Bush HIV prevention policies under attack at Toronto AIDS conference.
Perhaps no where is the Bush administration's political assault on sound science more clear than in the area of HIV prevention. Again and again, when faced with a choice between actions based on scientific evidence and actions based on right wing ideology, this administration has elected to ignore science in favour of ideology. The result is to deny millions of people access to the prevention information and technologies they need to protect themselves, and unnecessary new HIV infections.
terjeanderson's diary :: ::
Early in the Bush administration, I was part of small group that met with Margaret Spellings (then the President's Domestic Policy Advisor, before moving on to become Secretary of Education). One of the meeting participants summarized compelling data about the effectiveness of a scientifically sound approach to HIV prevention for sexually active young people. In response, Spellings simply said "Well, you've got your science and we've got our science."
Perhaps nothing better illustrates the Bush administration attitude toward science overall than that statement - the idea that there is some kind of alternative science out there supporting their political viewpoint, a science that is equal to the rigourous, peer reviewed work done by mainstream science. Whether it is global warming, stem cell research, health consequences of abortion, environmental toxins, HPV vaccination, or countless other issues, when scientific facts differ with the administration's politics, they simply make up their own science. The consequences are frequently dire.
Prevention issues were front and centre at the Conference's opening ceremonies on Sunday night and the Monday and Tuesday opening plenaries. Speaker after speaker highlighted the need to speak honestly and openly about issues that the US government is openly hostile to: condoms, clean needles, gay men, prostitution, and women's rights to control their own bodies.
Much has been made of the so called ABC approach to HIV prevention. (Abstain, Be Faithful, or Use Condoms) which is at the heart of US government policy. Yet, as Indian human rights lawyer Arnand Grover pointed out in the Monday morning plenary session "President Bush and the US Congress need to be told that the so called ABC approach is killing people in the US and in the rest of the world." Speaking of the many strings attached to US government funding Louise Binder, a Canadian lawyer living with HIV passionately declared ""These strings are ropes around women's necks and they are killing us."
On the surface, ABC seems like a common sense approach to comprehensive sexual health and offering real choices to people. But in reality, the administration is implementing "ABC" in a way that over-emphasizes abstinence and marriage and ignores the need for condoms. As one senior administration official told me several years ago "We think of it as capital A, capital B, small c"
Rather than presenting abstaining from sex until marriage as simply one choice that people can make, the government's policy is to preach that abstinence is the only choice that can protect against HIV. Domestically, the US government spends hundreds of millions of dollars every year on "abstinence-only" programmes for young people. By law, these programmes are required to teach that young people must remain abstinent from all sexual activity until marriage. They are forbidden to teach about condom use, and often present misleading data telling people that condoms don't work. They make no provision to teach gay youth how they can protect themselves - and since they can't get married outside of Massachusetts, official government policy is to teach that they can never be sexually active for the rest of their lives. Hardly a realistic prevention strategy.
We're exporting the insanity of the "abstinence only" policy throughout the rest of the world. With the support of the administration, Congress has passed a law requiring that "abstinence-only" programmes must receive 30% of all US government funding going to support HIV prevention. As a result, the US government is giving tens of millions of dollars every year to Christian groups to teach that the only way to avoid HIV is to not have sex. Often these programmes aggressively spread misinformation about condom effectiveness, telling people that they don't work and undermining other effective prevention messages.
It is one thing to tell people that not having sex will prevent HIV transmission- but it is yet another thing entirely to claim, falsely, that it is only way to prevent infection and to deny people access to information about other proven prevention methods. Teaching about abstinence in conjunction with information about condoms and other ways that people can protect themselves is a rational part of a comprehensive approach; teaching abstinence only in the absence of other life-saving information is nothing less than a lie resulting in murder.
It is this kind of approach that has prompted "Advocates for Youth" (a highly effective Washington DC-based group) to come to the conference distributing tee-shirts with the slogan "Stop the War on Condoms." It is why a group of respected community and scientific organisations have formed the "Caucus for Evidence-Based Prevention" to counter the unscientific viewpoints being advanced by many of the Bush administration's approaches.
During the conference's opening ceremonies, Bill Gates (yes, that Bill Gates) directly addressed why ABC is a fundamentally flawed strategy for millions of women around the world. Abstinence is not an effective prevention strategy for too many women who are denied the right to make choices about whether and when to have sex, in a world where sexual violence, coercion, and economic necessity take that choice away. Being faithful does no good if the woman is faithful but her husband is not. Data from some southern African countries shows that marriage is one of the major risk factors for women becoming infected with HIV. And condom use only works if condoms are available, and if their male partners are willing to use them.
"No matter where she lives, who she is, or what she does, a woman should never need her partner's permission to save her own life," declared Gates in the opening plenary.
Speaking at the conference site on Monday, Congresswoman Barbara Lee stated:
"For many women, the abstinence-until marriage policy makes no sense. When women face the constant threat of gender-based violence and rape, and can't demand that their partner be faithful or even use a condom, abstinence-until-marriage is meaningless as an HIV prevention policy." According to Lee, the April 2006 Government
Accountability Office (GAO) report confirmed that restrictions on prevention funding under PEPFAR (Presidents Emergency Plan for AIDS Relief) are undermining efforts to prevent the greatest number of infections possible at the country level and hampering the development of evidence-based strategies at the field level, which is needed to respond to local needs. (The full GAO report and a summary of findings from the report can be found at www.pepfarwatch.org
"We need an HIV prevention policy that recognizes these realities, that empowers women and girls to be independent, and that promotes equitable partnerships between women and men," stated Lee. "The first step in doing so is to remove the abstinence only funding requirement once and for all and let sound public health policy and the needs of people on the ground dictate how we spend our money."
Melinda Gates, speaking after her husband at the opening ceremonies took the discussion further raising the critical, challenging restrictive policies and practices that make it difficult to work with sex workers (prostitutes), calling sex workers "crucial allies in the fight to end AIDS." Current US government policy requires all recipients of global AIDS funding to sign statements that they oppose prostitution and the legalization of prostitution (even though it is legal in more than 80 countries around the world). Last year Brazil turned down a multi-million dollar US grant because they were unwilling to abandon their outreach programmes for sex workers. A US court recently ruled that the Bush administration exceeded their authority by requiring the anti-prostitution pledge from US organisations (although it still applies to foreign-based groups).
And this is minor, in some ways, compared to the impact of the global "gag rule" for family planning and reproductive health organizations. The first executive order that Bush issued when he became president in 2001 was to withdraw funding from family planning centres that included abortion services for their clients, that counseled clients about abortion options, or advocates for abortion access. The result has been the withdraw of significant resources for family planning clinics - many of which see some of the most vulnerable women and girls in the world. These clinics should be a bulwark in HIV-prevention efforts, but instead are forbidden from receiving any US government funding if they even talk about abortion. Because of their anti-abortion ideology, they are willing to risk the lives of millions of women and their children.
At home, the domestic HIV prevention programmes continue to be under attack from the political right and their allies in the White House and Congress. For years organizations that receive government monies to do HIV prevention have worked under restrictive circumstances (a legal requirement first written into law by then Senator Jesse Helms that says that they cannot "promote homosexual activity," content restrictions, a ban on using government money to help drug users access sterile injection equipment, targeted audits of groups engaged in controversial prevention activities, among other examples). As a result, for years community groups doing prevention have been fighting with one hand tied behind their backs.
But a series of programmatic decisions in the last three years by the Centers for Disease Control and Prevention (CDC) has quietly, but dramatically shifted monies away from the most controversial behavioural interventions (especially those dealing with sex and drugs). Instead, the CDC now pushes a prevention programme with a near exclusive emphasis on HIV testing, and provision of prevention services to people who test positive. They no longer emphasize efforts to impact the sexual and drug using behaviours of those most at risk, looking to doctors offices and churches to do most of the prevention work.
Across the country, small community organizations that have been conducting prevention efforts for key populations (gay men, African-Americans, Latinos, drug users, runaway and homeless youth, sexually active women, etc) find themselves starved for funds under the restrictive new approaches, and the pressing prevention needs of these communities are left unaddressed. It is hardly surprising, under these circumstances that there are a least 40,000 new infections every year in the US, that a huge epidemic is continuing to devastate African-American communities and that a resurgence of new infections among gay men.
Because dealing with HIV prevention means dealing with the inherently controversial topics of sex and drugs, it becomes a natural battle ground in the culture wars. An administration that was truly concerned about public health would allow sound science to guide their decisions. Unfortunately, George Bush's administration has opted time and time again to put pandering to their right wing political base above saving the lives of some of the most vulnerable people in our world.