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Don't Destroy the AIDS Program


By Richard M. Doerflinger

February 15, 2008

In a Congress known for partisan conflict, one consensus achievement has been the President's Emergency Plan for AIDS Relief (PEPFAR). Over five years this bipartisan program has provided nearly $19 billion to prevent and treat AIDS in the neediest countries of Africa and elsewhere. To reduce sexual transmission the program adopted the "ABC" model: promote Abstinence before marriage, then Being faithful to one partner, with Condoms as a last resort. To keep this priority intact it allocated 33% of prevention funds for abstinence programs. This has enabled Catholic programs, which do not endorse or promote condoms, to play a major role in prevention without compromising their values.

The result is a notable success, though much more funding and effort is certainly needed. As Dr. Norman Hearst of the University of California testified to Congress last September, "the few successes in turning around generalized HIV epidemics, such as in Uganda, were achieved not through condoms but by getting people to change their sexual behavior." Catholic Relief Services and other faith-based organizations have been instrumental in the program's success.

A happy ending, you might say: A bipartisan consensus, a sound emphasis on responsible behavior, and a medical success story that is saving millions of lives. The greatest need is for expanded funding along these lines.

So of course, Congress is now in danger of smashing the program to bits.

The threat comes from provisions in a draft reauthorization bill to be marked up by the House Foreign Affairs Committee. The bill removes any allocation for abstinence and behavior change, so condoms could take up the entire budget for preventing sexual transmission. New provisions call on PEPFAR programs to "integrate" and "coordinate" with contraceptive programs (meaning chiefly hormonal contraceptives, as condoms are already funded as part of HIV prevention). Mother-to-child transmission of HIV will be prevented not so much by providing effective anti-retroviral medicine to mother and child, but by marketing contraceptives to HIV-positive women. A program for preventing the next generation of Africans from getting AIDS could become a program for preventing the next generation of Africans.

Even those who do not hold the Catholic moral stance on contraception should be able to see what a disaster this may become. Consider the following.

First, a mandate that grantees "integrate" with clinics like those run by Planned Parenthood (which often provide abortions alongside contraceptives) will push Catholic grantees to the margins of the program. In many rural areas, Catholic health care institutions are the only source of AIDS prevention and treatment. If they lose funding because they can't "integrate" with contraceptive programs, no one will replace them, and more people could die of AIDS.

Second, all three aspects of the ABC program are undermined by simultaneously promoting contraceptives – even, ironically, the "C" of condoms. Due to the false sense of security given to men and women by drugs for preventing pregnancy, consistent condom use is notoriously rare among those using hormonal contraceptives – especially the injectable or implantable contraceptives favored by population control enthusiasts.

Third, a solid body of medical evidence indicates that due to biological effects on the uterus, hormonal contraceptives can increase the risk that a woman exposed to HIV will contract the virus and the disease. Facilitating access to these drugs to reduce AIDS is like promoting prostitution to increase abstinence. (As a matter of fact, the new bill also eliminates the program's mandate that grantees oppose prostitution.)

Any of these factors should make Congress think twice before endangering the success of the PEPFAR program this way. The three taken together suggest that the new bill shows an alarmingly casual attitude toward African women's lives.

Advocates for this change of direction in PEPFAR condemn their critics for putting "ideology" over an "evidence-based" approach to AIDS. To find a dangerous neglect of the evidence, however, they need only look in a mirror. The women of the Third World deserve better than this. To find out how to help them, see

Mr. Doerflinger is Associate Director of the Secretariat of Pro-Life Activities, U.S. Conference of Catholic Bishops. To learn more about the bishops' pro-life activities, go to 

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