Experts Chide US-Funded Anti-AIDS Programs

The US Agency for Interna­tional Development and the Ministry of Health are expected to sign a deal today for a $29.5 million grant—the largest ever given by the aid agency’s Cambodia office—about half of which will be used to fight HIV/AIDS.

US policy dictates that one-third of that $14.8 million be earmarked for programs emphasizing abstinence and monogamy, as part of what is known as the “ABC” mo­del of AIDS prevention: Absti­nence, Be Faithful and Condoms.

But those familiar with the na­ture of the epidemic in Cambo­dia said Monday that condom use outweighs abstinence and education in preventing the disease’s spread.

“Abstinence, being faithful, [are] very, very important. But the im­plementation…how can people be abstinent?” said Mean Chhi Vun, director of the National Cen­ter for HIV/AIDS, Dermato­logy and STI.

Abstinence education usually takes the form of discussions led by peer educators, said Mark White, director of the USAID Of­fice of Public Health.

While abstinence and mono­gamy should be emphasized, the message needs to change depending on the audience, he said.

“You don’t go into a brothel and start talking about abstinence,” he said Monday.

Even for peers, the message of abstinence is a difficult one to spread, said Moeun Channa, 21, a peer educator volunteer with Health Unlimited.

“I try to tell them not to have sex, but they don’t listen,” he said.

The US administration’s emphasis on abstinence drew criticism at the XV International AIDS Confer­ence in Bangkok last month, where delegates said the ABC policy shortchanged more effective programs aimed at condom use.

Conference participants cited the dramatic success of condom use programs in countries like Cambodia, where brothels are a pivotal site of HIV transmission.

HIV infection rates among sex workers in Cambodia plunged from 42.6 percent in 1998 to

28.8 percent in 2002 after a campaign promoting condom use in brothels. In Thailand, HIV infections among sex workers were re­duced sevenfold within 13 years af­ter a similar project, The As­so­cia­ted Press reported.