Bush Administration "mission creep" affects global sexual health efforts. (Policy Update).

This issue of the SIECUS Report addresses a gamut of international issues related to sexual and reproductive health. In many ways, they are the product of in-country dynamics. But more recently, we have seen the ideological and religiously conservative disposition toward sexuality in the United States become a product for export. For advocates of sound public health policies, this phenomenon of "mission creep" has become a source of deep concern.

For all intent and purpose, the Bush Administration has launched an all-out campaign to convince the rest of the globe that the only effective way to permanently address sexual and reproductive health issues is rather simple: first, all people--regardless of age--should remain abstinent until they marry; second, those who are married must remain monogamous and exercise fidelity. Coupled with this philosophy is an Administration willing to provide assistance to those in need, but only if they are willing to gamble-as we ourselves are domestically-that the approach is sufficient and workable.

RESEARCH POINTS TO GAMBLE

The most recent research underscores just how much of a gamble it is. The British Medical Journal released a study in June that found three abstinence programs in which the pregnancy rate among female partners of males was significantly higher than among those who did not take part in the program. The study also found that the pregnancy rate among adolescent women in four abstinence programs was higher than in the control group. None of the programs defined as "abstinence programs" in the study taught about any forms of prevention, such as contraception.

Socially conservative groups criticized on the study Focus on the Family described its "poor quality" and encouraged abstinence-until-marriage proponents to "take this report lightly." In addition, one of their analysts suggested that researchers should look at the largest program run by the Southern Baptist Church that focuses on pledging abstinence until marriage. Focus on the Family says the program run by the Ugandan government is an example of an effective application of the pledge program.

According to UNAIDS, Uganda's overall infection rate has fallen from eight percent in 1999 to five percent in 2001. But crediting the overall drop to pledge programs, as Focus on the Family does, is decidedly misleading. In fact, on June 21 at a meeting of the President's Advisory Council on HIV/AIDS--now co-chaired by abstinence-only champion and former Congressman Tom Coburn--Dr. Ann Peterson, assistant administrator for the United States Agency for International Development's Bureau for Global Health, presented data on Uganda's strategy to reduce its HIV-infection rates.

In reality, Uganda's approach is multifaceted in that it stresses both abstinence and faithfulness while also promoting condom use for those who are sexually active. Proponents of abstinence-only-until-marriage conveniently leave off the last part of the strategy in their propaganda to sell abstinence-only-until-marriage interventions in the international context. In addition, a study of the pledge card program's application in the United States found harm associated with the intervention. Those young people who broke the pledge were a third less likely to use contraception when they did have intercourse.

"MISSION CREEP" AT U.N. CHILDREN'S SUMMIT

And yet, the lack of scientific support has not swayed the Bush Administration's purposeful "mission creep" in advancing abstinence-only-until-marriage beyond our own domestic prevention portfolio.

At the United Nations Children's Summit this past May, the United States was in the embarrassing position of being ideologically akin to such totalitarian and theistic states as Iran, Sudan, Libya, and Iraq in denying language to a consensus document that sought to provide young people around the world with access to reproductive health care services.

During a speech at the Summit, U.S. Secretary of Health and Human Services Tommy Thompson reiterated unwavering support for the Bush doctrine that abstinence from "non-marital sexual activity" is the panacea for solving all matters related to sexual and reproductive health. Even Concerned Women for America was forced to report that the Secretary's speech "received tepid applause."

Additional evidence of the Bush Administration's "mission creep comes on its own views regarding HIV/AIDS prevention. Already, the United States is conducting a domestic review of those receiving HIV/AIDS-prevention funding. The Bush Administration insists this is designed to curb waste, but direct service providers fear that the review is really an effort to expunge programs not in sync with the Administration's abstinence-only philosophy on prevention.

It is no coincidence that the Bush Administration's high-profile decision on June 18 to allocate $500 million over the next three years to the international HIV/AIDS initiative was so narrowly focused as to provide funding only for medicine that prevents mother-to-child transmission of HIV 

While direly needed, the act gave the impression of leadership while entirely skirting the delicate issues involved in prevention--such as sex. In addition, it provided significantly less money than advocates had anticipated. One estimate found that the allocation aimed to prevent 30,000 infants from infection annually even though 800,000 infants are born HIV positive each year according to UNAIDS. This outermost indication from the Bush Administration on how best to prevent HIV in the developing world, while discouraging, perhaps indicates at the very least that the Administration is fully aware that a global abstinence-only-until-marriage campaign headed by the United States remains a hard sell.

UNFPA-FUNDING PHASE OUT

Finally, the Bush Administration's relentless attack on family planning continues to defy rational thinking in terms of preventing unintended pregnancy and protecting the health of women.

Domestically, the President has proposed flat funding for family planning for fiscal year 2003. But internationally, the President's budget blueprint entirely phases out support for the United Nations Population Fund (UNFPA).

The lack of forward-looking support for UNFPA is hardly surprising. In the last week of June, The Washington Post reported that "Bush aides directed State Department officials in recent days to devise a plan to eliminate" the $34 million allocated in the current fiscal year to UNFPA.

Under pressure from domestic groups opposed to family planning, the President has held up the release of the money citing allegations that it is used to enforce China's coercive abortion practice under that country's "one-child" policy. To date, no facts have been found to corroborate the allegations.

CONCLUSION

Separately, these examples might prove indicative of politics as usual--a President taking the opportunity to appease a particular constituency. But taken together, they are battles in the war to champion an ideology of hyper-moralism over sound public health policies designed to promote and secure sexual and reproductive health.

That this is an issue for the United States is abundantly clear. Yet, in spite of the loss of nearly a half million lives due to AIDS since 1981, the epidemic has slowed here and our access to anti-retroviral therapies is prolonging life and mercifully postponing our experience with deaths. It's telling that a recent estimate of HIV infections in Africa originated in an arm of the U.S. intelligence apparatus. That study estimated that 60 million Africans will become infected with HIV in next five years. A UNAIDS report in early July estimates that 70 million people will die of AIDS in the developing world over the next 20 years. Imagine watching an entire quarter of the United States population die a horrid death over the next 20 years. We cannot. Yet we couch it in terms that deal with global stability and stability of regimes, not in effective public health strategies to prevent infection.

That is why SIECUS hopes those gathering in Barcelona this July to asses the global HIV/AIDS epidemic and strategize about how to find solutions will not count on the United States government for inspired leadership. Unfortunately, our own government's strategy is a politically-and ideologically driven domestic experiment whose early indications suggest more harm than good.

RELATED ARTICLE: XVI WORLD CONGRESS OF SEXOLOGY SET FOR MARCH 10-14 IN HAVANA, CUBA

The XVI World Congress of Sexology is scheduled for March 10-14, 2003, in Havana, Cuba, under the auspices of the World Health Organization and the Pan-American Health Organization.

World Congress topics will include sexuality education; public policies related to sexuality; sexuality and violence; sexually transmitted infections; reproductive and sexual health; and gender and sexuality.

Registration fees until December 31 are $400, participants; $275, students; and $90, accompanying persons. Registration fees after December 31 are $500, participants; $300, students; and $100, accompanying persons.

For more information, contact [e-mail] or visit the Web site www.cubasexologia.com/16congreso/