Condoms Trump Abstinence in Obama Global AIDS Policy, Aide Says

President-elect Barack Obama will reverse U.S. family planning and AIDS prevention strategies that have long linked global funding to anti-abortion and abstinence education, a public-health adviser said.

Public health policies of President George W. Bush’s $45- billion PEPFAR program have brought AIDS drugs to almost 3 million people in poor countries such as Rwanda and Uganda, more than under any other president. Still, requirements that health workers emphasize abstinence from sex and monogamy over condom use have set back sexually transmitted disease prevention and family planning globally, said Susan F. Wood, co-chairman of Obama’s advisory committee for women’s health.


“We have been going in the wrong direction and we need to turn it around and be promoting prevention and family-planning services and strengthening public health,” said Wood, a research professor at George Washington University School of Public Health in Washington.

Bush on his first day in office in January 2001 reinstated the so-called Mexico City Policy — known as the global gag rule to critics — that bars U.S. family-planning assistance for organizations that use funding from any other source to provide counseling and referral for abortion; lobby to make abortion legal or more available in their country; or perform abortions except in certain cases. Those exceptions are a threat to the woman’s life, rape or incest.

Obama “is committed to looking at all this and changing the policies so that family-planning services — both in the U.S. and the developing world — reflect what works, what helps prevent unintended pregnancy, reduce maternal and infant mortality, prevent the spread of disease,” Wood said.

Gag Rule

Wood resigned as the top U.S. regulator for women’s health in 2005 in protest of the Food and Drug Administration’s delay in clearing over-the-counter sales of the “morning after” emergency contraceptive. Sale of the pill, called Plan B, without a prescription was held up for more than two years, after FDA staff recommended its approval in 2003.

Critics of the FDA have named Wood as among candidates they would like Obama to consider for the agency’s next commissioner.

“A lot of the family-planning associations in Africa refused the terms of the gag rule and they lost funding, they lost technical assistance and they lost contraceptives,” said Wendy Turnbull, a senior policy research analyst with Population Action International in Washington.

On the basis of that policy, Bush halted support for the United Nations Population Fund in 2002, saying it supported “coercive” abortion programs in China — an allegation the New York-based agency has denied. The directive cost UNFPA more than $200 million in lost funding, said William Ryan, a Bangkok-based spokesman for the agency.

Condom Use

Restrictions on education about condom use have hamstrung effective promotion, and the U.S. Centers for Disease Control and Prevention has had some condom information pulled from its Web Site, said Gill Greer, director general of the International Planned Pregnancy Federation in London.

“The U.S. administration has certainly succeeded in demonizing condoms rather than showing that they can be part of prevention of both unplanned pregnancy and sexually transmitted infections,” she said in a telephone interview. “I’ve always joked that the whole world should vote in the U.S. election because the whole world is so affected.”

Under President Bush, the U.S. has provided more money to fight AIDS than during any other administration. Seven years ago, before the Bush program began with about $15 billion, only about 200,000 people in poor nations got treatment, and few of them were in Africa.

Abstinence Success

The emphasis on abstinence and fidelity, “has been shown to have demonstrable success in Africa,” said Valerie Huber, executive director of the National Abstinence Education Association in Washington. “It would be more than unfortunate if that policy was changed.”

Both Republicans and Democrats have indicated support for the focus on abstinence and education that goes along with PEPFAR, which has also been shown to reduce the spread of HIV in countries such as Uganda, Huber said.

“If the president-elect wants to be science-based in foreign sex-education policies, it would be wisest to continue this way because it’s shown to be effective,” she said.

Calls to the office of Mark Dybul, coordinator for the Bush AIDS treatment program, weren’t returned.

Prevention Quest

Without a vaccine, AIDS advocates are looking for ways to slow the spread of the HIV virus that currently infects about 33 million people worldwide. Treatment, even with cheaper versions of HIV drugs, is beyond the means of many patients in Africa, where about 24 million infected people live.

“I am not denying that someone with AIDS in Africa being given anti-retroviral therapy is bad,” said Adel Mahmoud, a former head of Merck & Co. vaccines and professor in the department of molecular biology at Princeton University. “But when the data says for every person we put on anti-retroviral therapy in Africa there are six new infections and we are doing nothing about it, it’s absolutely mind boggling. Prevention is really the solution.”

Wood said that, in recent years, the U.S. government has influenced and “tightly vetted” international organizations to reflect its own policies.

Obama will bring “back a sense of balance and perspective and the use of good science and good medicine in these positions, and not just this narrow, political ideology,” she said.

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