With God on Their Side: How Christian Fundamentalists Trampled Science, Policy, and Democracy in George W. Bush's White House.

Editor's Note: In her new book Esther Kaplan examines the Christian right's influence on a number of issues of great importance to SIECUS Report readers, including scientific research, a woman's right to choose, and the rights of gays, lesbians, and bisexuals. The following is an excerpt from Chapter 7, "AIDS, BORN AGAIN."

Ronald Reagan had been president for only a few months when, in June 1981, scientists announced that a cluster of rare cancer cases among gay men signaled a new epidemic. It would be a year before AIDS would have a name, and five years more before the president would utter one word about the disease. Today, in the age of SARS and anthrax, Reagan's silence seems unimaginable, but as the new illness grew from 400 American cases to 70,000 during the 1980s; as it leaped from Los Angeles and New York to Paris, Kampala, and Rio; as it touched nearly one hundred nations and was fast on its way to becoming the most deadly epidemic in human history, the president simply refused to take notice. The Centers for Disease Control, under Reagan's watch, was slow to protect the nation's blood supply from infection. The National Institutes of Health researched only one prospective AIDS drug. Finally, in 1987, facing bipartisan pressure from Congress, civil disobedience in the streets, and increasing criticism in the media, Reagan appointed an AIDS commission to study the issue. Then he ignored the commission's 579 recommendations. (1) By the time Reagan's vice president, George Herbert Walker Bush, succeeded him 1988, the epidemic had killed 38,000 Americans. Yet Bush Sr. consistently fought full funding of the Ryan White CARE Act, a congressional initiative to provide federal assistance to American cities hardest hit by AIDS.

AIDS afflicted society's pariahs--homosexuals and heroin addicts, constituencies with little political power and even less relevance to the Republican Party. Moreover, any serious discussion about AIDS prevention required explicit talk about things most Americans didn't mention in polite company, if at all: vaginal, oral, and anal sex; drug injection; and gay relationships. Popular conservative solutions to AIDS, such as banning infected children from the public schools (forwarded by William Dannemeyer) and tattooing the buttocks of gay men (a William F. Buckley brainstorm), telegraphed conservatives' belief that neither the disease nor the infected had a place in their America. Indeed, several prominent congressional Republicans built their careers on AIDS bashing. Former North Carolina Senator Jesse Helms famously waved safer sex brochures on the Senate floor, branding them obscene; former Oklahoma Representative Tom Coburn, who came to Washington with Newt Gingrich's far-right class of 1994, pushed for such punitive measures as the criminalization of HIV transmission and the mandatory testing of pregnant women and sex offenders (though, a physician himself, he also helped push for Ryan White funds). (2)

Into this decade-long vacuum of political leadership exploded a massive private-sector response, from the street activism of ACT UP to such national advocacy groups as the National Association of People with AIDS, from research institutions like AmFAR to service providers such as Gay Men's Health Crisis. These organizations, it happens, were rooted in the gay and African American communities, constituencies that had held little interest for Republicans. And the more these organizations succeeded in collectively defining the national AIDS agenda to include publicly funded research and care, gay-friendly approaches to prevention, risk reduction for drug users, and efforts to fight stigma, the less interested fiscal and social conservatives became in AIDS.

THE BUSH FACTOR

When George W. Bush entered politics, he seemed destined to ignore AIDS in the Republican style. As governor of Texas from 1994 to 2000, a period when the state's AIDS cases surged to rank fourth in the nation. Bush never mentioned AIDS in a single public address. He appointed a Texas health commissioner who opposed condoms because "it's not what God intended," and Bush was so indifferent to AIDS care in his state he refused to sign letters of support for AIDS grant applications. (3) Little changed as the governor began to entertain presidential ambitions. When Bush held his famous Austin meeting with gay Republicans in April 2000, according to one attendee, Carl Schmid, "Global AIDS wasn't on his agenda and it wasn't on ours." An early draft of the 2000 Republican Party platform, a document the Bush campaign had micromanaged, omitted AIDS entirely. (4) And so it went when Bush first arrived in Washington.

A month into the new administration, Bush's chief of staff, Andrew Card, announced that Bush would shutter the White House office on AIDS policy. The comment made national headlines, forcing Card to retract it. Press Secretary Ari Fleischer claimed Card had simply "made a mistake," but beltway AIDS advocates regarded Card's announcement as a trial balloon, to test how far the administration could go in shunting AIDS to the sidelines. (5) Indeed, months passed before Bush named an AIDS czar, and a full year elapsed before Bush appointed members to his AIDS advisory council. HIV-doctor Scott Hitt, who served as chairman of the AIDS council under President Clinton, told me at the time, "I just don't get the sense that this administration is engaged."

But those AIDS council appointments in early 2002--followed by a series of public AIDS initiatives, secret AIDS strategy sessions, and aggressive audits of publicly funded AIDS service providers--actually signaled something quite extraordinary. George W. Bush was doing what no other Republican president before him had done: he was divining a way to make AIDS his own. Rather than focus on the uncomfortable challenges of the domestic epidemic, where three-fourths of all AIDS cases still occur among gay men, injection drug users, and their partners, Bush turned his sights on the global epidemic, with its millions of infected mothers and children and sympathetic AIDS orphans. At home he might have to grapple with condoms and clean needles, but abroad he could put his energies into mother-to-child transmission, a significant source of new infections in Africa and the Caribbean. Rather than seek advice from the AIDS researchers, doctors, social workers, advocates, and people living with HIV who had set the AIDS agenda in the past, he would listen to pharmaceutical executives intent on preserving drug profits and to social conservatives whose abhorrence of gay and extramarital sex was matched only by their lack of AIDS expertise. Rather than promote public health solutions, he emphasized "personal responsibility." Rather than condoms, his mantra was abstinence and marriage. In Bush's hands, AIDS was born again--as a conservative issue.

At the heart of this Republican AIDS makeover is an all-out war on condoms and safer sex, one with deep roots in the teachings of the Catholic Church and evangelical conservatives. The idea of altering sexual practices to avoid HIV infection--whether by donning a condom or by engaging only in oral sex and other low-risk activities--emerged first from within the gay community in 1983 and was only later adopted by health professionals and the American public as the key to preventing new infections. By 1995, Americans had so embraced the idea that 80 percent said they would like to see condom information aired on TV. (6) This was a devastating development for the Christian right. Jerry Falwell spoke for many when he said in the mid-1980s that homosexuality was a sin and AIDS was God's punishment of gay men for "violating the laws of nature," a view echoed today in pronouncements by such groups as the Traditional Values Coalition that homosexuality itself is a "public health hazard" and the only way to stop HIV is to "stop the behavior." Concerned Women for America extended the argument, insisting that all sex outside of a heterosexual marriage is "not natural" and that access to condoms would discourage young people from choosing the only spiritually healthy path: chastity until marriage. "Why abstain from sex when there can be protection from disease?" Concerned Women asked in a 1998 article, "Furthering the Safe Sex Lie." "Once again, 'free love' reigns." (7) Social conservatives wanted sexual promiscuity and gay sex to carry such a severe cost that young people would be scared straight. So condoms became the enemy.

Throughout the late 1990s, Tom Coburn served as a mouthpiece for this perspective in Congress, insisting that "condom distribution and similar risk-reduction strategies have been heavily funded and heavily promoted for the past thirty years with little or no beneficial effect." (8) A Christian fundamentalist himself who would go on to join the board of the Family Research Council after his retirement from Congress, Coburn teamed up with Joe McIlhaney of the Medical Institute for Sexual Health and Shepherd Smith of the Institute for Youth Development to conduct annual slideshows for his congressional colleagues about the scourge of sexually transmitted diseases, where he would rail against "permissive sexuality" and the "safe-sex establishment." (9) He introduced legislation to get warning labels put on condoms and instigated a full-scale investigation into condom effectiveness by the National Institutes of Health (NIH)--in effect, a fishing expedition for damning data. Months before the report came out, Smith, who sat in on some of the NIH meetings, claimed in an editorial that the evidence supporting condoms was so thin that promoting their use amounted to "consumer fraud." (10)

When the NIH report finally came out in July 2001, Bush was in the White House, Coburn was back working as an obstetrician in Oklahoma, and the results didn't quite turn out as planned. After an extensive review of all the scientific data on condoms, the NIH found "strong evidence" for the effectiveness of condoms in preventing HIV, as well as several other sexually transmitted diseases--facts that had already become common sense to most Americans. The scientific literature includes evidence that condoms and safe sex practices cut HIV rates in half among white gay men from 1988 to 1993, [results] hailed by many at the time as a public health coup, and that 98 to 100 percent of uninfected people in a long-term relationship with an HIV-positive partner avoided infection through consistent condom use. (11) But Coburn, McIlhaney, and a group of doctors associated with Focus on the Family calling themselves the Physicians Consortium held a press conference to claim the opposite. They latched onto the inconclusive data about one common sexually transmitted virus, HPV--a lack of data that NIH insisted "should not be interpreted as proof of the adequacy or inadequacy of the condom to reduce the risk of STDs"--to condemn condoms once and for all. McIlhaney declared that the report "reveals that condoms are not a reliable defense against today's epidemic of sexually transmitted diseases." (12) Coburn announced to reporters, "For decades, the federal government has spent hundreds of millions of dollars to promote an unsubstantiated claim that promiscuity can be safe. We all now know for a fact that that is a lie." For good measure, claiming that he was guilty of spreading lies about condom effectiveness, they called for the resignation of Jeffrey Koplan, then the director of the Centers for Disease Control (CDC). (13) Within seven months, Koplan had resigned, and Bush had appointed Coburn, McIlhaney, and Shepherd Smith's wife and colleague Anita to his Presidential Advisory Council on HIV/AIDS.

The CDC estimates that new HIV infections peaked at about 160,000 a year in 1985, and then dropped down to 40,000 by the mid-1990s. Since then, the rate has held steady, a stubborn fact that has been used by McIlhaney, Coburn, Smith, and others to suggest safe sex has run its course. "We've spent hundreds and hundreds and hundreds of millions of dollars [on safe sex]," Coburn said when he was named cochairman of Bush's AIDS council, "and HIV infection is going up." (14) "Comprehensive sex education programs just weren't performing," McIlhaney told me shortly after he joined the council. "Our feeling was it was time to try another approach, so that's why I supported funding for abstinence." Such arguments alarm long-time AIDS advocates, especially those concerned about rising infections among young gay men. "By going after condoms as a tool, they are destabilizing the whole structure of HIV prevention as we know it," says Daniel Wolfe, a former spokesperson for Gay Men's Health Crisis, the nation's oldest AIDS organization, and author of the gay men's health guide Men Like Us. "Their underlying message is that HIV prevention doesn't work and there's no use bothering." David Holtgrave, the CDC's former director of HIV prevention, also became worried about "this mantra that HIV prevention has failed," so he set out to study it.

From his new post as a professor of public health at Emory University, Holtgrave conducted a state-of-the-art analysis of the impact of HIV prevention since the mid-1990s, when that 40,000-infections-a-year rate more or less held steady. He found prevention efforts halted somewhere between 204,000 and 1.5 million new infections during those years, or enough people to fill a city the size of Baton Rouge or Philadelphia. Far from discovering the safe-sex message has failed, Holtgrave found that whenever the CDC's prevention budget rose, infections fell, and when funding leveled off, so did the infection numbers. He says the data prove "you get what you pay for." "What I don't understand," he told me, "is when we're talking about needing to break out of this 40,000 number, and there are people who are either unserved or underserved by our current prevention efforts, why wouldn't you want to provide the resources to do science-based prevention interventions in those populations?" Under previous administrations, members of the president's AIDS council would have called a press conference to make the case for increasing funds for prevention efforts that work. But Bush's council is another sort of animal.

THROUGH THE LOOKING GLASS

In the heyday of AIDS activism, in the late 1980s and early 1990s, AIDS advisory meetings were the targets of protest and scrutiny. Today, very few AIDS advocates and even fewer members of the press monitor the proceedings. When I journeyed to a nondescript Washington, D.C., hotel in June 2002 for an early meeting of Bush's new council, descending into that dimly lit conference room was like falling down a rabbit hole--into a world where AIDS reality had been turned upside down. The first afternoon, devoted to surveying the status of HIV prevention, lacked a single presentation on injection drug use, which accounts for at least one in four U.S. transmissions, or any mention of the recent spike in infections among black and Latino men who have sex with men. The lineup included one lone presenter on comprehensive sex education, which includes the range of options from condoms to chastity, but she was interrupted repeatedly by council co-chair Coburn, who presided like a family patriarch over Thanksgiving dinner. She was then outflanked by two speakers promoting the benefits of the abstinence-until-marriage message, neither of whom seemed aware that sex between men, who can't marry, causes most U.S. infections, or that many women get HIV from their husbands--marriage offering them little protection from a husband's infidelity or heroin use. Even though he's a member of the council, McIlhaney also snagged a presenter slot, which he used to warn that even 100 percent condom use leaves some "relative risk." He also insisted young people should be told to avoid not just penetrative sex, which carries HIV risk, but "any contact that creates arousal."

After that, Eve Slater, then assistant secretary of Health and Human Services, trumpeted her agency's aggressive audit of HIV-prevention spending. While earlier speakers had accused "so-called AIDS activists" of "actually furthering transmission of HIV," Slater ended her talk with the chilling complaint that "this field [AIDS] has often been plagued by an overenergetic desire to get things done."

The meeting devolved into utter surrealism on day two, when Coburn tossed out the schedule and ceded the floor to the council's staff director, Pat Ware (now a special assistant at HHS), who gave an impromptu twenty-minute monologue on the importance of marriage. "My goal," said the longtime single mom, "is to bring more black men into homes as loving, caring fathers. A two-parent household stabilizes the family, the community, and the nation." When council member Brent Minor, then one of a handful of holdover Clinton appointees, responded, "What about me as a gay man? We have to be included as part of prevention," born-again Christian council member Joseph Jennings erupted: "Is this a gay HIV agenda? Is this a gay thing?" Afterward, Minor told me another council member approached him to say, "Don't take this wrong, but I just don't believe in that way." Months later, in a conversation with gay Republican activist Carl Schmid, who frequently lobbies the administration on AIDS policy, Schmid told me, "The community most affected by AIDS in this country is still the gay community. How can you fight AIDS in this world and not mention the word 'gay'?"....

The first presidential AIDS council was established in 1987, and began a tradition of articulating prophetic calls to conscience in the face of presidential complacency. Though Ronald Reagan's Presidential Commission on the HIV Epidemic began ignominiously, embroiled in controversy over the appointment of one member who believed HIV was transmitted by mosquitoes and another who called AIDS "the due penalty for [gay men's] perversion," it didn't end that way. When retired admiral James Watkins took over as chair, he hired a staff of thirty experienced Capitol Hill operatives and, though a devout Catholic himself, vowed to "keep morals out of this." Within ten months he had held forty-three hearings with hundreds of witnesses and issued a 279-page report that excoriated Reagan for his "sluggish" response to AIDS and called for anti-discrimination legislation, comprehensive K-12 health education, and a big jump in federal funds. Following suit, Bush Sr.'s commission charged that Bush had "seriously underestimate[d] the scale of the AIDS disaster," and when the administration resisted its no-nonsense call for universal health care, drug treatment on demand, and the legalization of hypodermic needles, commissioner Magic Johnson resigned in protest. (15)

Clinton's Presidential Advisory Council was no softer. It expressed "grave concerns" about the government's "overly timid" prevention plan and pushed the administration, in countless memos, reports, and editorials, to endorse needle exchange. It was stacked with people who had devoted their lives to AIDS--from pioneering women-and-AIDS researcher Alexandra Levine, MD, to Ronald Johnson, associate director of Gay Men's Health Crisis--many of whom were living with HIV themselves. (16) According to Levi Strauss representative Stuart Burden, another Clinton appointee who remained on the council for the early months of the Bush administration, "the Clinton council had big-time wonks who knew the entire history of a bill, who was lined up around it, and the complete political context."

The thirty-four current Bush council members, however, include only one scientist, addiction specialist Beny Primm, and a handful of public health officials from rural states. The dearth of HIV researchers makes Hank McKinnell, CEO of the pharmaceutical giant Pfizer, the most knowledgeable person on HIV drug development in the room, which creates at least the appearance of a conflict of interest. (AIDS advocates have pressured McKinnell's company to reduce the price of its drug Diflucan, used to treat HIV-related fungal infections, and Pfizer contributed $1.4 million in soft money donations to the Republican Party during Bush's presidential campaign.) What's more, the council lacks a single representative from a major national AIDS organization. Instead, it features nine longtime advocates of abstinence-only HIV prevention, a few of whom, such as twenty-six-year-old Dandrick Moton, openly acknowledge that "I'm not an expert on AIDS." Cynthia Gomez, co-director of the Center for AIDS Prevention Studies (CAPS) at the University of California at San Francisco and a Clinton-era council member, says, "For any other advisory group, you'd be hard-pressed to find someone to suggest that a third to a half of the council should be composed of people who don't know the field."

Moton, who directs the Arkansas abstinence-until-marriage group Choosing to Excel, has recruited a group of kids he dubs "The A Team," each of whom has taken a public pledge of abstinence to show other kids that virginity until marriage is "a realistic approach." In effect, Bush had appointed his own A Team to the AIDS council: Moton; Rashida Jolley, a former Miss D.C. and self-proclaimed virgin who once interned at the conservative Heritage Foundation; Mildred Freeman, who directs abstinence education at an association of historically black colleges; Lisa Shoemaker, one of Bush's few HIV-positive appointees, who says she was infected by her dentist and now does the pro-abstinence speaking rounds; Jennings, a former gang member and evangelical "motivational speaker" who uses a scared-straight style to send a message of abstinence from sex and drugs to at-risk youth; Anita Smith, vice-president of the pro-abstinence Children's AIDS Fund, who serves as chair of the council's prevention committee; and McIlhaney, one of the administration's most prolific promoters of questionable condom science. Tom Coburn and Pat Ware--until mid-2003, when Ware took a post at HHS--are the unofficial team captains, united in their goal of unraveling the safer sex consensus.

Coburn has done little to modulate his rhetoric now that he holds this influential AIDS post. While he described himself to me as someone who "understands the sensitivities of the gay community and the Christian right," he also said, "Do I agree with the homosexual lifestyle? No. That's a well-known fact. The attitude in the gay community is unless you have a lifestyle that's promiscuous you're not free. How about abstinence until you have a partner that you want to live with?" Ware, though less of a public figure than Coburn, has also made a career out of hailing abstinence until marriage--with a special emphasis on marriage. She deploys her own story as former single mother from the "inner city" (Raleigh, North Carolina) to argue that chastity and two-parent households are the magic bullets for all that ails the African-American community. She and her message were snapped up by the first Bush White House, which awarded her a teen-pregnancy post, and by the Christian right, in the form of a senior position at Americans for a Sound AIDS Policy, best known for its unsuccessful campaign to block people with HIV from protection under the Americans with Disabilities Act. (The group, founded by Shepherd and Anita Smith, was recently renamed the Children's AIDS Fund.) She spoke warmly to me about "male friends" from her days in the theater who got sick from AIDS, saying, "I promised then that I would do something to help stop this suffering." But she insists that her abstinence-until-marriage concept would have applied to them, too. "For young gay men," she said, "it's the same message." According to Greg Smiley, who served as interim director on the council until Ware took over, she exerted a strong hand in stacking the council with like-minded people she met on her extensive travels as an abstinence advocate.

This replacement of experts by ideologues on Bush's AIDS council, mirrored in scientific advisory bodies at the Environmental Protection Agency, the State Department, the Food and Drug Administration, and across the federal government, has opened the door for politics and morality to trump public health throughout the Bush administration. This would prove to be particularly true in the field of AIDS....

With God on Their Side; How Christian Fundamentalists Trampled Science, Policy, and Democracy in George W. Bush's White House by Esther Kaplan, published by The New Press, 38 Green Street, New York, NY; 212/629-4281.

References

1. On Reagan's commission, see, e.g., MacNeil/Lehrer NewsHour, June 2, 1988, when Watkins was a guest and Sally Squires, "Setting the Course on AIDS: How an Admiral Turned Around the President's AIDS Commission," Washington Post, June 7, 1988.

2. On Buckley, see, e.g., "Stigmatizing the Victim: Homosexuals, AIDS," Nation, April 12, 1986; on Dannemeyer, see, e.g., Joan Mower, "Dannemeyer Urges Steps to Curb Spread of AIDS," Associated Press, October 30, 1985; on Helms, see, e.g. "AIDS Booklet Stirs Senate to Halt Funds," Los Angeles Times, October 14, 1987; on Coburn see "Rep. Tom Coburn, M.D. to Announce the Introduction of a Comprehensive HIV Prevention Proposal." Rep. Tom Coburn press release, August 1, 1996, available from PR Newswire.

3. Doug Ireland, "What Dubya Stands For," POZ, September 1999, and Ireland, "Grin and Cast It," POZ, November 2000.

4. Interview with Carl Schmid, a delegate to the 2000 Republican National Convention.

5. Mimi Hall and Judy Keen, "Bush to Close Offices on AIDS, Race; Advocates Say Move Sends Wrong Message," USA Today, February 7, 2001; press briefing by Ari Fleischer, James S. Brady Briefing Room, February 7, 2001.

6. A 1995 public opinion poll by Chilton Research, as cited by the U.S. Centers for Disease Control and Prevention, www.cdc.gov/hiv/pubs/facts/compyout.htm.

7. Falwell in Fred Bayles, "AIDS: Virus of Fear: Clergy Mixed in Response to AIDS Crisis," Associated Press, September 15, 1985; Federal AIDS Dollars Fund Homosexual Proms and Fisting Seminars, Traditional Values Coalition, November 2002; "'Safe' Sex Is False Concept." Concerned Women for America press release, February 8, 1999; "Furthering the Safe Sex Lie." Concerned Women for America, May 11, 1998.

8. Jim Myers, "Coburn Outraged Over Condom Promotion," Tulsa World, December 15, 1999.

9. "Tom Coburn: Lawmaker Hosts Slide Show on Dangers of STDs," American Health Line, July 27, 2000.

10. Alma Golden and Shepherd Smith, "Warning Labels for Condoms?" Washington Times, February 11, 2001.

11. National Institute of Allergy and Infectious Diseases. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. July 20, 2001; additional data from the Centers for Disease Control and Prevention.

12. "Scientific Review Panel Confirms Condoms Are Effective Against HIV/AIDS, but Epidemiological Studies Are Insufficient for Other STDs," U.S. Department of Health and Human Services press release, July 20, 2001; "Federal Panel on Condoms Offers Crucial Warnings to Sexually Active Americans, Says the Medical Institute for Sexual Health." Medical Institute for Sexual Health press release, July 19, 2001.

13. Coburn from "Report Raises Questions About Condoms--Post," Reuters, July 20, 2001; Koplan from "10,000 Physicians to Ask for Resignation of CDC Director, End of Cover-Up." Physicians Consortium press release, July 23, 2001, available from PR Newswire.

14. Laura Meckler, "Conservative Ex-Congressman to Head AIDS Advisory Panel." Associated Press, January 23, 2002.

15. On Reagan's commission. see, e.g., Judy Foreman, "AIDS Panel Chief Paints Dire Future," Boston Globe, November 19, 1998: on Bush Sr.'s commission. see, e.g., Robert Pear, "As Bush Defends AIDS Policy, Its Critics See Flaws," New York Times, October 18, 1992.

16. "Council Raps Clinton for Not Moving on Needle Exchanges," AIDS Policy and Law, August 9, 1996: see AIDS council roster at www.pacha.gov.