World view - Lindsey Hilsum measures the cost of US aid

Evangelical hardliners have gained such a stranglehold on US policy in the developing world that som

In a week when George W Bush has been talking up US aid to Africa, we should look at how that money is spent. As the old song says: "It ain't what you do, it's the way that you do it."

Take the President's Emergency Plan for Aids Relief (Pepfar) - $15bn (£8.2bn) over five years "to turn the tide in the global effort to combat the HIV/Aids pandemic". It sounds good, but Aids organisations around the world are concerned that Bush's "faith-based" approach, which views abstinence from sex as the only way to prevent Aids and stigmatises prostitutes and drug users, may make things worse not better.

Alice Welbourn was surprised last month to find that the body she chairs, the International Community of Women Living With HIV/Aids (ICW), was under attack in Washington. Alice was diagnosed HIV-positive in 1992 and understands the needs of women struggling not only to survive but also to keep their self-respect. "A lot of people think: Stupid woman, she must have done something foolish," she says. She looks well, her blonde hair pulled back into a chignon, her skin clear. "I'm kept alive by drugs, but that doesn't mean the stigma goes away," she says.

Alice is dedicating her life to helping HIV-positive women in poorer countries. Recent ICW projects have been part-funded by the US government, but there are problems now with the ultra-conservatives shaping US policy.

Last month Senator Tom Coburn, a Republican from Oklahoma who campaigns against abortion and thinks condoms should carry a health warning, wrote to Bush to condemn cash from the US Agency for International Development going to the ICW. The ICW, he said, "is one of many created to take advantage of the availability of funding from Usaid". Wrong: founded in 1992, it tries to fund projects from multiple sources. He referred to an ICW workshop in South Africa, at which HIV-positive women called for "access to sexual and reproductive rights", including the right to terminate unwanted pregnancies. Coburn wrote: "It is stunning that funds appropriated to save lives are instead being siphoned to promote the taking of lives of unborn children." Views such as these now permeate US funding for Aids projects and women's healthcare in the developing world. "There is a great emphasis now on abstinence only and marital fidelity, despite clear and compelling international evidence that all such narrow and judgemental approaches just do not work," says Dr Welbourn.

Any organisation receiving public money, even a body such as the Ford Foundation, must sign a declaration that it does not support prostitution, drug use or abortion. Some of the most alarming results have occurred in the country often touted as Africa's success story on Aids: Uganda. During the 1990s, prevalence rates declined from 15 to 7 per cent, and most experts attribute this partly to sex education and partly to the promotion of condom use. The approach was called ABC - "Abstain, Be faithful or use a Condom". But that has changed. Now it's A for the unmarried and B for the married, with no C at all.

Janet Museveni, the president's wife and a born-again Christian, has led marches for virginity in Kampala. She has also been to Washington to help Republican senators campaign against the use of condoms in US-funded Aids prevention programmes. A fanatical born-again pastor, Martin Ssempa, who advises her on Aids, testified to Congress that Usaid was promoting "promiscuity and condoms" and not allowing "faith-based organisations" - such as his - to help. In fact, one of Pepfar's aims is to back faith-based organisations, potentially undermining the strategies of Usaid and other donors that oppose the "abstinence only" approach, on the grounds that it is unrealistic.

The impact is being felt. Condoms are in short supply in Uganda because, although there is no testing machine there, the government is insisting on "quality controls" before they are distributed. President Museveni, who has also become a born-again Christian, no longer talks of condoms, only abstinence and fidelity. American evangelical churches are pouring in money and pushing for more from George Bush's fund.

Last month, the Brazilian government turned down $40m of US government money for Aids programmes, believing that signing a declaration condemning prostitution and drug-taking would jeopardise Brazil's success in controlling Aids. It's hard to turn down money when millions are dying, but maybe the Brazilians have a point. Rather than persuading the US to give more money to Africa, we should be using European money to counter the US approach, and help African governments distinguish between aid that helps, and aid that does more harm than good.

Lindsey Hilsum is international editor of Channel 4 News

Lindsey Hilsum is China Correspondent for Channel 4 News. She has previously reported extensively from Africa, the Middle East, the Balkans and Latin America.

This article first appeared in the 13 June 2005 issue of the New Statesman, G8 protest: how far should you go?