December 1st is officially recognized as World AIDS Day, an event meant to galvanize and give voice to the global movement to stop the pandemic decimating of an entire generation in certain parts of the globe. The United States was slow to join this movement, but under President Bush had appeared to be increasing its response and funding. Unfortunately, it is becoming increasingly clear that the current administration’s embrace of the global fight against HIV/AIDS is more politics than compassion.
Under the President’s Emergency Plan For AIDS Relief (PEPFAR), the Bush administration pledged a total of $15 billion over five years for 15 countries hardest hit by the pandemic= With resources so desperately needed, longtime HIV/AIDS activists welcomed this bold new plan.
Initially, the Bush administration appeared to embrace the prevention strategy of Uganda. In the early 1990s, with nearly one-third of its population infected with HIV, Uganda’s leaders marshaled every possible means to combat the epidemic. This worked. By 2000 the infection rate had plummeted to less than 10 percent. But as outside observers began their analysis of this success story, they “dumbed down” a very intensive, comprehensive and complex societal response to focus on what has become known as the ABC model – A for abstain, B for be faithful, and C for use a condom every time you have sex.
The Bush administration took the ABC model, but distorted it to fit its own ideological agenda. Ignoring the evidence and pandering to its social conservative base, what President Bush and his allies define as ABC is a far cry from the approach that led to the Ugandans’ success. Instead, the administration portrays condoms as negligible in their overall impact and asserts that abstinence and fidelity are primary and paramount. PEPFAR describes condoms as acceptable, but only “where appropriate.” It then goes on to say that condoms are only appropriate for “prostitutes” or married couples where one person is already positive and the other is negative. This approach could not be further from the cardinal rule that pervaded Uganda’s effort: do not undermine condoms.
The political hijacking of HIV prevention will stand as one of the most cynical and short-sighted efforts of the Bush administration to politicize public health. By misrepresenting Uganda’s comprehensive effort to combat HIV and pitting prevention strategies against one another, the current U.S. policy has plunged the entire global discourse over HIV prevention into utter turmoil. Our time is now spent muddled in an incomprehensible and counter-productive exercise of arranging A, B, C and other letters in bowls of alphabet soup. In the meantime, the Bush administration is using the power of the purse to advance its ideological agenda.
Under PEPFAR, the Bush administration’s ideological allies are poised to reap a windfall. The law mandates that one-third of all prevention funds – nearly a billion dollars – must be spent on abstinence-until-marriage programs with no mention of condoms. That does not, however, mean that the remaining two-thirds will go to programs that are permitted to talk about condoms. In fact, analysis of PEPFAR prevention funds awarded to date indicates that a greater percentage of funding is going to abstinence-until-marriage efforts.
Some might argue that this funding for abstinence-until-marriage programs is still a small amount of money in real terms. But our domestic experience underscores why there is cause for concern. In 1982, a small amount of money was set aside to do “chastity education” in the United States. Twenty-five years later, the federal government has spent nearly a billion dollars on abstinence-until-marriage programs that have yet to be found effective in even a single respected, peer- reviewed journal. An entire industry of right-wing organizations has been created and fed through this “political pork”—the same organizations that now take the lead in pushing the administration to increase support for abstinence-only programs. PEPFAR is the proverbial foot in the door for abstinence-only-until-marriage programs being exported en masse overseas.
Through PEPFAR and a variety of other international development programs, the Bush administration has managed to divert substantial funding from experienced public health agencies, purposefully developing and legitimizing a new industry that not only promotes its abstinence agenda worldwide, but works to undo policies that support a more comprehensive and science-based approach to public health. For example, the State Department recently announced that Concerned Women for America (CWA) will be receiving a portion of a $10 million dollar federal grant to combat sex trafficking in Mexico. CWA is a right-wing advocacy group whose mission “is to protect and promote Biblical values among all citizens – first through prayer, then education, and finally by influencing our society – thereby reversing the decline in moral values in our nation.” CWA has never held a single federal grant and lacks the experience to be working in this area.
The United States is a compassionate nation. And it is a wealthy nation. Assisting the global community in the fight against HIV/AIDS is the noble and upright thing to do. But we should not be using this great challenge to humanity as a way to advance ideological agendas. Science and public health data are not just another opinion. We need a sound, science-based policy if America is to make a real contribution to this global fight. We must move beyond the Uganda trap that has been so artfully assembled by the administration and renew our efforts to promote sound and practical alternatives.
William A. Smith is the Vice President for Public Policy at the Sexuality Information and Education Council of the United States (SIECUS).