A couple of weeks back we wrote about how the Bush administration has allocated two-thirds of funding for preventing the sexual transmission of AIDS in Africa to abstinence programs. (No matter how many times you say it, it never fails to amaze: Fighting AIDS with abstinence.) Well, surprise! It turns out it's not working so well, according to President Bush's chief advisor on HIV and AIDS. Speaking at the International AIDS Society conference in Sydney, Australia, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said: "For every one person that you put in therapy, six new people get infected. So we're losing that game, the numbers game."
There's more. Monday, the Public Library of Science reported that researchers have found another major problem with the President's Emergency Plan for AIDS Relief (PEPFAR): In order to receive funding, organizations must take a pledge against prostitution. The legislation authorizing PEPFAR "advanced a new policy goal for the U.S.: the global eradication of prostitution," says the article. "Requirements for grantees were based on this explicit link between HIV prevention and the eradication of prostitution." But, by "prostitution," the administration means both sex trafficking and voluntary sex work. The article's authors argue that as long as the administration conflates sex trafficking with prostitution, "women and men who voluntarily sell sex may be at risk of further marginalization and may ... be less likely to receive the health, social, and education services they need to eventually move out of the industry."
The report concludes with these scalding-hot words on the politics of HIV/AIDS policy: "The history of HIV prevention is all too full of programs that have proven to be politically unfeasible in the U.S. despite overwhelming scientific evidence in their favor, such as the efficacy of needle and syringe exchange programs as HIV prevention tools for injecting drug users ... The provision of support, goods, and services to sex workers who want and need them is a compelling ethical and public health priority ... Whether these goals can be met if we must 'oppose prostitution' is actively being argued in the courts, and perhaps more vitally, in the many settings where sex workers provide services societies continue to disdain and demand." Preach on!
Moving on to other news on the HIV prevention front that's bound to be yet more controversial: Today, at the International AIDS Society conference, circumcision was again raised as a potentially powerful prevention tool. Professor Robert Bailey of the School of Public Health at the University of Illinois said, "If we had a vaccine that was 60 percent protective we would be very happy and rolling it out as fast as possible. But no one stands to profit from male circumcision -- no one but the 4,000 in Africa who will be infected tomorrow." He also said that if all men in sub-Saharan Africa were circumcised, it could prevent 2 million infections and 300,000 deaths. But, widespread circumcision could prove a tough sell when, by many accounts, we're failing to employ even the most basic and, arguably, effective prevention programs.