When Treatment and Abstinence Fail

President Mogae preaches HIV prevention
BY NALEDI MOKGWATHI
The Voice
9 November 2007

Botswana may be a long way from winning the fight against HIV/AIDS. This may be mainly due to the fact that the country’s emphasis has been on treatment, neglecting prevention.

At the ACHAP/BOTUSA sponsored training workshop for journalists, which ended on Wednesday, Peter Stegman, a strategic planning consultant at the National AIDS Coordinating Agency, revealed that one of the recommendations from the 2003-2009 National Strategic Framework review is that emphasis should be on prevention. He said that there was a need to target a dramatic scale up of prevention efforts in both the community and clinical settings.

There is also need to develop a minimum package for HIV prevention for national and district levels.
Stegman also revealed that the government is developing a National Prevention Plan.

President Festus Mogae agreed, stressing that when it was necessary, the focus was on provision of anti-retroviral drugs, care and support. But now that potential deaths due to HIV and AIDS have been curbed, it was now necessary to deal with the ever increasing rate of infection, hence the need to review strategy and focus on preventative methods. “Priority number one is prevention; priority number two is prevention; and priority number three is prevention,” said the president, emphasising that the change in strategy does not, therefore, mean the country failed in the battle against HIV and AIDS.

He warned the media against making wild allegations and assumptions that other countries’ strategies have worked, because HIV and AIDS is still a problem in the very same “success” cases, such as Uganda. In the Ugandan situation, where the prevalence rate is said to have declined, the president insisted it was a misconception that that was due to the sole strategy of advocating for abstinence.

He said by the time President Yuweri Museveni of Uganda advocated for abstinence, “he had no other alternative. People were dying and there were no ARVs at his disposal. That was in the 1980’s when there was no treatment, so when you were HIV positive then, you died, that’s how the prevalence rate declined.”

Mogae pleaded with the media to join hands in the gospel of abstinence, advising young journalists to ensure they stay HIV negative. “The one, but not only way, to stay negative is to abstain. I want you to stay alive so that you write about me when I die,” said Mogae, adding that, “I want to encourage the youth to please abstain.”

Also adding her voice to the prevention message was the US Ambassador to Botswana, Katherine Canavan, who also insisted that knowing ones’ status is critical to ensuring survival. She said daily, 12 000 people worldwide would contract HIV, but 90% of them, or about 10 800, would not learn that they are infected until full-blown AIDS hits them sometime around the year 2015.

“Until then those people will unintentionally spread the virus that lies silently within them.” Canavan said it was not her intention to scare anyone, but to remind attendants that the fight against HIV/AIDS was far from over.

The Ambassador said it was heartening to know that more than 90% of people in immediate need of ARV’s in Botswana are receiving them, adding that Botswana has been particularly successful in the prevention of transmission from the mother to child, through the PMTCT program.

“Thanks to routine testing; more than 90% of pregnant who are HIV positive are enrolling in the program.”
While treatment is critical, prevention was key. “Picture a water tap running and flooding the floor. Instead of struggling to mop the floor, shouldn’t we first try to turn off the tap?” asked Canavan.

She said that a viable prevention strategy would encompass education and counselling, free condoms, female empowerment, male circumcision, other biochemical options and abstinence.

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How is Abstinence-Only Sex Education Like South Africa’s Driving Exam?
By Ryan Hagen
14 November 2007
Freakonomics Blog

South Africa has had, for the last dozen years, what may be the world’s most difficult driver’s license exam. It’s an exercise in extremely defensive driving. Test examiners take off points for, among other things, failure to check all mirrors every seven seconds. An applicant can fail instantly if he lets his car roll backwards even an inch when stopping or starting, or simply if his test examiner hasn’t met his daily failure quota. In a recent Times article, Michael Wines writes that passing the test requires an applicant to “imagine that he is driving a live claymore mine under assault by guerillas in bumper cars.”

So South Africa must have the safest roads in the world, right? Well, no. The fatality rate per mile is five times higher than that of the United States, and rising fast. Why? Because the test is so hard, and the accompanying bureaucratic process so byzantine, that it acts as a strong disincentive for South Africans to get proper driver training. Many people simply drive without a license or buy one off the black market. So the unintended consequences of South Africa’s rigorous licensing program seem pretty plain: there is more bad driving as a result.
Turn now to the United States, where the Federal Government has spent upwards of $1 billion over the last decade on abstinence-only sex education. (Call it defensive dating.) The idea is that not teaching students about contraception, safe sex, etc., will lead to better outcomes, including less unwanted pregnancies and fewer sexually transmitted diseases.

Except … it turns out that teenagers are circumventing their abstinence education and having sex anyway. 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.

That’s one of the reasons why New York State recently canceled its abstinence-only program, passing up millions of dollars in Federal aid. Congress nevertheless appears ready to continue funding for similar programs. Maybe abstinence-only would work better if the classes were administered by one of those stern South African driving examiners.