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From AIDS treatment to prevention. There's been some success in controlling the spread of AIDS in Kenya as well as in Uganda and Zambia. That's been attributed to an approach that urges abstinence, monogamy and condoms. Well, now an AIDS advocacy group in the US is charging that the Bush administration is hindering that approach. They say the US is requiring prevention programs to emphasize abstinence and to de-emphasize condoms. The administration says it will support programs that do both. NPR's Brenda Wilson reports.

BRENDA WILSON reporting:

Jodi Jacobson, the director of the Center for Health and Gender Equity, just returned from a visit to Nigeria.

Ms. JODI JACOBSON (Director, Center for Health and Gender Equity): We were told by a sex worker group in Kano State, Nigeria, that their manual for training sex workers on reducing risk now emphasized abstinence and `be faithful,' and their condom supply has disappeared. This is ridiculous. These are commercial sex workers.

WILSON: She says it started when conservatives complained that abstinence was being slighted under a program modeled on Uganda's AIDS prevention campaign called ABC for `abstain, be faithful and use condoms.' So Congress directed 33 percent of US assistance for prevention to be spent on programs that promote abstinence until marriage. Jacobson, a critic of the administration's AIDS policy, says the US has now gone overboard in carrying out an agenda that is based on ideology and not public health.

Ms. JACOBSON: We are taking an approach where the general population is receiving only abstinence programs or abstinence and be-faithful programs. And condom procurement, distribution and social marketing is being shifted and redirected away from the general population toward so-called high-risk populations.

Mr. MARK DYBUL (Deputy Coordinator, Global AIDS Program): No, that's absolutely incorrect.

WILSON: Mark Dybul, the deputy coordinator for the global AIDS program, insists that the message hasn't changed.

Mr. DYBUL: Abstain and be faithful. If you can't do either of those, use a condom. And this is public health. We know the best way to avoid infection is to abstain and be faithful to an HIV-negative partner. That's a hundred percent. Correct and consistent condom use is about 90 percent effective. People deserve that information to make a decision. With that information, should a person decide to engage in risky activity, they should have a condom available. That's ABC. That's what we support. Now when we have to report financially, we have to say how much money went for each component of that, but that doesn't mean you don't have a program that covers all of them.

WILSON: But the accounting is controversial. Guidance and operating plans sent to countries that received US assistance this fall lend support to the argument that there has been a shift to abstinence. Abstinence must make up 33 percent of the total a country spends on all prevention; that includes treatment for mother-to-child transmission of HIV and assuring that the blood supply and medical equipment are safe. But programs that encourage people to abstain from sex, delay it until marriage and limit the number of partners make up two-thirds of the budget for preventing the spread of HIV that is transmitted sexually. And though Dybul says you can do ABC in a single program, that isn't always what happens on the ground. Shepherd Smith sits on the board of the Children's AIDS Fund, a supporter of faith-based programs.

Mr. SHEPHERD SMITH (Children's AIDS Fund): You have people today--let's say faith-based groups--who are giving a strong abstinence and be-faithful message. They aren't really even discussing condoms. You have people who equally are giving very strong condom messages in those same countries. The only difference today is they aren't all talking to the same people. The abstinence and faithfulness people are talking to young people and to married couples. The people now distributing the condoms and giving that message are going to the truck stops, to the bars, to where the prostitutes are, and they're giving out condoms.

WILSON: The guidance and operating plans have only made things worse, according to Jodi Jacobson.

Ms. JACOBSON: We have inconsistent messages, and we have really what is in effect a mess.

WILSON: AIDS prevention, both internationally and domestically, has always been a contentious subject. Stephen Morrison, the director of the Africa division of The Center for Strategic and International Studies, says there's been no shift, but neither the 33 percent earmark nor this fall's guidance has eased tensions.

Mr. STEPHEN MORRISON (Director of Africa Division, The Center for Strategic and International Studies): The money that's flowing into the system is enormous. You have mobilized constituencies on quite different perspectives. And fundamentally, HIV-AIDS is about sex and stigmatized behavior which is polarizing. And you're in a country where you have weak institutions and the resource flows have enormous consequences in people's--the extension of people's lives, but also their ability to become major players on the ground. So we're going to see more of this, I believe, unfortunately.

WILSON: The danger is, Morrison says, that people will lose sight of the bigger picture. And the bigger picture is that prevention efforts have not been succeeding across the board. What is needed from Washington, he says, is more leadership, sensitivity and very methodical explanations, or the tensions will only get worse. Brenda Wilson, NPR News, Washington.

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