Jamie Tobias Neely: Abstinence message often misses mark

You just don’t expect this kind of sex talk from a cheerful 65-year-old graduate of St. Augustine’s grade school and Holy Names Academy.

But there she was, chatting over coffee at Rockwood Bakery, and pointing out gentle conclusions about America’s recent efforts to influence the world’s morality. We spoke as World AIDS Day approached.

Donna Reilly Flanagan left home to join the Peace Corps in 1963 and has lived overseas nearly ever since. For years she worked with the World Health Organization in Southeast Asia, the Middle East and Africa. Twelve years ago she joined a research and education group called Family Health International, and recently her job included designing programs to reduce HIV/AIDS transmission by Asian sex workers.

That’s how she came to be the first Holy Names graduate I’ve ever met to whip out a pen and draw a picture for me of a female condom – one of her latest campaigns for Asian prostitutes. She sketched a wide plastic bag with soft rings at the top and bottom.

“You squeeze this ring, insert it in the vagina and then this hangs over,” she said, pointing to the billowing polyurethane.

Flanagan retired just over a year ago, leaving her job as technical director serving 14 Asian countries. She left Bangkok ready to spend more time with her grandchildren and also frustrated by Bush administration policies promoting conservative American values around the world. Now U.S. funds come with strings attached and a significant percentage of prevention dollars gets diverted into promoting abstinence and fidelity rather than buying condoms and microbicides to fight the virus.

She knows that efforts to promote abstinence to school children are politically palatable here, but school children, she points out, don’t spread the disease. Male and female sex workers do. And they don’t have much use for abstinence.

In Asia, wives often remain faithful, yet expect their husbands to visit prostitutes. These days the men bring home the HIV virus.

Flanagan’s programs, in countries like Cambodia, target not only the female sex workers, but also the straying husbands and the hapless wives. They teach prostitutes to use condoms, madams to clamp down on reluctant clients and wives to require condoms at home.

A new United Nations report shows that programs like these have been effective in Cambodia. Now sex workers and clients report much higher rates of condom use and HIV prevalence has dropped.

Yet worldwide, the epidemic continues to grow. The report counts an estimated 39.5 million people living with HIV today, an increase of 4.3 million this year.

Flanagan places her hopes in shifting cultural norms. Fifty to 75 years ago, in many places around the world, people still cleaned their teeth with sticks. As consciousness shifted, people began buying toothbrushes and toothpaste.

She hopes the same will be true with condoms.

Yet cultural differences are striking.

Four years ago Flanagan visited a Laotian village that had long struggled to get its crops to market during the rainy season. A dirt portion of the road kept washing out.

The villagers eventually realized the government wasn’t going to help, so they came together to devise a solution of their own. Two families offered up their daughters.

The young women were sent off to the city to become sex workers and dutifully sent the money home. The village finally could pay for paving its dirt road with gravel.

When the young women returned, the villagers carried through on their promises. They built each woman a house and allowed them their pick of husbands. When Flanagan visited, they’d both married; one was pregnant and the other was hoping to conceive soon. Their neighbors treated them as village heroes.

Flanagan plans to return to Cambodia in January to do consulting work. She tells the story of the Laotian brides to illustrate one of the important lessons she’s learned in 43 years of international service.

Americans may be comforted by exporting their morals throughout the globe. But when World AIDS Day rolls around, and we discover the abstinence message hasn’t exactly triumphed, Flanagan is one hometown girl who isn’t at all surprised.