Under pressure from the Bush administration, Uganda has taken a dangerous turn toward an abstinence-only approach. In April, the country's Ministry of Education banned the promotion and distribution of condoms in public schools. To make matters worse, the government has even engineered a nationwide shortage of condoms, issuing a recall of all state-supplied condoms and impounding boxes of condoms imported from other countries at the airport, claiming they need to be tested for quality control. As of this year, a top health official announced, the government will "be less involved in condom importation but more involved in awareness campaigns: abstinence and behavior change."

The Bush administration is supporting the shift by pumping $10 million into abstinence-only programs in Uganda. "One can put a dollar figure on the political pressure," says Cohen, who has closely studied the initiatives in Uganda. "Groups know the more they talk about abstinence, the more they'll get U.S. funding. And they fear that if they talk about condoms they'll lose funding -- or, worse, get kicked out of the country."

Tobias issued written guidelines to PEPFAR partners in January that spell out the administration's agenda. Groups that receive U.S. funding, Tobias warned, should not target youth with messages that present abstinence and condoms as "equally viable, alternative choices." Zeitz of Global AIDS Alliance has dubbed the document "Vomitus Maximus." He says, "I get physically ill when I read it. It has the biggest influence over how people are acting in the field."

The anti-condom order issued by Tobias is already having a chilling effect among the groups most effective at combating AIDS. Population Services International, a major U.S. contractor with years of experience in HIV prevention, says it can no longer promote condoms to youth in Uganda, Zambia and Namibia because of PEPFAR rules. "That's worrisome," says PSI spokesman David Olson. "The evidence shows they're having sex. You can disapprove of that, but you can't deny it's happening." What's more, conservatives are attacking PSI for promoting condoms -- a campaign that prevented an estimated 800,000 cases of HIV last year. Focus on the Family recently denounced PSI as a "shady" and "sordid" organization that is leading Africans into immorality.

And in April, conservative Republicans in the House invited Martin Ssempa, a Ugandan minister, to Capitol Hill, to berate PSI for "promoting promiscuity and condoms" in his country. "Today, we face a new enemy in the fight against HIV/AIDS, not only in Uganda but in all the other African countries," Ssempa told the House International Relations Committee. "That enemy is the Western belief that condoms can end the HIV/AIDS epidemic." The attacks on PSI have become so extreme and ideological that even some Republicans think they've gone too far: Utah Sen. Orrin Hatch sent a letter to USAID last month expressing dismay over "inaccurate information" being spread about PSI. Still, this year, U.S. funding for PSI has been reduced for the first time.

Religious conservatives intent on hijacking global AIDS prevention funds are putting heavy pressure on legislators and the Bush administration to strip funding from established public-health organizations like PSI in favor of faith-based groups that promote a moralistic agenda. Some faith-based organizations have long, admirable histories of working in Africa. But soon, even these groups could face a litmus test -- if they don't strictly adhere to abstinence promotion, they could lose funding to smaller, more ideological groups. "Throw out the window any public-health test," Jacobson said.

Groups that support the president's religious agenda, meanwhile, are beginning to receive money that has traditionally been devoted to more experienced organizations. The Children's AIDS Fund, a well-connected conservative organization, received roughly $10 million last fall to promote abstinence-only programs overseas -- even though the group was deemed "not suitable for funding" by an expert review panel. Fresh Ministries, a Florida organization with little experience in tackling AIDS, also received $10 million. "Bush has enacted policies that will redirect millions of dollars away from groups that have experience fighting HIV and AIDS and toward groups that don't but are members of his religious constituency," Cohen says.

In the end, say public-health experts, the administration's diversion of funds from tried-and-true HIV-prevention methods is more than a misguided experiment -- it's a deadly game of Russian roulette that could mark a calamitous turn in Africa's attempts to get a handle on the AIDS epidemic.

It's hard to imagine how the health crisis could get worse in sub-Saharan Africa, where life expectancies have plummeted below 40 in some nations and more than 12 million children have been orphaned by AIDS. HIV prevalence has been somewhat stable in recent years, but experts are worried that could be disguising the worst phases of the epidemic, with roughly the same number of people getting newly infected with HIV and dying of AIDS. Africa's fight against AIDS is a tragedy that, with all of the resources at our disposal, we could be doing something about -- but so far, we're not. "People will look back and say, Why didn't they stop the dying?" Zeitz says. "Why don't we show our compassionate selves? What kind of country are we?"

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