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The Guardian (London), July 15, 2004

US Defends Abstinence Policy Amid Uproar

BYLINE: Sarah Boseley in Bangkok

The man charged with implementing George Bush's $ 15bn (£8bn) emergency plan to fight Aids yesterday embarked on a spirited defence of American policy, calling for his opponents to sink their differences with the US in the interests of global action against the disease.

Randall Tobias, speaking to the International Aids conference in Bangkok, supported policies that have been heavily criticised - such as sexual abstinence - as the best way to avoid HIV/Aids. He also backed the US's determination to spend its money on its own bilateral priorities in selected countries. He suggested that the sometimes aggressive opposition to the US way of doing things was counter-productive.

"Let me say this as directly as I can: HIV/Aids is the real enemy," he said. "The denial, stigma and complacency that fuel HIV/Aids - these too are the real enemies. It is morally imperative that we direct our energies at these enemies, not at one another.

"We may not agree on every tactic employed by every donor and we may have passionate opinions about how things can be done better, but we must work with each other to find the best solutions, while knowing that every person in this fight simply wants to save lives. That is a noble calling and should be appreciated and respected."

Demonstrators delayed Mr Tobias's presentation, chanting "Bush lies, people die". He declined to go to the podium until the placards in front of him stating "He lies" were lowered.

But he did not duck the controversial issues. He cited the Ugandan president, Yoweri Museveni, in support of the US "ABC" policy - abstinence, be faithful and condoms - "where appropriate".

Mr Tobias said: "When we say we are listening, and we say those on the ground know best, then we must surely listen and learn from the man who has led one of the most successful and pivotal battles against this disease. Yoweri Museveni has, largely by sheer leadership and will, fought back this disease in his country with an ABC prevention focus.

"We must learn from his leadership in the fight against Aids. Abstinence works . . . being faithful works . . . condoms work. Each has its place."

The UN agencies have all expressed their doubts about abstinence and fidelity, pointing out that women in southern Africa often do not have the power to say no and that married women are more likely to be infected with HIV, via their unfaithful husbands, than unmarried women.

"There is an urgent need to rethink the ABC approach," said Thoraya Obaid, executive director of the UN's Population Fund, at the launch of a report which outlined the dire plight of women in southern Africa, who make up 57% of those now infected and unable to protect themselves.

But Mr Tobias said there was confusion about the US position and there was no right answer to preventing the spread of Aids. "Those who want to simplify the solution to just one method, any one method, do not understand the complexity of the problem," he said.

The US president's emergency plan for Aids relief (Pepfar) would work with local people in affected areas, he said, giving money directly to groups in the communities who would know best what worked for them.

Mr Tobias, who has expressed doubts about the quality of the generic Aids drugs made in India, said if the drugs were submitted for approval by the US drug regulators, they would be eligible for US purchase "so long as international patent agreements and local government policies allow their purchase".

The US has been criticised for failing to put more money into the Global Fund for HIV/Aids, Tuberculosis and Malaria, which funds programmes put forward by developing world governments. The fund was "a young venture and still maturing", Mr Tobias said, but "a very promising vehicle and a critically important part of the work that all of us are doing".

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