Category Archives: World Health

Mark Dybul by all indications was as effective as an HIV/AIDS coordinator could be working for a narrow minded, religious right agenda driven administration. That being said it appears he compromised too often to be held over in the new administration.

This from Michelle Goldberg in the American Prospect:

“A gay man who had, in the past, donated to Democrats, Dybul seemed to pride himself on his ability to make common cause with conservatives. As global AIDS coordinator in the Bush White House, he often sided with allies like Rick Warren rather than with women’s-health advocates on issues ranging from abstinence to sex-worker outreach to family-planning funding.”

“Thus, while PEPFAR did miraculous things to treat and care for people with HIV — an expensive but relatively uncontroversial undertaking — it missed many opportunities to prevent new infections. Initially, at the administration’s behest, the legislation authorizing PEPFAR earmarked a third of the money dedicated to HIV prevention for abstinence and faithfulness programs, often run by religious groups. With other PEPFAR prevention funds directed toward things like mother-to-child transmission, very little was left over for comprehensive sex education and condom distribution. In fact, in order to fulfill the abstinence earmark, Dybul’s office told those in the field to devote a full two-thirds of the money available for the prevention of sexual transmission of HIV to programs encouraging chastity and fidelity.”

Medicynical note: An effective proponent of ineffective prevention policy is not an automatic reappointment candidate. As noted the abstinence mandate in the Bush/Dybul program corroded the effectiveness of the interventions. Dybul appears to have compromised what might work with the ineffective and scientifically flawed.

I’ve always felt that selling out the AIDS program to the religious right, who previously couldn’t even say the AIDS word, was a travesty. In that Dybul facilitated this sell out he didn’t deserve reappointment.

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In of all places, Bloomberg, there is an article on the failure of abstinence education and “virginity pledges, more here. These faith based approaches to teen pregnancy and controlling the HIV/AIDS epidemic rely on “reason” to control lust. Unfortunately several studies have now shown that this approach doesn’t work. In the U.S. young people taking virginity pledges were as likely to have sex as those not doing so. Imagine how effective this approach is in Africa controlling HIV/AIDS.

The article reported:

“Teenagers who pledged to avoid sex until marriage were as likely to have intercourse as other U.S. adolescents, according to a survey of conduct mostly in 1990s.”

“Teens who took the pledge also were less likely to use birth control pills or condoms”

“Today’s study relied on surveys of students in 1996, when Congress authorized increased funding for abstinence-only education as part of an overhaul of welfare, and 2001. A Congressionally authorized report in 2007 on the program in that bill, Title V, also found students were no more likely to abstain. That program gets about $50 million a year.”

The article notes a study showing some effectiveness in one program but the overall results indicates that the strategy is not a success.

And from Freakonomics:

“Studies have repeatedly shown that abstinence-only students have almost the same number of sexual partners, and have sex almost as early, as students who receive traditional sex ed. In fact, abstinence-only programs may actually increase the risk of STDs and unintentional teen pregnancies. That’s because those abstinence-only students who do have sex tend to be less likely to use protection.”

What’s fascinating about the discussion in the article is the all or none philosophy of the abstinence types. They simply won’t countenance a program that has both abstinence and safe sex components. It’s another example of pre-existing bias affecting the implementation of public policy.

Young people need all the information and advice available. We need to encourage abstinence but also equip them to protect themselves when and if they decide to be sexually active. People are not machines with on off switches, they need options and alternatives.

Meanwhile in Africa the AIDS epidemic continues and the U.S. policy to deemphasize safe sex and emphasize abstinence , more here, does not appear to promoting abstinence. Those counseled were more likely to use condoms, abstinence doesn’t appear to be likely in those situation. The study in Nigeria “did not see a reduction in the number of partners.”

So in Africa we have a program forced to devote 1/3 of it’s spending on an ineffective strategy. Inefficiency in our health care programs is not limited to our domestic health care system.

Medicynical comment: What’s fascinating is that when one does a google search on abstinence education Africa, you find many sites associated with church causes promoting the concept but relatively few facts. We need more studies on this and need to merge the two approaches–abstinence and safe sex.

For the record most of these Christian groups, including Rick Warren’s, had nothing to do with HIV for the first twenty years of the epidemic. That neocon icon, Ronald Reagan, couldn’t even bring himself to say the word AIDS during his presidency. Twenty million people died and another twenty or so million became infected in this period.

These groups opposed funding of any anti-HIV intervention in the 80’s and 90’s. Their philosophy, as voiced to me by a missionary in Uganda in 1988, was that those with HIV got what they deserved. When Bush, to his credit, decided to put money into HIV in Africa. These churches, so to speak got religion, and followed the money. The only problem is that they wish to dominate the program with an ineffective HIV education message. Hopefully this will change.

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