Abstinence-only sex education in Uganda

The ABC approach was introduced during the US-Ugandan efforts to propose Abstinence-only as a way to lower HIV transmission. ABC is an acronym, A being Abstinence, B being Be Faithful, and C being Condom use.[1] It would seem that this form of abstinence-only includes some education and encouragement of condoms, but the application of ABC is disaggregated for specific populations. The breakdown is Abstinence for people not yet married, Be Faithful for those in marriages, and Condom Use only for people that are already infected or are in a marriage where one person is infected.[1]

ABC has evolved since its inception to a program known as AB, released in 2004 as an official abstinence-only education program for Uganda specifically. AB has lessened the emphasis on condoms due to the confusing nature of teaching the two simultaneously and the fear that condoms undermine the message of abstinence.[1] AB is criticized for its lack of follow-through of collecting data on whether participants are abstaining or not.[1] The main source of data collected for AB is the number of AB rallies, organizations and discussions concerning AB, instead of the behavioural changes proposed by AB. Therefore, AB is difficult to monitor as the true success of the programs aims for abstinence and social modifications, but no data is kept.

Condoms, Needles and Negotiations was born out of the necessity of failing marital monogamy. CNN stands for Condoms, Needles and Negotiation. In sub-Saharan Africa, Uganda included, married women in monogamous relationships are at a disadvantage due to the lack of rights within marriage, bargaining power, and domestic violence.[3] The need was discovered as most new HIV cases come from HIV women contracting the disease in their marriage through their husbands. In this way, AB abstinence-only education falls short for protecting the lives of those practicing it. The Condoms part of CNN is two-fold to reduce condom stigma and promote use within the B (Be Faithful) section of AB. Women are still practicing faithfulness, but in order to protect their health, they still need to be able to understand and use condoms. The first N in CNN covers needle exchange, which doesn't relate to abstinence-only sex education. But the second N stands for Negotiation, which again plays a part for individuals practicing faithfulness who could still be harmed. Negotiation informs partners of the risks they might encounter if their partner is not being monogamous and teaches them skills to bargain in their position in the relationship.

In 2001, Ugandan President Yoweri Museveni introduced his official program for sex education for the youth of Uganda, Presidential Initiative on AIDS Strategy for Communication to Youth, abbreviated as PIASCY. PIASCY mainly targets primary schools, secondary schools and after school youth rallies with materials and instruction (HRW, 29). The main focus of PIASCY is for young people to empower themselves to delay their sexual relations until marriage through abstinence. PIASCY is primarily funded through the United States Agency for International Development and the U.S. Centers for Disease Control and Prevention, both of which provide many other services outside of finances to support the program. In addition, PIASCY has since become a foundation feature in the United States’ President's Emergency Plan for AIDS relief (PEPFAR).[1]

The medium for primary school involvement with PIASCY is a combination of manuals, instruction for teachers to relay to students, as well as materials given directly to the students based upon their age/grade. An assembly is normally held twice a month school wide for teachers to give presentations outlined from the curriculum within the PIASCY manuals.[1] The first message is the choice of abstinence and its benefits, but subsequent lessons can include teachings of self-esteem and how to be above peer-pressure.[1] Although other parts of PIASCY include correct condom application and uses, at the primary level, abstinence-only is the majority of the message.

In 2004, the Ugandan government incorporated PIASCY in secondary schools, in the form of handouts for students as well as teachers.[1] The curriculum is disseminated in the classroom format on a regular basis. The secondary school level information was drafted to include age sensitive subjects such as masturbation, abortion and homosexuality, but was met with strong opposition from many powerful, yet undisclosed, groups in Uganda and the United States.[1] In addition, draft copies of the secondary school handouts contained misleading and inaccurate information about condoms and HIV prevention. Furthermore, condoms were encouraged after marriage as HIV prevention, but did not explain how this differed with unmarried youth.[1] The final drafts did include rudimentary instruction on condoms without the corresponding photos.

PIASCY also has a significant section of their focus targeting youth that are not in school by holding rallies and events after school or outside of school. In Uganda, there are significant numbers of youth that are not enrolled in school, despite the recent movements to educate everyone. Although these events are generally held on a school campus or facility, anyone aged 15–30, student or not can participate.[1] These events generally have speakers who are as diverse as the President of Uganda to religious leaders.[1] In more rural areas, these serve to disseminate important abstinence messages but have been criticized as supporting an agenda of re-election and political messages and including inaccurate information about condoms and abstinence. After the formal rallies and programs, it is made aware that political leaders are around to take questions that youth may have about the current government.[1] PEPFAR, an organization providing funding to PIASCY, outlines promotion of information, prevention and treatment of HIV, and is in contradiction with the political agenda and misleading information sometimes found in the PIASCY after school programs.[1]

In Uganda, there are a number of faith-based organizations that provide abstinence-only education to youth. Many of these are financed and supported by not only the Ugandan Government, but also the United States. In general, these are based on Christian beliefs, as 60% of Ugandans are Christian.[4]

The National Youth Forum was founded by one of the nation's largest activists for abstinence-only sex education, first lady Janet Museveni. The primary objective for the National Youth Forum (NYF) is to coordinate assemblies where young boys and girls pledge to stay sexually pure until marriage. More than 70,000 Ugandan youths have committed to this through NYF.[5] NYF and Museveni advocate abstinence-only education in its most exclusive form, even pushing the notion that condoms are inadequate in preventing HIV and education involving them promote sexual activity among youth.[1] She has gone so far as to propose a nationwide testing of young boys and girls for virginity, although this has not come to pass. Ms. Museveni's organization NYF also obtains funding from the American government.[6] This relationship has been called under scrutiny on the grounds that UNF Proselytizing and the laws of the United States regarding the secular nature of congressional funding.[7]

The Makerere Community Church is another national leader in the abstinence-only push. Martin Ssempa, who is one of the writers of the Ugandan AB policy, directs the church and foundation.[1] Ssempa leads the fundamentalist Makerere Christian Church and his policies fall in line. He takes a more extreme version of abstinence only sex education, sometimes speaking out directly against condoms and women's rights.[1] His is a more outlying approach to abstinence-only and the lifestyle that he connects with it.

The Family Life Network is a non-profit organization that teaches abstinence-only techniques alongside value based sexual education. Since 2002, they have reached at least 130,000 students in over 400 schools.[1] A tactic readily put into place is to create abstinence-only in the public discussion is a signing of "True Love Waits" cards to pledge abstinence until marriage.[1] Stephen Langa, the executive director, defines the Family Life Network as having four goals: bring back faith in the marriage institution; show the danger of sexual involvement; warn children on the dangers of globalization, such as pornography; and ask children to make a commitment of abstinence. Although Langa does not actively speak out against condom use, his beliefs when questioned contain false information about the protection provided by condoms against sperm and HIV transference.[1] The Family Life Network receives money from foreign and Ugandan donors, but has not in the past received any contributions from the United States or PEPFAR.[1]

In many situations, the choice to abstain is non-existent. Many young girls and some boys are sex workers, selling their bodies to survive. In these high-risk environments, the participants do not have the ability to abstain or enter into a faithful monogamous relationship.[1] Abstinence-only sex education in Uganda has been criticized for ignoring the thousands of citizens that are forced into sexual relations and therefore unprotected against HIV/AIDS. Due to abstinence-only sex education teaching abstinence until marriage as the only option, many sex workers do not know about or use condoms. This creates a breeding ground for HIV transmission. Abstinence-only sex education is woefully discriminatory against lower socioeconomic peoples.

Outside of sex work, there exists young women and men that also cannot abstain due to social or financial pressure from older parties that act as "sugar mommies" and "sugar daddies".[11] Young men and women engage in sexual relationships in order to obtain items, treats or opportunities that they would not be able to otherwise receive. Abstinence-only sex education in Uganda disregards the existence of these relationships and does not provide any program or policy to protect against HIV/AIDS infection.

Another criticism levelled at abstinence-only sex education in Uganda is the limiting language and subsequent exclusion that the policy promotes when addressing lesbian, gay and bisexual (LGB) people. Abstinence-only sex education teaches to abstain from sex until marriage to a faithful partner. In Uganda, same-sex marriage is not recognized, and gay people can be penalized for coming out. In this way, some believe that abstinence-only sex education in Uganda discriminates against LGB individuals and does not provide them with adequate tools to combat HIV/AIDS infection.[1]

Critics of abstinence-only sex education have made the point that abstinence-only truly curbs education and a well-rounded knowledge to fight HIV/AIDS infection. The implied mutual exclusivity of abstinence-only harms followers as they are not able to receive as much knowledge as possible. Leaders of the ABC method have highlighted the use of abstinence as a tool among others. The mutual exclusivity that so many abstinence-only teachers espouse does not need to exist.[10] Abstinence can be an aspect of sex education without being the only curriculum in order to support an educated platform against HIV/AIDS infection in Uganda.