Bush Administration Policies Hinder Global Effort to Fight AIDS

July 30, 2005
By Gene C. Gerard

Last month, the Bush administration put further impediments in the way of effectively treating the global AIDS crisis. The administration is now requiring American organizations that receive federal funding to sign an agreement pledging their opposition to prostitution. Of course, it’s ludicrous to think that anyone actually supports prostitution. But in requiring organizations to formally declare their opposition, this will put those organizations that are trying to reduce the spread of AIDS among prostitutes in a difficult position.

In 2003, when President Bush declared AIDS to be a global epidemic, the President’s Emergency Plan for AIDS Relief (PEPFAR) was created. Almost from the beginning, PEPFAR required foreign AIDS organizations receiving U.S. funding to sign a pledge opposing prostitution and sex trafficking. However, in 2003, the Department of Justice advised the Bush administration that First Amendment rights prevented American organizations from having to make the pledge. But last fall, the Justice Department reversed its position, advising Mr. Bush that domestic organizations could now lawfully be required to oppose prostitution.

This new requirement will affect approximately $2.2 billion in federal funding distributed by the U.S. Agency for International Development (USAID). Kent Hill, acting director for global health at USAID, defended the policy, telling the Associated Press, “Prostitution is not a positive for the people who are involved in it. The vast majority of people, globally, do not find themselves there by choice.” While that is certainly true, castigating prostitutes, while at the same time attempting to help them avoid AIDS, is counterproductive. And it is allowing conservative ideology to dictate public health policy.

Prostitutes will be less likely to interact with an organization if they feel that it has contempt for them. In turn, these organizations will have less opportunity to communicate with and educate prostitutes about the dangers of AIDS. Terri Bartlett, vice president of Population Action International, a group that addresses women’s health concerns, echoed this frustration when she told the Associated Press, “We want to build trust and reduce stigma. This policy flies in the face of what we know works.” Thirteen international health organizations have sent a letter to Ambassador Randall Tobias, U.S. Global AIDS Coordinator, opposing the policy, noting, “Contributing to the stigmatizing of populations that are at risk, infected, or affected by HIV/AIDS greatly undermines the success of AIDS prevention, testing, and care efforts.”

One organization that conservatives have criticized for working with prostitutes is Population Services International. This organization attempts to educate prostitutes in bars and nightclubs on how to prevent the transmission of AIDS, since this is where they meet their clients. Last month, Senator Tom Coburn (R-OK) wrote a letter to President Bush stating, “There is something seriously askew at USAID when the agency’s response to a dehumanizing and abusive practice that exploits women and young girls is parties…” Senator Coburn was presumably referring to funds distributed by USAID to Population Services to send its staff members into nightclubs to counsel prostitutes. Yet it makes perfect sense to interact with prostitutes where they work.

The policy applies to all AIDS organizations that receive federal funding, even if they do not work with prostitutes. As such, organizations will have to spend time and money to supply the government with the appropriate documents demonstrating their opposition to prostitution. Given the escalating AIDS crises, this is a poor use of valuable resources.

It’s well known that AIDS is increasing in some parts of the world owing to prostitution, such as India and Brazil. This is also the case in Russia. Earlier this month, a group of Russian and American scientists, under the auspices of the U.S. Centers for Disease Control, released the results of a study of AIDS among prostitutes in Moscow. The study determined that the prevalence of HIV infection among the prostitutes was at least 30 times higher than in the general Russian population. The study, published in the medical journal Lancet, concluded that unless an AIDS education program is started in Moscow aimed at prostitutes, there would be an “explosive growth of the epidemic” nationwide.

The Bush administration announced two other policy changes last month. AIDS organizations must now inform their clients about the failure rates of condoms. Although condoms are not foolproof, numerous studies have confirmed that when used properly they vastly reduce the chances of contracting a sexually transmitted disease. What is really behind this requirement is an attempt by conservatives to convince uneducated third-world populations that condoms are ineffective, and therefore abstinence should be practiced rather than safer sex.

Additionally, the U.S. government is now required to given equal funding consideration to AIDS organizations that hold “a religious or moral objection” to any method or program intended to prevent AIDS. As such, a religiously based AIDS organization that opposes safer sex in favor of abstinence, or is against needle exchange programs, can receive funding. Religious organizations do play an important role in the global AIDS strategy. But federal funding should not be spent on organizations opposed to the most basic tenets of AIDS prevention.

America contributes more funding to international AIDS prevention and treatment programs than any other country. As such, it’s important that the funds be spent based on widely recognized medical science and public health policy. But the Bush administration instead has clearly based these recent policy changes on conservative ideology. And that’s deadly.

 
Gene C. Gerard taught history, religion, and ethics for 14 years at various colleges in the Southwest and is a contributing author to the forthcoming book "Americans at War," by Greenwood Press.