AIDS As a Moral Disease, Once Again: How Government Policies on Abstinence Promotion Teach Old-School HIV Stigma in the U.S. and Uganda

by Suzy Subways, Editor, Solidarity Project

DECEMBER 2006 • Issue 2

People often talk about stigma when describing challenges in fighting HIV/AIDS. Stigma can underlie a spectrum of human rights violations—from neighborhood snubbing or family rejection to denial of medical care, to outright mob violence and murder. Suggested remedies range from what can be painstakingly slow cultural work and sensitivity training to aggressive enforcement of legal protections. But what is the solution when stigma is a top-down phenomenon?

Governments can infuse HIV stigma deeply into a nation, with cold, hard cash to back it up—operating at levels of power far above the misinformed family that sets a paper plate and plastic ware at the HIV+ person’s place-setting at holiday visits. As we arm individuals to fight stigma at the family and community level, we also need to demand that governments stop spreading stigma and start addressing its consequences.

There is now ample evidence that the funding of abstinence-only policies brings systemic promotion of HIV stigma. And the data show that abstinence-only-until-marriage programs don’t work for preventing HIV. If we can pull their massive funding—especially in the U.S. and Uganda, which are held up as models for other countries—we’ll also dismantle a powerful source of stigma and blame that hurts people living with HIV as well as members of marginalized groups like sex workers, LGBT people, and sexually active girls and women.

Under the abstinence education provision of the U.S. welfare reform law signed by President Clinton in 1996, teachers who receive the funding must say, “sexual activity outside of marriage is likely to have harmful psychological and physical effects.” The federally funded Sex Respect® curriculum teaches that “the best ways to avoid AIDS are: Remain a virgin until marriage…. Avoid homosexual behavior.” Lessons like these blame the AIDS epidemic on gay men, imply that people living with HIV got it through bad behavior, and feed into stereotypes about sexually active girls that make all young women more vulnerable to blame and coercion.

HIV stigma is built upon existing inequalities. For example, HIV positive women are often blamed for their husbands’ illness, even if they are abstinent before marriage and faithful to their husbands. “After my husband’s death, I also tested positive for HIV,” Ugandan AIDS activist Beatrice Were says. “My in-laws wanted to grab my property, take my children and marry me to my brother-in-law. Although I was still a young woman then, I struggled.” In the early 1990s, Were started the National Community of Women Living With AIDS (NCWOLA), fighting discrimination, domestic violence and marital rape. Now, as a result of U.S. policy, she says, “we are seeing a new wave of stigma through a moralization of the disease by new and radical evangelical groups.”

Ugandan AIDS activist Beatrice Were

The U.S. Christian Right once opposed AIDS funding on the basis that the virus was a judgment from God. Now, they are reveling in hundreds of millions of HIV prevention dollars that fund them and their allies to promote that same AIDS-as-punishment message around the world—especially in Uganda. President Yoweri Museveni and his wife Janet have welcomed the influx of U.S. abstinence-only cash and changed Uganda’s HIV prevention tune accordingly. In a 2004 speech, he called AIDS “a moral problem” and said that condoms should only be for sex workers. Examined next to a 2001 statement by Peter Piot of UNAIDS that HIV stigma comes from shame because “the sex or drug injecting that transmit HIV are surrounded by taboo and moral judgment,” Museveni’s new approach appears to be a clear case of intentional stigmatization.

This stigmatization is opening the door to a new wave of HIV infection in the nation once touted for its success rolling back high HIV prevalence. In the first two years of Uganda’s new “abstinence and be faithful”–only approach, condom use declined and the HIV rate nearly doubled—from 70,000 in 2003 to 130,000 in 2005. And on December 6, Uganda’s AIDS Commission announced that the biggest proportion of those newly positive people—42%—got the virus while married. Yet young women are not warned about risks within marriage, and once they test positive, they will increasingly be treated like they have sinned.

Although Ugandan youth are at high risk for HIV, condoms are only appropriate for the orphans, internally displaced and street youth, government officials claimed in a 2005 Human Rights Watch report. But marginalized youth still don’t get adequate outreach. And LGBT communities are “erased from all HIV programs,” one activist told Human Rights Watch. Queer youth are expelled or beaten at school assemblies, and adults face imprisonment and torture.

Like Museveni’s comment that condoms are for sex workers, stigmatizing approaches say that HIV is a problem for other people—people who others should look down on and isolate in order to feel (falsely) safe. But like racism and homophobia, AIDS is a social disease, one that affects everybody—and one that we all have a responsibility to fight. That fight must include the highest levels of governments that are promoting stigma instead of promoting public health and human rights.

This image was removed from Uganda’s 2003 HIV prevention handbook for primary-school teachers at the insistence of some individuals from faith-based organizations. They argued the picture was too explicit and children might see it if they borrowed the books from their teachers. The U.S. government paid for the publication of these censored new editions.

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Filed under gay and bisexual men, gender, imperialism/colonialism, people with AIDS in leadership, sex education, Solidarity Project, stigma, Uganda, Uncategorized, women, youth

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