Site Presented By
Monday, Nov 9, 2009
The president's AIDS initiative, like his invasion of Iraq, is a go-it-alone affair that ignores the clear global consensus on how to fight AIDS. In launching his own initiative, Bush has shifted the bulk of U.S. money away from the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international financing mechanism established before PEPFAR and widely recognized as the best way to distribute AIDS funds. "Bush is starving the fund," Zeitz says. "It's despicable, frankly."
Unlike PEPFAR, which focuses on 15 countries -- inexplicably excluding the AIDS-ravaged nations of Swaziland and Lesotho among others -- the Global Fund has committed funds to 128 countries. Economist Jeffrey Sachs, special advisor to U.N. Secretary-General Kofi Annan, recognizes the Bush administration's modus operandi. "This group is so convinced they have to do everything by themselves even though they often know the least about the issue," he said. "They reinvent everything -- reinvent it wrong at the beginning, learn along the way, explain that it takes time, and here we are." Where we are, unfortunately, is much like where we were two and half years ago.
But the failures of Bush's global AIDS policy go beyond how much money is being spent. Perhaps even more disturbing is how it's being spent. Overlooking the grim realities on the ground, Bush is using AIDS funds to place religion over science, promoting abstinence and monogamy over comprehensive sex education that includes information about and access to condoms. This should be no surprise, given the administration's track record. Yet it is still shocking to observe an administration that claims to be acting in the name of morality consigning tens of thousands, perhaps millions, of people to death because of its policies.
In 2002, America joined Libya, Sudan, Iran, Iraq and Syria -- a veritable axis of the unenlightened -- to scuttle an endorsement of sex education from a global declaration on children's health. Before overseas groups can receive U.S. funding, the Bush administration requires them to take a "loyalty oath" to condemn prostitution -- a provision that AIDS workers say further stigmatizes a population in need of HIV education and treatment. Brazil recently became the first country to rebel against the oath, announcing in May that it was rejecting $40 million in AIDS grants from the administration. "What we're doing is imposing a really misguided and ill-informed ideology on top of a public health crisis," says Jodi Jacobson, executive director of the Center for Health and Gender Equity in Takoma Park, Md.
Just as U.S. abstinence-only programs that push partial or false information on teens have doubled under Bush, so are such morality-driven programs cropping up under U.S. auspices in places like Africa -- where the stakes are much higher and a lack of vital information can kill. PEPFAR is fast becoming equated with a notorious emphasis on abstinence education -- nearly $1 billion of Bush's global AIDS pledge is earmarked for abstinence promotion. Bush's plan calls for an ABC approach to HIV prevention -- which stands for "Abstinence, Being faithful, Condom use," but the administration is stressing the "A." In its first year, PEPFAR spent more than half of the $92 million earmarked to prevent sexual transmission on promoting abstinence programs. "It's only a matter of time before the impact of abstinence-only programs can be measured in needless new HIV infections," says Jonathan Cohen, an HIV/AIDS researcher with Human Rights Watch.
Administration officials deny inappropriately stressing abstinence over all else, and point out that the epidemic worsened in Africa and other nations even with condom promotion. "If there is a sense of focus on abstinence until marriage now, it's because we've never been focused on these important things," said Dr. Mark Dybul, assistant U.S. global AIDS coordinator. But there is a good reason global AIDS experts haven't focused on abstinence: Scientific evidence shows no indication that trying to persuade young people to abstain from sex at the expense of condom education reduces the spread of HIV. Studies show that such programs actually increase risk by discouraging contraceptive use.
What's more, focusing on abstinence and monogamy ignores the reality facing young women and girls in Africa and other impoverished regions, who are often infected by wandering husbands or forced to have sex in exchange for food or shelter. Among 15- to 24-year-olds in sub-Saharan Africa, studies show, more than three times as many young women are infected with HIV as young men. Preaching about abstinence and faithfulness to girls and women in risky situations "can't be made sense of on any level," Jacobson says. "It's not only contrary to public-health best practices, it's contrary to common sense and contrary to human rights principles."
The emphasis on morality is being driven by social conservatives who have made spreading the gospel of abstinence and monogamy to Africans their primary mission. "Condoms promote promiscuity," says Derek Gordon of the evangelical Christian group Focus on the Family. "When you give a teen a condom, it gives them a license to go out and have sex." At a congressional hearing in April, Rep. Henry Hyde, R-Ill., threatened to cut funding for organizations that promote condoms. "The best defense for preventing HIV transmission is practicing abstinence and being mutually faithful to a non-infected partner," Hyde declared. And under a proposal being pushed by Hyde and his Republican colleagues on Capitol Hill, Tobias would be given the power to divert even more money toward promoting abstinence. "All [conservatives] can think about is making Africans abstinent and monogamous," says a Democratic staffer. "It's the crassest form of international social engineering you could imagine."
Nowhere is the effort by conservative Republicans to turn back the clock on sex education more pronounced than in Uganda. By aggressively promoting condom use and sex education, Uganda has managed to cut its HIV rate from 15 percent of the population to barely 6 percent during the past decade, making it Africa's biggest success story. Social conservatives argue that an emphasis on abstinence and monogamy drove down Uganda's HIV prevalence -- and if only other African nations could adopt such rigid moral standards, they would see similar success. While it's true that partner reduction may well have helped lower Uganda's HIV rates, the role of abstinence has been distorted and overblown by evangelicals seeking to control U.S. AIDS funds.
