aired on British terrestrial TV.

The sexual health of young people

SOURCE: Alison Davis, www.communitycare.co.uk

The role of sexual health services

Rising levels of sexually transmitted infections (STI) have led many local education authorities to recognize the need for comprehensive sexual and relationship education. Meanwhile, many hard-to-reach young people are being contacted through pupil referral centres, youth offending teams and leaving care teams.

Topics covered include the factors that influence young people in their ability to form and maintain relationships. This may include discussion on how to say "no" to unwanted attention and sex.

The risks associated with unprotected intercourse should also be highlighted, raising awareness of how to access local sexual health services and how to gain the knowledge and skills to practice safer sex.

Other areas to cover include the prevalence of STIs and HIV, how they are spread and how to minimize the risk of an unwanted pregnancy.

In some areas, outreach teams may offer a trip to sexual health clinics or run virtual clinics.

Sex and the law

Although the age of consent for sexual intercourse is 16, a doctor or other professional can advise or treat someone under 16 without their parents' knowledge or consent if they meet the Fraser guidelines, named after Lord Fraser who stood in judgement in 1985 in the case of Victoria Gillick, who objected to her under-16-year-old daughter being prescribed contraception without parental consent. The five guidelines are:

- The young person will understand the advice.

- S/he can't be persuaded to tell parents.

- S/he is likely to have sex anyway.

- His/her physical or mental health would suffer without the advice or treatment.

- His/her best interests require it.

The Best Practice Guidance (DH 2004) highlighted the benefit of establishing a rapport with the young person who is engaged in sexual activity by giving support and time to make an informed choice. This can be done by discussing emotional and physical risks, and coercion or abuse and the benefits of talking to the GP, parent or other adult (especially in cases of abortion referral).

Best practice within sexual health clinics maintains that all clients have a right to a confidential service. Anyone treated for an STI should only have their identity disclosed to someone involved in their treatment or preventing the spread of infection (NHS trusts 2000).

Contraception and young people

Condoms remain the most popular first method of contraception used by young people, probably due to their high accessibility. In some areas, schools and colleges will supply condoms to pupils.

The combined contraceptive pill is probably the most popular hormonal method of contraception. This is prescribed free, and as with all consultations, confidentially - even if the person is under 16, so long as they meet the Fraser guidelines (see above). Hormonal methods of contraception do not protect against STI and HIV - condoms should always be used.

For emergency contraception, the most common form is the one-off progesterone-only pill. It has to be taken within the first 72 hours of unprotected sex. This is widely available, including from some pharmacies and via school nurses.

Taking action to prevent abuse

British Association for Sexual Health and HIV (BASHH) guidance from 2003 advises to question and check that there has been no coercion (especially when there are large age differences between sexual partners), exploitation, rape or other abuse. Child protection referral procedures should be used for under-18s in these situations.

Working Together (April 2006) advises professionals to use a concern checklist when dealing with young people engaged in a sexual relationship, but also retain a professional discretion. For those young people under 13 who have disclosed sexual activity, it is vital to:

- Consult the child protection lead.

- Presume that you will always refer except in exceptional circumstances.

- If a decision is made not to refer, keep full records of reasons for the decision.

- Note that an assessment must be made in more depth than usual, and that the threshold for referral is much lower.

It is important to note that Home Office Sexual Offences Act guidance states that although the age of consent is 16, it is not intended that the law should be used to prosecute mutually-agreed teenage sex between two young people of a similar age, unless it involves abuse or exploitation.

Bush's Embattled AIDS Bill

Serious Concerns Raised Over Use of Funds

By Sue Ellin Browder

WASHINGTON, D.C., JUNE 30, 2008 (Zenit.org).-Pressing the Senate to rubberstamp $50 billion in global spending on AIDS, malaria and TB, AIDS activists marched on the White House last week bearing signs with slogans like "Now or Never."

But this week, a Anglican priest from Uganda opened more serious dialogue about the bill, saying that "condom promotions have failed in Africa" and AIDS "profiteers" have subverted African fidelity and abstinence programs in order to sell commodities for a profit.

"AIDS is no longer simply a disease; it has become a multibillion-dollar industry," Reverend Sam Ruteikara, co-chair of Uganda's national AIDS-prevention committee, wrote today in the Washington Post.

Stalled for months in the Senate, the reauthorization for the President's Emergency Plan for AIDS Relief (PEPFAR) would more than triple program spending from $15 to $50 billion over five years. But Ruteikara told ZENIT that if the money is misspent, it won't stop the spread of AIDS in sub-Saharan Africa, and it could even raise HIV rates.

President George Bush wants the bill passed before the G-8 summit in Japan next week. But in a March 31 letter to Senate Republican leader Mitch McConnell, seven senators led by Senator Tom Coburn of Oklahoma urged delay, saying the bill has "serious problems."

Among other concerns, the senators said the new initiative costs too much and would fund "morally dubious" activities such as needle-exchange programs for drug addicts.

Further, the letter expressed major concerns about the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The senators wrote, "The [Global] Fund has serious policy problems, drug quality problems, administrative corruption, and [it] operates programs not bound by U.S. laws on abortion, needle exchange, prostitution/trafficking policy and others."

Over five years, the new PEPFAR bill would give the Global Fund $10 billion -- a quarter of the fund's budget. But the U.S. has only one vote out of 20 on how the money is spent.

The senators also want to reinstate wording from the original PEPFAR bill specifying that 55% of AIDS monies will go for treatment.

Prevention first

An AIDS-prevention authority on the frontlines in Africa, Ruteikara agreed the Global Fund has serious problems that merit more U.S. oversight, but he questioned whether 55% of AIDS monies should be spent on treatment.

"HIV-testing and treatment are good, but they won't stop the pandemic," Ruteikara said. "With six Africans becoming infected for every person who gains access to treatment, we can't treat our way out of this tragedy. Effective prevention must come first."

Coburn, a physician, and others have argued that anti-retroviral treatment will do more than just prolong lives; it will prevent new AIDS cases by making the HIV virus less infectious and, therefore, less likely to be transmitted.

But in The Lancet, a leading British medical journal, James Shelton of USAID called this theory a "myth" unsupported by science. Shelton observed that as people become healthier on anti-retroviral treatment, they're likely to become more sexually active, creating further chances for the virus to spread.

Physician Norman Hearst of the University of California, San Francisco, agreed that "treatment is important, but it's not prevention."

"In sub-Saharan Africa, prevention must be linked to sexual behavior, because that's what fuels the pandemic," Hearst explained. Whereas most Westerners are monogamous -- one sex partner at a time -- many Africans, even when married, have one or two long-term lovers on the side. In a young-adult survey in Botswana, where one-third of the population carries the HIV virus, 43% of men and 17% of women reported having two or more regular lovers.

"The latest evidence shows it's these long-term, overlapping multiple partnerships that drive the pandemic," Hearst said. "This new scientific understanding that the African pandemic is fueled by people having more than one current sex partner explains why public-health campaigns urging sexually active adults to be faithful have worked so well in Africa."

ABC

Between 1991 and 2002, Ugandans lowered the proportion of the population infected with HIV from 21% to 6% with their famous ABC (Abstain, Be faithful, or use a Condom) campaign -- with "B" as the pillar. "We promoted fidelity for sexually active people, abstinence for young people, and condoms only as a last resort," Ruteikara said.

In response to the campaign, the number of Ugandan men embracing monogamy shot up from 59% to 79% -- and the number of faithful women rose from 79% to 91%. Rates of new HIV infections fell by two-thirds.

"Uganda provides the clearest example that HIV is preventable if populations are mobilized to avoid risk," Cambridge University researchers Rand Stoneburner and Daniel Low-Beer wrote in Science magazine. They likened Uganda's plunge in casual sex to the equivalent of an AIDS vaccine that's 80% effective.

What's more, prevention advocates say, sexual behavior change is a bargain. "HIV treatment costs an estimated $1,000-per-patient per added year of life. Uganda's successful prevention campaign cost less than 30 cents per person per year," says Edward Green, head of Harvard's AIDS Prevention Research Project.

"Because we knew what to do in our country, we succeeded," Ruteikara wrote in the Post. But he said that when "international AIDS experts" arrived in Uganda, they came with their own "casual-sex agendas," which they forced on Africans -- even to the point of rewriting Uganda's National Strategic Plan, which guides how PEPFAR money is spent.

Ruteikara reported that he and his fellow Ugandans would repeatedly put abstinence and fidelity into the National Strategic Plan. "Repeatedly, foreign advisors erased our recommendations. When the document draft was published, fidelity and abstinence were missing." Meanwhile, a suspicious statistic blaming most HIV infections on marriage appeared. Repeated requests for the source of the statistic have gone unanswered, the priest said.

"As fidelity and abstinence have been subverted, Uganda's HIV rates have begun to tick back up," Ruteikara wrote. "The Western media have been told this renewed surge of HIV infection is because there are 'not enough condoms in Uganda,' even though we have many more condoms now than we did in the early 1990s, when our HIV rates began to decline."

Off course

Green said that Western "sexual freedom ideologies" have caused successful AIDS-prevention strategies to be derailed in Africa, perhaps costing millions of lives.

"If AIDS prevention is to be based on [scientific] evidence rather than ideology or bias, then fidelity and abstinence programs need to be at the center of programs for general populations. [...] What the churches are inclined to do anyway turns out to be what works best in AIDS prevention," Green and his Harvard colleague Allison Herling Ruark wrote in the April issue of First Things.

In a 2004 "common ground" statement in The Lancet, 150 global AIDS-prevention leaders agreed fidelity should be the first-line prevention strategy for population-wide epidemics like those in sub-Saharan Africa.

The Senate bill mentions fidelity, but not as a central priority. Instead, the initiative, if passed, will fund a wide array of commodities and services to combat AIDS indirectly -- from HIV tests and Chlamydia treatments to female condoms. The latter are more expensive than male condoms -- and so unpopular in Africa that Uganda has stopped importing them.

Only 20% of funds in the new PEPFAR bill would go for prevention. Ruteikara would like to see that percentage doubled until the pandemic is under control.

The only hint of a spending requirement for fidelity in the current bill is a clause stating that in the event a country chooses to spend less than half its prevention funding on fidelity and abstinence programs, a report must be sent to Congress.

The bill also calls for preventing 12 million new HIV infections worldwide, but doesn't specify how.

Calling for HIV/AIDS profiteers to "let [his] people go," Ruteikara wrote, "We understand that casual sex is dear to you, but staying alive is dear to us. Listen to African wisdom, and we will show you how to prevent AIDS."

Green said, "This is a challenging moment for Congress to unite behind objective scientific evidence, and do the right thing. If Congress puts fidelity promotions at the center of our AIDS response, billions of tax dollars will be effectively spent and millions of African lives will be saved."