Bush Administration Policies Hinder Global
Effort to Fight AIDS
July 30, 2005
By Gene C. Gerard
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
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
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
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
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
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.