Friday, March 04, 2005
A Republican effort to stamp out needle-exchange programs abroad incensed editorial boards at The Washington Post and The New York Times last weekend, and both pages slammed the latest congressionally-mandated gag rule to hit the United Nations.
That conservatives are trying to stamp out harm reduction abroad is no small story, but both pages missed the fact that this is only the latest installment in a long story of strings-attached giving that has been changing U.S. foreign aid policy for years. From AIDS prevention measures stigmatizing sex, to anti-human trafficking targeting prostitution, to drug policies purged of pragmatism, foreign aid has become an American adventure in social engineering.
Global AIDS conferences have become as much a matter of America-bashing as AIDS-fighting. Last July, U.S. AIDS coordinator Randall Tobias was heckled mercilessly at the International AIDS conference in Bangkok. The discord stems from U.S. gestures toward a comprehensive approach on AIDS that never quite panned out. The Global Fund to Fight AIDS, Tuberculosis and Malaria was founded three years ago as a multilateral effort to help funnel vast sums of money to developing countries in need of public health funding. It took a localized, hands-off approach, scrutinizing applications but generally leaving questions of implementation and disbursement to local agencies and governments. The U.S. offered the first grant of $200 million and was expected to be a major supporter.
But during the president's State of the Union Address in 2003, he busted out with something called the "President's Emergency Plan for AIDS Relief," or PEPFAR, and a competing bureaucracy was born.
PEPFAR was smaller in its ambitions – only 15 countries were targeted – but much better funded, with $15 billion promised over five years. The Global Fund's biggest donor had proven itself capable of promising huge sums of money, but they would not be going into the Global Fund. Tobias tried to stem the ensuing wave of criticism by claiming that the organizations could work together. But it soon became clear that they had fundamentally different missions. PEPFAR enthusiastically endorses the so-called "ABC" approach – Abstinence, Be Faithful, and Condoms. The program gave President Bush an opportunity to scale up from his $10 million abstinence crusade in Texas (where there is no evidence it worked) to a billion-dollar version in Africa (where there is new evidence it's not helping.)
PEPFAR promises that 33 percent of all funds are spent on abstinence-promotion and that faith-based organizations can receive funding even if they refused to talk about or provide contraception. Condoms, the most statistically proven and economically sound method of prevention, are a last resort to be distributed to "high-risk" groups. The program also forces any organization receiving funds to explicitly oppose the legalization of prostitution.