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Bush’s Foreign Sex Policy


It didn’t garner much media play, but shortly before the 109th Congress ended, Democratic lawmakers successfully foiled a Republican effort to push through one more anti-abortion bill. In keeping with the Christian fervor that has driven regressive sexual politics over the last six years, this bill would have required medical personnel to inform women that a fetus could feel pain and to offer anesthesia to the fetus. This modest victory may signal the first shot across the bow in the battle to halt ­ reverse? ­ the Bush administration’s horrendous sex policies, especially its foreign sex programs.

The release of the Iraq Study Group report has focused public attention on one of the gravest failures of the Bush administration’s foreign policy, the invasion and occupation of Iraq. However, little attention has been paid to an equally pernicious Bush-administration foreign policy effort, its campaign to control the private sex live of people throughout the world. The centerpiece of this campaign is the President’s Emergency Plan for AIDS Relief (PEPFAR).

In his 2003 State of the Union address to Congress, President Bush declared: “I ask the Congress to commit $15 billion over the next five years, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.” PEPFAR is intended for the care, treatment and prevention of HIV/AIDS in developing countries. Unfortunately, it has become the quintessential example of what happens when Christian conservatives take control of a key program of American foreign policy.

Not since Prohibition, those “Roaring ’20s,” has America’s modern Puritans gained such power over the most intimate aspects of private, personal life. While Christian conservatives have pushed many initiatives to contain sexual life (especially at the local and state level), individual sexual freedom in the U.S. remains relatively protected due to three key Supreme Court decisions: Loving, Roe and Lawrence, which, respectively, protect an American adult’s freedom to engage in miscegenation, pregnancy control and sodomy, and, therefore, all consensual and noncommercial perversions. Internationally, and fully exploiting the power of the American empire, Christian conservatives have been far freer to inflict sexual tyranny.
* * *

Recent reports by the Center for Public Integrity (“Devine Intervention”), Amnesty International (“I Am Not Ashamed!”) and the General Accounting Office (“Global Health”) provide an invaluable summary of the innumerable problems with the PEPFAR program. In their respective country-by-country analyses, these reports painfully reveal that while about 40 million people in the world are living with HIV/AIDS, two-thirds of them in sub-Saharan Africa, the health crisis is only getting worse. Much of this crisis, like the failed occupation of Iraq, can be attributed to ideological-driven policies of the Bush administration.

According to Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a Washington-based AIDS advocacy group, PEPFAR “is failing to stop the global spread of AIDS and failing to help lead the world to stop this deadly disease.” Zeitz and many others identify the source of PEPFAR’s failure in two policy features backed by the Christian fundamentalists who control the program: the systematic discouragement of condom use and a prohibition against providing HIV/AIDS prevention services to commercial female sex workers.

Under its enabling legislation, PEPFAR allocates spending into four principle activities: treatment of individuals with HIV/AIDS (55 percent); HIV/AIDS prevention (20 percent); providing palliative care to individuals with HIV/AIDS (15 percent); and helping orphans and vulnerable children (10 percent).

The State Department reports that PEPFAR has spent about $8.3 billion that has resulted in what it sees as many successes. The program claims that, by the end of September 2005, it supported care for nearly 3 million people. It also claims that during FY 2005 it supported counseling and testing services for over 4.6 million people. Additionally, in FY 2004 around 125,500 women were provided with antiretroviral therapy to prevent infection of their unborn child. As a result, an estimated 23,700 infant infections were averted; the figures for FY 2005 dropped slightly.
* * *

This apparently-successful spending model is compromised in three important ways. First, at least a third of the monies targeted for prevention must be spent on abstinence-until-marriage programs. Second, three-fourths of the monies allocated for treatment must be spent on the purchase and distribution of antiretroviral drugs from U.S. pharmaceutical manufactures and cannot be substituted by generic alternatives. Finally, at least half of that allocated for helping children and orphans is to be provided through nonprofit, nongovernmental organizations, particularly faith-based groups.

The faith-based ideologues who control PEPFAR have replaced the widely accepted anti-AIDS approach of “ABC” with what is called the “AB” message. While they aggressively champion “Abstinence” until marriage and “Being faithful” to one’s partner, the traditional reliance on the use of “Condoms” has assumed a small “c” status and been relegated to the broader “other preventions” category that includes mother-to-child transmission, blood safety, safe medical injections and control of intravenous drug use.

The revision of the “ABC” model has had particularly horrendous consequences. A major source of HIV infection is sexual transmission through commercial sex work. The administration requires organizations receiving PEPFAR funding to take an “anti-prostitution loyalty oath,” a signed statement saying they oppose prostitution. As a result, many organizations that work in women’s and children’s healthcare refuse to sign the oath and, thus, do not qualify for U.S. support.

A review of the experiences of two countries, Uganda and Thailand, illustrates just how disastrous PEPFAR can be. In 2002, James Dobson, an evangelical leader and head of the influential group, Focus on the Family, declared that, “Uganda has made great progress against AIDS by emphasizing abstinence, not condoms.” President Bush also praised Uganda as a success implementing PEPFAR’s “AB” program. Sadly, according to the director general of the Uganda AIDS Commission, since it adopted the program, the rate of new HIV infections has almost doubled, from 70,000 in 2003 to 130,000 in 2005.

A similar fate has befallen Thailand. In 1991, when it adopted a “100 percent condom” program, the rate of HIV infection among female sex workers declined from 30 percent in the mid-1990s to less than 10 percent in 2004. However, with its adoption of PEPFAR anti-condom program, as a 2005 World Health Organization report found, new infections are no longer declining as rapidly as they did in the 1990s.

Another factor that alarms many who’ve reviewed PEPFAR’s activities is its support for questionable faith-based groups to implement its programs. Congresswoman Barbara Lee (CA-D) has voiced concern with the fact that 98 percent of the faith-based foreign-aid money goes to Christian groups who, some report, are using it to further their proselytizing efforts. Others point to the crony capitalism in the awarding of contacts — like that evident in many contracts awarded for Iraq rebuilding and Katrina recovery.

Anita Smith’s Children’s AIDS Fund (CAF) is a case in point. Smith, a longtime champion of abstinence programs since Bush’s days in Texas, has been the co-chairwoman of the President’s Advisory Council on HIV/AIDS. While her original PEPFAR application was rejected by a scientific review committee as “not suitable,” the head of USAID intervened on her behalf and CAF received a $10 million grant to run abstinence-centered programs in Uganda, Zambia and South Africa.

With the Democrats about to take control of the 110th Congress, a number of Representatives have indicated their intention to push for a long-overdue examination of PEPFAR. Tom Lantos (CA-D), who will head the International Relations committee, insists: “We will take a close look at the impact of these ideological restrictions on the effectiveness of HIV/AIDS programs abroad.” William D. Delahunt (MA-D), who will head the International Relations subcommittee on Oversight and Investigations, also supports investigating the program. A vigorous Democratic challenge of the Bush administration’s evangelical campaign against sex, both domestic and international, would be a great benefit that the new Congress could provide to Americans and people throughout the world.
* * *

The U.S. war in Iraq is over, but has a long way to go to end! Victory, however defined, is no longer an option. All options are acknowledgments of defeat. All that is needed to end this horrific military and political catastrophe is to order all American forces to leave, to close down all American bases and ­ if there was justice in America ­ to impeach, prosecute and imprison Bush, Chaney and their co-conspirators.

Unfortunately, whatever the outcome, justice will likely not occur. Like the fate that befell American servicemen and the people of Vietnam during that long period of negotiations that accompanied Henry the K’s (for killer) peace efforts in Vietnam, U.S. military occupation of Iraq will continue for the indefinite future. And many, many will suffer.

In all likelihood, the Democrats will be complicit in the prolongation of Iraq war until Bush’s presidency ends, if not longer. However, they could redeem themselves, if only modestly, by reorganizing PEPFAR to be more compassionate and intelligent in fulfilling its mission. Two immediate changes should involve: (i) the dispersing of condoms and other birth control services to all people in need and (ii) the providing of all services to female sex workers, thus removing the shame of prostitution, of being a woman having to sell her body, her being, to survive. If nothing else, the Democrats could show that they were helping these desperate women, perhaps the most exploited in the world.

DAVID ROSEN is completing the manuscript for “Perversions: America’s Secret Passion for Deviant Sexual Pleasures.” He is author of, most recently, “130 Parties in 30 Days: Matt Gonzales & Indie Culture,” The Political Edge, a collection on the 2004 San Francisco mayoral election (ed., Chris Carlsson, City Lights, 2005). He can be reached at




David Rosen is the author of Sex, Sin & Subversion:  The Transformation of 1950s New York’s Forbidden into America’s New Normal (Skyhorse, 2015).  He can be reached at; check out

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