Last month, the Bush administration put further impediments in the way of
effectively treating the global AIDS crises. 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.
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Gene C. Gerard taught American history at a small college in suburban Dallas, and is a contributing author to the forthcoming book “Americans at War,” to be published by Greenwood Press. His previous articles have appeared in Political Affairs Magazine, Dissident Voice, The Free Press, OrbStandard, Intervention Magazine, The Modern Tribune, and The Palestine Chronicle
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