Editorial: Ideology and AIDS:

http://www.mapinc.org/drugnews/v05/n321/a03.html

FOREIGN AIDS

America's Overseas Social Engineering

A Republican effort to stamp out needle-exchange programs abroad incensed
editorial boards at the Washington Post and New York Times last weekend,
and both pages slammed the latest Congressionally-mandated gag rule to hit
the United Nations. That conservatives are trying to stamp out harm
reduction abroad is no small story, but both pages missed the fact that
this is only the latest installment in a long story of strings-attached
giving that has been changing U.S. foreign aid policy for years.

From AIDS prevention measures stigmatizing sex, to anti-human trafficking
targeting prostitution, to drug policies purged of pragmatism, foreign aid
has become an American adventure in social engineering.

Global AIDS conferences have become as much a matter of America-bashing as
AIDS-fighting. Last July, U.S. AIDS coordinator Randall Tobias was heckled
mercilessly at the International AIDS conference in Bangkok. The discord
stems from U.S. gestures toward a comprehensive approach on AIDS that never
quite panned out. The Global Fund to fight AIDS, Tuberculosis and Malaria
was founded three years ago as a multilateral effort to help funnel vast
sums of money to developing countries in need of public health funding.

It took a localized, hands-off approach, scrutinizing applications but
generally leaving questions of implementation and disbursement to local
agencies and governments. The U.S. offered the first grant of $200 million
and was expected to be a major supporter. But during the president's State
of the Union Address in 2003, he busted out with something called the
"President's Emergency Plan for AIDS Relief," or PEPFAR, and a competing
bureaucracy was born.

PEPFAR was smaller in its ambitions-only 15 countries were targeted-but
much better funded, with $15 billion promised over five years.

The Global Fund's biggest donor had proven itself capable of promising huge
sums of money, but they would not be going into the Global Fund. Tobias
tried to stem the ensuing wave of criticism by claiming that the
organizations could work together.

But it soon became clear that they had fundamentally different missions.

PEPFAR enthusiastically endorses the so-called "ABC" approach-Abstinence,
Be Faithful, and Condoms. The program gave President Bush an opportunity to
scale up from his $10 million abstinence crusade in Texas (where there is
no evidence it worked) to a billion dollar version in Africa (where there
is new evidence it's not helping.)

PEPFAR promises that 33 percent of all funds are spent on
abstinence-promotion and that faith-based organizations can receive funding
even if they refused to talk about or provide contraception. Condoms, the
most statistically proven and economically sound method of prevention, are
a last resort to be distributed to "high-risk" groups.

The program also forces any organization receiving funds to explicitly
oppose the legalization of prostitution.

The anti-prostitution demand is major, and it affects anti-human
trafficking funds as well as AIDS funding.

NGOs and organizations fighting trafficking are likely to be working
against the stigmatized, underground nature of illicit prostitution, but
they can't accept U.S. funds unless they condemn the practice.

In the U.S., the push for action on human trafficking has come from the
Christian right, and the lines between victim and sex worker have all but
disappeared. U.S. funds go to outfits like the International Justice
Mission, which has been accused of "brothel raids" in which its
representatives "rescue" Asian sex workers against their will. Human
trafficking is a much bigger issue than sexual slavery, but U.S. efforts
thus far have focused almost exclusively on women, children, and sex work.

With sexually active Africans and Southeast Asian prostitutes on the hit
list, intravenous drug users couldn't be far behind.

Representatives Mark Souder (R-Ind.) and Tom Davis (R-Va.) are now trying
to keep American aid money out of the hands of any organization that
promotes clean needle exchanges. Assistant secretary of state Robert
Charles has already succeeded in scaring the United Nations Office of Drugs
and Crime (UNODC) out of mentioning harm reduction in its literature, and
UNODC projects are being threatened. Their actions have sent a ripple of
terror through the network of international organizations. Martin Jelsma, a
program coordinator at the Transnational Institute, has been following the
tension between the U.S. and UNODC for years.

He worries that the current pressure "threatens the very heart of the few
proven methods that are effective to stem the spread of HIV/AIDS." As with
condom distribution programs, there is no real question that needle
exchange programs are effective in reducing AIDS transmission. In a hearing
he held last month (tellingly titled "Is there such a thing as safe drug
abuse?"), Souder didn't take long to reveal the root of his antipathy to
harm reduction, and it had nothing to do with his alleged doubts about
efficacy. "These lifestyles," he said, "are the result of addiction, mental
illness, or other conditions that should and can be treated rather than
accepted as normal, healthy behaviors."

Souder's objections have to do with determining what is "normal" and
"healthy" for other people; preventing AIDS transmission isn't on his
agenda. As with the rest of U.S. AIDS assistance, his policies are more
concerned with shaping a certain kind of global citizenry than stopping a
virus. The New York Times editorial calls this a "triumph of ideology over
science," but Souder and his coterie simply have different goals in mind.
If keeping condoms and clean needles out of foreign hands are worthwhile
goals in themselves, the science doesn't matter.

Stopping the spread of AIDS would be a bonus, but it's not the priority,
and it hasn't been for a long time.

Souder and others will talk of halting funding, but funding will only be
redirected elsewhere.

The UNODC has already buckled.

The U.S. contributes far more than any other government to the fight
against AIDS, and NGOs that depend on USAID will change their policies to
survive.

"Compassionate conservatism" used to be a punch line, but it's in full
swing these days, and it appears to involve throwing huge sums of our money
into programs that don't work. If compassionate conservatism turns out to
be neither, it will indeed be U.S. policy that finally brings wealthy
Americans taxpayers and impoverished AIDS victims together.

Both will be paying the price.