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The Point Special Edition - April 18, 2013

In this edition of The Point:

Article #1

Excerpt from "Good news on AIDS in Africa," Slate, by Jenny Trinitapoli and Alexander Weinreb. March 27, 2013--The latest news on AIDS in sub-Saharan Africa, the epidemic’s epicenter, is good. New HIV infections have declined by 25 percent since 2001, AIDS-related deaths have decreased by 32 percent over the past six years, and there are expanded options for testing and treatment. After decades of doom-and-gloom news about AIDS in Africa, optimism is finally in the air.

What’s behind this positive turn? The standard narrative attributes these recent improvements to Western engagement. The heroes are the best-known acronyms in the world of AIDS (PEPFAR, UNAIDS, WHO), the Global Fund and a host of NGOs. Together, these organizations have waged total war against AIDS in Africa—or what looks like total war if you compare it to efforts devoted to other diseases. They have spent tens of billions of dollars. They have mobilized legions of scientists, medical professionals, development workers, educators, TV programmers, marketing specialists and volunteers. And they have shunned, silenced and demonized those who oppose their good work. The good news about AIDS in Africa—so this standard narrative goes—is the result of their efforts. It’s proof that even on that dark and desperate continent, awash with ancient superstitions, hypersexuality, dangerous traditional practices and poor leadership, AIDS cannot withstand a sustained pummeling by well-intentioned and well-financed outsiders.

This narrative contains some important elements of truth: Pharmacological treatments in particular are transforming HIV from a death sentence into a manageable, chronic condition, at least for those with access to antiretrovirals. But most of the measured improvements in AIDS in Africa are actually the result of cumulative, widespread behavior change that has led to a reduction in new HIV infections. In other words, the standard narrative is wrong. The narrative is wrong because it ignores local African responses to AIDS and characterizes religion and religious leaders as part of the problem. We have systematically studied the role of religious leaders in sub-Saharan Africa for about a decade. As a single class of people, local religious leaders sit at the very top of our list of who should receive credit for the behavior changes that have curbed the spread of HIV in Africa.

This statement may surprise or even irritate people imagining fire-and-brimstone preachers who condemn the use of condoms, push conservative messages about sex and morality and interpret AIDS as God’s wrath. That’s not what African religious leaders have been doing—quite the contrary.

Approximately 90 percent of Africans participate regularly in some religious congregation, and religious leaders have been preaching about sexual morality, in particular about abstinence and fidelity. But Africa’s religious leaders began doing this before PEPFAR and Western public health authorities told them to—long before the attention of the development world turned to AIDS in Africa. What prompted their efforts? Certainly not the fact that they were, or are, getting paid to do this by foreign NGOs. Ninety percent of congregation leaders in Malawi, where we began working on AIDS in 2004, have never seen a penny from any international NGO or their programs. Rather, they started preaching and teaching and facilitating conversations about AIDS when they became overwhelmed with caregiving and burial responsibilities, and when their members—especially the women—began demanding that they do so. On the world’s most religious continent, people use religious ideas, language and organizations to address problems, big and small. This is the source of religion’s positive contribution to the recent improvements in Africa’s AIDS situation.

Commentary #1

President and Founder of The Institute for Youth Development Shepherd Smith: "Authors Trinitapoli and Weinreb are to be congratulated for their objectivity in reporting on the primary reason for reductions in HIV infections in Africa during the last decade. Long before the urbanization of Africa and the attending communication networks of radio and now television, Africans had their own communication networks with most revolving around the church or other places of religious worship. Beyond their value of disseminating morals, values and biblical truths, these centers of community involvement were focal points for news, education and interconnections of families and friends. And they have been largely ignored by Western experts until very recently. The role they have played in reducing HIV infections, as the authors point out, should not be underestimated.

"In Malawi, where we have supported a rural faith-centered hospital for more than a decade that serves more than 600 villages and a population exceeding a quarter million people, the abstinence and faithfulness messages that permeate the entire region have had an incredible affect. About 50 miles from the capital of Lilongwe where the HIV infection rate hovers around 15 percent, the catchment area of the hospital now sees a rate falling below 3 percent. In a church service we attended in 2002 in Kampala, Uganda, I can vividly recall a rather dramatic skit played out concerning an unfaithful husband and how he brought AIDS home to his faithful spouse and how it tore the family apart. A very compelling message for the church.

"Regarding the Western experts and their love of condoms, I believe history will show us that the African skepticism of them was well founded. As Ambassador Dr. Mark Dybul testified before Congress, 'the more condoms we sent to Botswana the more we saw their HIV infection rates rise.' As contended by the authors, the role of condoms has been overstated…and the church’s role understated."

Article #2

Excerpted from "Prostitution policy splits NGOs in top court AIDS case," Reuters, April 10, 2013--A Supreme Court case that challenges a law requiring anti-prostitution policies for HIV/AIDS programs seeking federal money has generated a split among non-profit groups that counsel sex workers overseas. The case involves a 2003 law that bars funding for groups that work on HIV/AIDS prevention but do not have a policy opposing prostitution and sex trafficking.

It has pitted two non-governmental organizations that operate programs overseas, backed by umbrella organizations representing others like them, against 46 organizations that have sided with the federal government in defending the law.

"The split is about whether you support the sex industry," Norma Ramos, executive director of the Coalition Against Trafficking in Women, one of the groups siding with the government. "Prostitution is the end point of sex trafficking" and cannot be separated out from efforts to fight public health problems, including the spread of HIV/AIDS, she said.

The organizations challenging the provision on First Amendment grounds do not want to take a stand on prostitution. They say the law interferes with their work providing advice and counseling to prostitutes about the risks of HIV infection. The court on April 22 will consider whether the requirement, which has not been enforced since a 2006 injunction, is valid under the U.S. Constitution.

The Alliance for Open Society International and Pathfinder International - NGOs that receive funding for overseas HIV/AIDS prevention - sued in 2005, citing the First Amendment's guarantee of free speech. The two groups have since been joined in the litigation by the Global Health Council and InterAction, two sizable alliances of NGOs that work in developing countries.

In response to their criticism, Punima Mane, the president and CEO of Pathfinder, said, "We would not want to condemn the groups we work with and for." Such a move would threaten her organization's ability to provide "life-saving health services" to a vulnerable population, she added.

Outside the courtroom, a group representing sex workers started a petition to reverse the policy, saying it has "resulted in the reduction or complete elimination of HIV prevention and treatment services for sex workers in numerous countries." The case is U.S. AID v. Alliance for Open Society International, U.S. Supreme Court, No. 12-10.

Commentary #2

Vice President for Government Relations Jonathan Imbody: "Prostitution harms, degrades and kills women; it provides sex traffickers and terrorist groups with a lucrative income rivaling that of the drug trade; and it helps fuel the spread of AIDS and other diseases. President Bush noted in his National Security Presidential Directive (NSPD-22), that prostitution and related activities 'are inherently harmful and dehumanizing. The United States Government position is that these activities should not be regulated as a legitimate form of work for any human being.'

"In 2003 Congress passed a law (U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act) aimed at 'eradicating prostitution, the sex trade, rape, sexual assault and sexual exploitation of women and children' and provided that 'No funds made available to carry out this Act … may be used to promote or advocate the legalization or practice of prostitution or sex trafficking.' The law required 'a policy explicitly opposing prostitution and sex trafficking' and made clear that nothing in the law could 'be construed to preclude the provision to individuals of palliative care, treatment' and other help. So the talking point stated above by opponents that the policy somehow precludes providing 'life-saving health services' is completely spurious.

"When some groups opposed the anti-prostitution policy as 'unsophisticated,' CMA prepared, circulated and delivered to the Bush administration a letter, signed by more than 100 organizations and leaders, supporting the government's requirement that grantees document their opposition to prostitution. Years later, CMA wrote a letter strongly opposing the '[Obama] administration’s proposed rule that would relax the requirement of explicit guarantees that U.S.-funded grantees and sub-grantees oppose prostitution and trafficking in persons.'"

"The anti-prostitution policy regarding grants simply ensures that our tax dollars will not be used to promote an activity (prostitution) that spreads the very diseases and injustices the grants are designed to prevent."

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