Since its earliest days, the Bush administration has promoted abstinence-only-until-marriage programs as its preferred means of HIV prevention. A like-minded Congress approved over $120 million for domestic abstinence programs in its fiscal year 2003 budget, $50 million of which was connected to the U.S. Welfare Reform Act and to programs that teach that a "mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity." These federally funded initiatives limit all discussion of contraceptives-and condoms-to a focus on their failure rates.

A range of organizations have pointed out that the administration is making vital public health decisions based not on scientifically proven fact, but on ideology. From AIDS organizations to the ACLU, groups in the U.S. have argued that abstinence-only programs constitute a lethal form of censorship by withholding information on methods known to prevent HIV and STI (sexually transmitted infection) transmission.

Most organizations are currently focused on U.S. domestic concerns about abstinence-only education and funding. However, it is also vital to consider the global arena, where the U.S. administration exports its sectarian ideology and morality, primarily through restrictions on foreign assistance funds and the policy positions of U.S. delegations at the United Nations. Both domestically and internationally, scientifically sound arguments could be strengthened by use of a human rights perspective, namely one that rests on the ideas enshrined in the Universal Declaration of Human Rights and other internationally agreed instruments that all people have the right to information, to education, to enjoy the benefits of scientific progress, to be free from discrimination, to freedom of expression and to enjoy the highest attainable standard of health. Taken together, these and other standards form the basis of international human rights law. The denial of these rights (and others) in relation to public health threatens each person's right to life and constitutes an infringement of international law for which governments, including the current U.S. administration, must be held accountable.

Human rights organizations are especially well positioned to address abstinence-only programs as a rights issue. In doing so, they could hold governments accountable for human rights violations inherent in the implementation of many abstinence-only programs, which are enforced through discriminatory and moralistic restrictions on what can and cannot be taught or discussed. They could build coalitions between domestic and international groups concerned with public health and discrimination. They could also capitalize on the opportunity to develop their own advocacy positions on gender and health.

The people who have the most to gain from collaborative work grounded in human rights analysis are those who need and want information but are denied accurate, scientifically proven information about disease prevention and transmission, condom use, and contraception. While false and misleading information about health jeopardizes the well-being of all people, certain groups are at particular risk when accurate information is censored, altered or withheld. These include women and young people (particularly girls) and people who are already marginalized, including sex workers, lesbian, gay, bisexual and transgender people, and people who inject drugs.

U.S. Abstinence Agenda: Policy without Proof

Fictional claims, manipulation of information and imposition of gag rules are emerging as three consistent tools in the administration's implementation of its domestic and international public health agenda. This is especially true where sexuality and reproductive rights are concerned. The Secretary of Health and Human Services, who is also the chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has justified increased domestic spending on abstinence-only programs knowing that there is no credible proof that they are effective. As he once said: "Let's try them out and see if we can't get it to work" (AP Online; January 30, 2002). The policy, in effect, would deny scientifically proven methods of reducing HIV transmission in order to promote an idea that is popular with a core of conservative Republican voters.

In this administration, the desire to "make abstinence work" trumps the human right to life. The consequences of these skewed priorities are deadly, especially as young people constitute one of the groups with the most rapidly rising rates of HIV infection. U.S. polices are, in effect, eliminating one of the only tools available that can save people's lives: information.

In Congress, right-wing policy makers such as Rep. Chris Smith (R-NJ) and Rep. Joseph Pitts (R-PA) have worked to ensure that programs with no medically-proven effectiveness have been funded. Political pressure also has been used to de-fund family planning programs (such as the United Nations Family Planning Association). HIV prevention and other sexuality education programs have been audited when their work was seen to stray from the abstinence-only line. While there is a growing list of organizations that have been targeted, two examples are worth noting: San Francisco's Stop AIDS program faced over a year of continuous federal reviews, and Advocates for Youth endured three audits in one year.

One of the more egregious examples of Congressional efforts to promote abstinence-only ideology in the international arena is directly pegged to fighting the AIDS pandemic. Even though the U.S. administration called for $15 billion to fight AIDS in Africa and the Caribbean, the congressional budget appropriations process shows this commitment to be subject to conservative ideological constraints. Congress earmarked one third of prevention funds to programs that promote abstinence-only ideology, and reduced funding for comprehensive prevention efforts that have shown positive results.

Members of Congress and the administration in part justify this allocation of funds by touting the success of abstinence programs in Uganda, even though public health officials in Uganda and elsewhere question the validity of those claims. The Lancet medical journal recently reported that increased condom use also contributed to the decline in prevalence rates, and that conclusions crediting only the abstinence portion of Uganda's AIDS prevention programs are based on scientifically unsound data collection and manipulation of numbers (The Lancet, Parkhurst, July 6, 2002).

Policies from Washington are fundamentally flawed because they ignore the realities of millions of people, particularly women and girls, all over the globe. Abstinence is meaningless for many women and girls who have limited or no power to negotiate condom use or to resist violence by male partners or strangers. There are 82 million young women in developing countries currently between the ages of 10 - 17 who will marry before their 18th birthdays. It is foolish to insist that these young women "just say no" to sex demanded by their older and more powerful husbands. In many scenarios, it is the husbands who have the power to abstain; too often, they don't and their young wives can't.

U.S. and Abstinence at the UN

Many of the same groups that promote the most conservative and restrictive policies on sexual and reproductive rights domestically are appearing on the global scene, and in recent UN meetings related to health, children and population issues. In these settings, U.S. delegations have attempted to insert abstinence in their negotiations on international agreements and have protested if abstinence provisions were removed. In many of these meetings, the U.S. administration worked directly with advisors from right wing organizations such as the Family Research Council (FRC), Focus on the Family, and Concerned Women for America (CWA). Whether in relation to abstinence specifically, or reproductive rights more generally, U.S. delegation statements and positions reflect a swing to an extremist ideology.

At the UN General Assembly Special Session on Children in 2002, the U.S. delegation, which included FRC and CWA, tried to block international consensus on comprehensive sexuality education and related services for young people. In an official written explanation of its position, the delegation emphasized its "commitment to programs that address ... the need to stress the practices of abstinence, of delaying sexual initiation, monogamy, fidelity and partner reduction..." to prevent HIV infection. In its positions, the U.S. delegation supported myopic and moralistic domestic policies that sought to position abstinence as the only worthwhile method of reducing transmission.

In 2002, over thirty Asian countries voted against conservative U.S. positions at an important regional meeting on population and development in Bangkok. At the end of the meeting, the entirely isolated U.S. delegation issued an official statement on the final agreed document. The statement repeats the language from the earlier meeting on children and adds that the "United States made every effort to insert language in the document reaffirming the importance of abstinence" and "remains disappointed" that the assertion that "abstinence is the healthiest choice for unmarried adolescents" was deleted from the final text.

Resistance

Disinformation and ideologically-driven funding are beginning to be challenged. Feminist and reproductive rights organizations such as the International Women's Health Coalition are working to counter extremist ideologues at the UN and in other global policy forums. Progressive coalitions of non-governmental organizations are cooperating with ally delegations here and overseas to share accurate information about comprehensive sexuality education and to strengthen the ability to refute abstinence-only messages.

There is clear progress domestically, as well. Human Rights Watch compiled a bold and first-of- its-kind report critiquing abstinence-only programs in Texas. Rep. Henry Waxman (D-CA) recently issued a report criticizing the administration's persistent misuse and manipulation of science. Whistleblowers within the National Institute of Health and the Centers for Disease Control tell of being pressured to alter or suppress scientifically accurate information. And AIDS service organizations have begun to decry the prioritization of abstinence in U.S. global AIDS funding.

The right wing has been very effective at melding its domestic and global strategies. Progressive organizations and social movements must do the same, and with urgency. Using a human rights lens to critique abstinence-only programs and the manipulation of valid scientific data would go a long way in fostering effective coalitions. Coalitions of human rights organizations, and sexual and reproductive health and rights organizations, must increasingly take their fight to global and UN levels to protect gains already won.

Organizations working in domestic and international arenas would do well to build on one another's analyses and work together to challenge the current administration's "make abstinence work" philosophy, and to expose its strong links with conservative extremist advisors. We must do this by deploying a variety of rights-based arguments and by making a renewed and passionate commitment to linking the domestic to the global.

Cynthia Rothschild is the former Program Officer in the International Policy Program of the International Women's Health Coalition, and is based in New York.

This article was originally published in an issue of American Sexuality Magazine devoted to the "abstinence-only" debate. Click here to access the full issue online. Reprinted with permission.

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