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Monday, December 01, 2008

A Return to Reality in Fighting HIV/AIDS

Back in 2006, I wrote a post I called "A Delusion-Based Global AIDS Policy." Since it was way back in the days before we had any hope of reason in the White House, the news on the global fight against HIV/AIDS wasn't all that good. The Bush administration, not wanting to contradict its domestic education policy, created a global AIDS strategy based on the same non-reasoning. That non-reasoning worked like this; since HIV/AIDS is a sexually transmittable disease, then the only way to fight it is to fight human nature -- which the religious right believes is basically evil -- and promote abstinence above all other measures. The only way for the world to fight this contagion would be for everyone in the world to adopt a tiny fraction of global population's world-view -- that of the Evangelical right -- and become "good people" the only way they believed it was possible to be a good person. In other words, by acting like a right wing evangelical. Or, least, like right wing evangelicals pretend to behave.

Of course, this works about as well as you'd expect it to work. The most pious wingnuts have failed at it in very humiliating and public ways. These people made their livings pretending human nature is a matter of choice -- imagine how hard it must be for an amateur. The results were as predictable as they were tragic.

Bloggers Unite

The Bush administration, trying to mend fences after the globally unpopular invasion of Iraq, unveiled a new strategy to fight HIV/AIDS. Called the President's Emergency Plan for AIDS Relief (PEPFAR), Bush promised a worldwide approach to fighting the disease. What it consisted of at heart was mostly spending a lot more money in foreign aid. But this was the Bush administration -- that money would now come with strings. Countries had to drop whatever policies they'd been pursuing in the fight and adopt the policies of right wing American nutjobs. Condom use, which had been front and center in most nations' AIDS policies, was forced to take a backseat to abstinence. Condoms only encourage sex, they argued, which was the root of the problem. Let's do a quick head count; how many people reading this need to be encouraged to have sex?

Yeah, you see the problem.

In Uganda, AIDS had been on the decline. The success of the Ugandan program had been attributed to a policy they called "ABC" -- "Abstinence, Be faithful, use Condoms." For the religious whackjobs who had their own ideas about how to fight an STD, this was completely unacceptable. They didn't care that it was extremely successful, mostly because they saw it as extremely immoral. By putting as much emphasis on condom use as abstinence, the Ugandan government was -- *gasp* -- encouraging people to have sex. Worse, they were working with the international aid group CARE, who saw that prostitution was a big part of the problem. CARE did the completely immoral by providing health care and condoms to prostitutes. Former Pennsylvania senator Rick Santorum freaked out, said CARE was "anti-American" and carrying out a "pro-prostitution agenda." In order for Uganda to continue to get funding for its program, they'd have to drop CARE in favor of "Christian" relief organizations. No more free health care and condoms for prostitutes. Because they're bad people and shouldn't be rewarded, much less encouraged.

At the same time, ABC came to mean "Abstinence, Be faithful, Condoms when necessary." Condom use was discouraged and was finally dropped under a new program called AB. AIDS cases did decline and the Bush administration took credit for it. But the reason for the decline had less to do with this new, more "moral" approach than it did with nature taking its course.

Washington Post, 2005:

Abstinence and sexual fidelity have played virtually no role in the much-heralded decline of AIDS rates in the most closely studied region of Uganda, two researchers told a gathering of AIDS scientists [in Boston].

It is the deaths of previously infected people, not dramatic change in human behavior, that is the main engine behind the ebbing of the overall rate, or prevalence, of AIDS in southern Uganda over the last decade, they reported.

"Abstinence and monogamy are very good behaviors," said Maria J. Wawer, a physician at Columbia University's Mailman School of Public Health. "On the other hand, the data support that in this setting, the behavior that seems to have been the easiest to increase over time is condom use." Exactly what the Bush administration had dropped.

PEPFAR, hampered by it's stupid, short-sighted, and ideology-based reasoning, was a $15 billion failure. A failure with tragic human consequence. Luckily, it's a consequence that's easily addressed by a new president more interested in reality than religion-based wishful thinking.

David Rosen, Counterpunch:

President-elect Obama should move quickly to adopt Congress’ revision of the Bush administration’s PEPFAR programs (for President's Emergency Plan for AIDS Relief)...

PEPFAR, the centerpiece effort for U.S. "soft" foreign diplomacy, suffers the same failures as other Bush-administration programs that deal with cultural values, including abortion and teen sex education. It is intended to improve the care, treatment and prevention of those suffering from HIV/AIDS in developing countries. While limitedly successful, for anything is better then nothing, it could never achieve its true potential because of its ideological blinders. Put simply, its prevention efforts are inhibited by its restrictions on condoms.

Remember, Uganda wasn't the entire scope of the program, it's just the most studied example. Every nation that has received US funding to fight HIV/AIDS has the same restrictions on the spending of those funds.

That's about to change. Barack Obama has promised to put condom use front and center in a new focus on fighting AIDS.

For once, the light at the end of the tunnel isn't a train.