As the AIDS epidemic devastates Africa and other parts of the world, having taken the lives of 23 million worldwide, and as the disease continues to be the leading cause of death of Americans 25-44, our nation has taken the lead in moving backwards to a time of fear and misinformation. Tragically, this administration has chosen to incorporate the AIDS crisis into its larger effort to wage a culture war against their political opponents -- certainly the opposite of what its priorities should be.

We begin with a few passages illustrating the state of fighting AIDS in the Bush era.

* Bush's plan calls for an "ABC" approach to HIV prevention -- which stands for abstinence, "be faithful" and condom use -- but the administration is stressing the "A." In its first year, PEPFAR spent more than half of the $92 million earmarked to prevent sexual transmission on promoting abstinence programs. Studies show that such programs actually increase risk by discouraging contraceptive use. What's more, focusing on abstinence and monogamy ignores the reality facing young women and girls in Africa and other impoverished regions, who are often infected by wandering husbands or forced to have sex in exchange for food or shelter. Among fifteen- to twenty-four-year-olds in sub-Saharan Africa, studies show, more than three times as many young women are infected with HIV as young men....

The emphasis on morality is being driven by social conservatives, who have made spreading the gospel of abstinence and monogamy to Africans their primary mission. "Condoms promote promiscuity," says Derek Gordon of the evangelical Christian group Focus on the Family. "When you give a teen a condom, it gives them a license to go out and have sex." At a congressional hearing in April, Rep. Henry Hyde threatened to cut funding for organizations that promote condoms. "The best defense for preventing HIV transmission is practicing abstinence and being mutually faithful to a non-infected partner," Hyde declared.

... Ambassador Randall Tobias, who serves as Bush's global AIDS czar, issued written guidelines in January that spell out the administration's agenda. Groups that receive U.S. funding, Tobias warned, should not target youth with messages that present abstinence and condoms as "equally viable, alternative choices." Zeitz of Global AIDS Alliance has dubbed the document "Vomitus Maximus." He says, "I get physically ill when I read it. It has the biggest influence over how people are acting in the field." And under a proposal being pushed by Republicans on Capitol Hill, Tobias would be given the power to divert even more money toward promoting abstinence. "All Republicans can think about is making Africans abstinent and monogamous," says a Democratic staffer involved in the negotiations. "It's the crassest form of international social engineering you could imagine." (Geraldine Sealey, "An epidemic failure," Rolling Stone, 6/2/05)

* Social conservatives have long opposed government efforts to support birth control. In recent years, some have claimed that condoms are not very effective in protecting against sexually transmitted diseases and have pressed federal agencies to adopt this viewpoint. Under the Bush Administration, scientific evidence on the effectiveness of condoms has been suppressed or distorted to reflect this conclusion.

In October 2002, CDC replaced a comprehensive online fact sheet about condoms with one lacking crucial information on condom use and efficacy. The original information, titled Condoms and Their Use in Preventing HIV Infection and Other STDs, included sections on the proper use of condoms, the effectiveness of different types of condoms, and studies showing that condom education does not promote sexual activity. It noted that "a World Health Organization (WHO) review . . . found no evidence that sex education leads to earlier or increased sexual activity in young people."

A revised fact sheet was subsequently posted entitled Male Latex Condoms and Sexually Transmitted Diseases. The new fact sheet lacks instruction on condom use and specific information on the effectiveness of different types of condoms. It begins by emphasizing condom failure rates and the effectiveness of abstinence. (Investigating the State of Science in the Bush Administration, Government Reform Minority Committee)

*At a December 2002 meeting of 30 Asian/Pacific nations in Bangkok, U.S. officials demanded the deletion of a reference to "consistent condom use" to fight HIV/AIDS and other STDs, and issued an official statement that, because "condoms are simply not 100% effective," the United States "promotes abstinence for the unmarried and fidelity for those who are married" as its primary STD prevention strategy. ("Ignoring medical evidence, anticondom campaign threatens public health," Alan Guttmacher Institute, 3/25/03)

And so on. That many social conservatives seem peculiarly obsessed with sexual sin is not news, but when their factually-incorrect perspective shapes our policy -- and when millions of lives are in the balance -- it should be cause for outrage at the steady supply of hateful and bizarre barrages such as the following typical examples.

MYTH: Condom use causes HIV and pregnancy

The myth that condom usage will fully protect one from AIDS, other venereal diseases, and pregnancy has poured gasoline onto the raging worldwide pandemic of sexually transmitted diseases and unwanted pregnancies.

... Liberal secular society cannot bring itself to realize that their desire to have sex without consequences has disastrous and deadly results. They are unwilling to cage the demon they have nourished. Condoms fail, as much as 15% of the time or more, and are often not used.

... The secular approach is to promote extramarital sex, including prostitution, and to pretend that everyone can have "protected" sex.... Promoting "safe" or "protected" sex provides a false sense of security. This encourages increased sexual contacts and risky behavior that can result in AIDS.

... Common sense tells us the only way to curb the unbridled spread of AIDS and other sexually transmitted diseases is with monogamous relationships and the elimination of risky sexual behavior. This is not about to happen until people's hearts change. Until they are held financially responsible for the children they produce and the diseases they contract and spread by risky behavior, the problems will not subside. ("Dr." Donald May, "Only courage can stop the spread of AIDS," Town Hall, 6/17/05)

REALITY

While the "liberal" and the "secular" are the clear enemies of culture warriors like "Dr." May, those of us who care about the health of the people of the world believe the enemy is the deadly disease itself. Once that distinction is made, many facts fall into place. According to both science and practice, education and condoms are not just the most effective weapons we have -- they are also absolutely critical to curbing the spread of AIDS.

It is a fact that abstinence is the only sure way to prevent sexually-transmitted diseases. It is also a fact that since the dawn of mankind, we have been having sex, including -- gasp! -- outside the confines of holy matrimony. It's one thing to denounce unsafe behavior -- but it's quite another to stifle attempts to mitigate its consequences by spreading smears and misinformation.

(1) Condoms, when used correctly, are as much as 99% effective in preventing the transmission of HIV. For example, in one study of couples in which one partner carried the virus and the other did not, consistent condom use resulted in an transmission incidence of just 0.9 per 100 person-years. That suggests that if you have sex with an HIV-positive partner for a whole year, using a condom, you have less than 1 chance in 100 of getting the virus. It's not perfect -- it never is -- but it's a hell of an improvement over the "Hail Mary" technique.

(Perhaps "Dr." May is confused by the second number in that study -- "The level of protection approximates 87%" -- which means that those in the study who never used condoms had 7.5 times the incidence of transmission.)

There is a wide variety of contradictary numbers put out about the effectiveness or failure rate of condom use, but most of this variation is due to inconsistent use and human error -- factors which more than anything else suggest the necessity of education. Perhaps the education should begin with Bible-thumping "doctors" like Mr. May or Senator Coburn of Oklahoma, who cited 69% in a recent seminar to Capitol Hill interns.

(2) "Although the popular belief is that teaching kids about sex will lead to promiscuity, in fact, the opposite is true. A comprehensive review of 23 school-based programs found that teens who received specific AIDS education were less likely to engage in sex, and those who did were more likely to have sex less often and use contraception." (Center for AIDS Prevention Studies)

Like Sen. Coburn and his anticondom sideshow, May figures if you scare frisky youngsters into not using condoms, they won't have sex. In reality, they just won't bother with condoms ...

But hey, if you throw together a bunch of myths, along with a healthy dose of innuendo about liberals, abortion, and other conservative values ("held financially responsible for the children they produce," indeed!) you might just help stop real efforts to curb the epidemic. Way to go, "doctor." In fact, the only thing missing from his screed was some old fashioned gay-baiting ...

MYTH: Condom and needle-exchange programs are part of a conspiracy to advance the gay agenda

The unvarnished truth was that the face of AIDS apparently had changed from the image of homosexual white men and black junkies shooting up dope in ghetto back alleys to images and behaviors that are as multifaceted and complex as the very medical cocktails available to treat the disease.

Americans now know they were suckered. While gay white men might have "protected" themselves by using condoms, they also ratcheted up their push for federal, state and local policies that allowed them to hide "sexual preferences" and practices in the name of privacy and civil rights.

The liberals' advocacy for needle-exchange programs is but one example. The push for condom availability for teens is another, as well as the shouts against what the new pope, Pope Benedict the XVI, rightly calls "pseudo matrimony"— that is, "same-sex marriage." And one of the most untenable issues of them all: allowing public schools to teach children in the name of education that when it comes to sexuality and sex itself, anything — and everything — goes.

Activists surely don't want any alarms sounded about what the politically correct term "MSM," the so-called down-low practice of bisexual men keeping their devilish proclivities on the hush-hush, and they certainly don't want us to focus on pedophilia. [???]

[...A]dult American voters do need to wake up to the stark realization of the discolorations and distortions that are pushing public policies and tax dollars into the darker corners of immorality. I'm hardly advocating anti-gay activism or bashing homosexuals. It just seems to me that if Americans can get the Senate to "apologize" for the lynchings that proliferated in the South and accept Bill Clinton's "apology" for slavery, then Americans can come to terms with what's right and what's wrong and get America's moral house in order. (Deborah Simmons, "Blessed public-health curse," Washington Times, 6/18/05)

REALITY

Truth be told, it is almost impossible to make sense of this screed -- mainly due to the contortions Ms. Simmons goes through to code her hatred of gays into a more bland "public health" syntax. It's hard work, the culture war.

At least one thing is clear from her feverish scribbling, though: gays are up to something. Let's look at what she lists as the ways by which gays have "suckered" Americans into letting them "hide" their "sexual preferences" in the fight against AIDS: (1) Needle exchange, (2) Condom availability and sex ed, and (3) Gay marriage.

We already cited the critical effectiveness of condom and education programs. As for clean needles, we know that works too. For example: "In Tacoma, WA, where prevention efforts for IDUs began in 1988, the prevalence of HIV among IDUs [injection drug users] has remained steady at 3-4%. In New York City, NY, where prevention efforts for IDUs met with early opposition, HIV among IDUs increased from 10% to more than 50% in five years."

What condoms and needles have to do with the "gay agenda" is beyond me, though, as is the connection between gay marriage (presumably between monogamous and safe partners) and spreading AIDS. But once again, if you put your ear to the ground and listen to the innuendo -- "devilish proclivities," "liberals," "darker corners of immorality" -- you begin to pick up on the paranoia and incoherence that seems to serve conservative ideologues so well these days.