Gates breaks ranks with attack on US Aids policy

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August 15, 2006

Bill and Melinda Gates came off the political fence yesterday and backed key causes of Aids campaigners, criticising the abstinence policies advocated by the US government and calling for more rights for women and help for sex workers.
Making the keynote speech of the opening session of the 16th International Aids conference in Toronto, Canada, the Microsoft billionaire and his wife spoke with passion and commitment about the social changes necessary to stop the spread of HIV/Aids.


The so-called ABC programme - abstain, be faithful and use a condom - has saved many lives, Mr Gates told the conference of more than 20,000 delegates. But he said that for many at the highest risk of infection, ABC had its limits. "Abstinence is often not an option for poor women and girls who have no choice but to marry at an early age. Being faithful will not protect a woman whose partner is not faithful. And using condoms is not a decision that a woman can make by herself; it depends on a man.
"We need to put the power to prevent HIV in the hands of women. This is true whether the woman is a faithful married mother of small children or a sex worker trying to scrape out a living in a slum. No matter where she lives or what she does, a woman should never need her partner's permission to save her own life."

The Gates Foundation is funding research into microbicides - gels or barrier creams that a woman can use before sex and that could destroy the virus.

Mrs Gates called for an end to the stigma that affects those with HIV. "Stigma makes it easier for political leaders to stand in the way of saving lives," she said, in an attack on some African leaders influenced by the pro-abstinence agenda of the Bush government and the Christian fundamentalist right in the US. "In some countries with widespread Aids epidemics, leaders have declared the distribution of condoms immoral, ineffective or both. Some have argued that condoms do not protect against HIV, but in fact help spread it. This is a serious obstacle to ending Aids ... If you oppose the distribution of condoms, something is more important to you than saving lives," she said.

The promotion of abstinence is a key policy of George Bush's $15bn (£7.9bn) five-year President's Emergency Plan for Aids Relief (Pepfar). By law, 33% of funding must be spent on policies that promote abstinence outside of marriage.

The UN special envoy for HIV/Aids to Africa, Stephen Lewis, accused the Bush government of neo-colonialism. He has given his backing to US Congresswoman Barbara Lee, who has introduced legislation to get the abstinence-first rule overturned. "No government in the western world has the right to dictate policy to African governments around the way in which they structure their response to the pandemic," he said.

Ms Lee, one of the chief authors of the Pepfar legislation, said she had the backing of 80 members of Congress and 70 non-governmental Aids organisations.

"For women, the abstinence-until-marriage policies make no sense when they face gender discrimination, violence and rape and can't control their own bodies," she said.

Jodi Jacobson, executive director of the Centre for Health and Gender Equity in the US, said that in some African countries abstinence policies were absorbing much more than 33% of Pepfar's prevention funding. "In Nigeria nearly 70% went to abstinence-until-marriage policies. In Tanzania, the newest grant is 95% on abstinence and be faithful programmes for youth aged 15-24," she said.

On the agenda

· Preventing the spread of HIV tops the agenda now drug treatment is being rolled out in developing countries

· Controversy is likely over a push towards universal testing for HIV

· Science is taking a back seat, partly because there are no imminent breakthroughs

· The need to improve the lives and status of women is seen as crucial
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