American Prospect: How Bush's AIDS Program is Failng Africans

[Guest guest]

http://www.prospect.org/cs/articles;jsessionid=apOBBt8gsz5gKqmZ3o?article=how_bushs_aids_program_is_failing_africans

How Bush's AIDS Program is Failing Africans

The

president's much-lauded international AIDS initiative has succeeded in

saving lives through treatment. But its abstinence-focused prevention

programs have put many more lives in jeopardy.

Goldberg | July 10, 2007

| web only

NAIROBI, Kenya

-- On July 5, Beatrice Were, the founder of Uganda's

National Community of Women Living with HIV and AIDS, stood before hundreds

of other HIV-positive women in Nairobi's

vaulted city hall and denounced the Bush administration's AIDS policies.

Like

many in attendance, Were contracted HIV from her husband, a common occurrence

in a region where women make up the majority of new infections and marriage

is a primary risk factor. For those like her, the White House's AIDS

prevention mantra -- which prescribes abstinence and marital fidelity, with

condoms only for " high risk " groups like prostitutes and truck

drivers -- is a sick joke.

" We

are now seeing a shift in recent years to abstinence only, " she said.

" We are expected to abstain when we are young girls and to be faithful

when we are married to men who rape us, who are not necessarily faithful to

us, who batter us. " The women in the audience, several waiting to share

their own stories of marital rape, applauded.

Were

exhorted her audience to " denounce programs that are not evidence-based,

that view AIDS as a moral issue, that undermine the issues that affect us,

women's rights. I want to be very clear -- the abstinence-only business,

women must say no! " Again, there were hollers and applause.

There

were lots of voices like Were's in Nairobi

last week, where the YWCA sponsored a massive international conference on

women and HIV. Yet they rarely seem to break through in the United States,

where the conventional wisdom holds that the President's Emergency Plan for

AIDS Relief (PEPFAR) is a bright spot in an otherwise execrable presidency,

one that only the ideologically blinkered refuse to credit. Nick Kristof

seems to repeat this notion in The New

York Times every other week, and Bono affirmed it when he insisted

on putting Bush on one of the 20 different covers that graced Vanity Fair's special Africa

issue. " USA

TODAY's Page just got off the telephone with Bono. She says President

Bush can count the rock star as a fan today, " the newspaper's blog reported

in late May. " The Grammy winner was singing the praises of the American

president for his announcement today that he would propose spending an

additional $30 billion over five years to fight AIDS in Africa, doubling the U.S.

commitment. "

For

many toiling in the trenches of the pandemic, though, opinions about PEPFAR

are far more ambivalent. It's a moral conundrum: how do you weigh lives saved

by treatment against lives lost through policies that sabotage prevention?

It's

important to be clear: PEPFAR has done some good. Thanks in part to the

program, upwards of 800,000 people are now getting anti-retrovirals that can

turned AIDS from a death sentence into a chronic condition. There are

remarkable stories of those once wasted and desiccated now restored to life.

It may very well be true to say that PEPFAR is the best thing that W.

Bush has ever done. But that's not saying very much at all.

In late May, the White House made the announcement that so pleased

Bono, promising to double spending on AIDS from $15 to $30 billion. Like most

of the administration's financial figures, the numbers were misleading. The

$30 billion was to continue funding PEPFAR for five more years essentially at

current levels.

As Health GAP, a U.S.-based NGO, pointed out, " Given that the

White House requested $5.4 billion on global AIDS this year (expected to be

increased to fulfill U.S.

obligations to the Global Fund to fight AIDS, Tuberculosis and Malaria), the

$6 billion annual request effectively represents flat funding into the next

decade. " What the administration is trying to spin as a staggering new

burst of generosity is basically the maintenance of the status quo.

Nevertheless,

$6 billion a year is a significant amount of money. It remains to be seen,

though, how much of it will be spent in ways that worsen the epidemic instead

of making it better. Under the current policy, one third of the money

allocated to HIV prevention goes to abstinence-only campaigns, often run by

evangelical allies of the administration.

But

this figure is also deceptive, because the prevention budget includes things

like fighting mother-to-child transmission. In fact, a full two-thirds of the

money for the prevention of the sexual spread of HIV goes to abstinence.

What's left is targeted to groups considered high-risk. HIV-activists have

spent the last two decades trying to show that condoms aren't just for

prostitutes and the promiscuous; Bush has undone much of their work.

Officially,

the abstinence-only money was a Congressional earmark, but it was the White

House's doing. " I found the argument about the earmark not coming from

the administration to be disingenuous, " says Evertz, Bush's first

AIDS czar. " The White House had a legislative office that was on the

Hill pushing this! Sure, you can say it's [sam] Brownback and [Curt] Weldon

and the likely suspects, but they were up there on the Hill arguing for

it. " (Last month, senators Diane Feinstein (D-CA) and Olympia Snowe

(R-ME) introduced the HIV Prevention Act of 2007, which would repeal the

abstinence-only earmark. It remains to be seen whether it will pass, and if

it does, whether Bush will veto it.)

Evertz

was a Log Cabin Republican who trusted in the administration's good faith,

and thus was quite shocked to see how HIV prevention funding turned into a patronage

system for the religious right. " The ideologues in and around the

administration are not scientists, and they're not even people in many cases

who are concerned about data when it comes to proving the abstinence

works, " he says.

In her

brilliant new book, The Invisible

Cure: Africa, The West, And The Fight Against AIDS, Helen

Epstein shows what some of the ideologues' policies have meant on the ground.

Much of her reporting is from Uganda,

a country whose history with the disease is hotly contested. In the 1990s,

following a concerted campaign by both grassroots organizations and president

Yoweri Museveni, Uganda became the first African

country to see a significant drop in its infection rate. This wasn't the

result of an abstinence campaign, but abstinence crusaders in the west

claimed the country's success as their own, and it became a principal

justification for Bush's PEPFAR policies.

Indeed,

religious conservatives worldwide now tout Uganda's example. Last year in Nicaragua, I

asked Monsignor Mantica, spokesman for the Archdiocese of Managua, why

he thought abstinence education is appropriate in a country like his, where

men rarely stick to one partner at a time. He replied that Uganda has

proven that it works.

Epstein,

who has a background in biology and public health, argues that people in East Africa, where the spread of AIDS has been

especially catastrophic, don't have more partners over a lifetime than people

in other regions, but they are more likely to have simultaneous long-term

relationships. Citing the work of the sociologist and statistician a

, she writes that concurrent liaisons " are far more dangerous than

serial monogamy, because they link people up in a giant web of sexual

relationships that creates ideal conditions for the rapid spread of

HIV. "

Uganda's

initial response to AIDS addressed this, and urged partner reduction, or

" zero grazing, " which was not the same as abstinence. Condoms played

a role as well. " HIV infection rates fell most rapidly during the early

1990s, mainly because people had fewer casual sexual partners, " Epstein

writes. " However, since 1995, the proportion of men with multiple

partners had increased, but condom use increased at the same time, and this

must be why the HIV infection rate remained low. "

Yet in

a grotesque irony, PEPFAR funding has refashioned Uganda's

anti-HIV campaign to fit the distorted notions of American conservatives (and

their allies among Uganda's

evangelical revivalists, who include First Lady Janet Museveni). " The

policy is making people fearful to talk comprehensively about HIV, because

they think if they do, they will miss funding, " says Canon Gideon, an

HIV-positive Anglican minister from Uganda who has been a leader in

the clerical response to the epidemic. " Although they know the right

things to say, they don't say them, because they fear that if you talk about

condoms and other safe practices, you might not get access to this money. "

Today, Uganda's

infection rate is once again rising.

A few

weeks before I came to Kenya,

I spoke with , who until last year was the United Nations

Secretary General's Special Envoy for HIV/AIDS in Africa.

I asked how he understood the balance between the harmful and the helpful

aspects of Bush's AIDS initiative. " It really is difficult to

quantify, " he said. " The only thing one can categorically say is

that the overemphasis on abstinence probably resulted in an unnecessary

number of additional infections. " That this policy is celebrated as

Bush's greatest moral achievement shouldn't be understood as praise.

Goldberg

is the author of Kingdom

Coming: The Rise of Christian Nationalism. She is working on a

book about the global battle for reproductive rights, to be published by

Penguin Press in 2009.