Wall Street Journal - May 21, 2007
Michael M. Phillips, michael.phillips@wsj.com

WASHINGTON -- When Democrats took over Congress, liberal AIDS activists thought they would finally see the end to a requirement that the federal government spend hundreds of millions of dollars to promote sexual abstinence in the developing world.

The activists say the conservative-backed rule, passed in 2003 by the Republican-controlled Congress and signed by President Bush, diverts money from programs that promote condoms, provide AIDS drugs and care for the ill, into abstinence efforts of dubious effectiveness. They are pressing Democrats to repeal that mandate in a coming foreign-aid spending bill. Meanwhile, proponents of abstinence programs are opposing such a change, saying that the African nation of Uganda shows abstinence works.

There are signs, however, that Democratic leaders don't want to get into the middle of the fight right now.

House Appropriations Committee Chairman David Obey of Wisconsin and other Democrats, already entangled in the Iraq war debate and other battles, are preparing a draft of their foreign-aid spending bill and appear reluctant to send the White House a measure that deletes the abstinence language, according to health activists and Capitol Hill aides. Instead, Democrats seem likely to push the issue off until later this year or even next year, when Congress will have to reauthorize the president's AIDS initiative. That could mean that any relaxation of the AIDS funding restrictions might not take effect until 2009 or 2010.

"The Democrats have the power to do the right thing; they don't seem to be willing to do it," says Jodi Jacobson, executive director of the Center for Health and Gender Equity, in Takoma Park, Md., an advocacy group that is leading the lobbying effort. "What is the point in being in the majority if you can't take action?"

Behind the fight over spending is a fierce debate, tinged with both science and ideology, over whether abstinence programs actually delay the onset of sexual activity among young people or instead draw funding away from more-effective approaches. The pro-abstinence side says that Uganda, for instance, has succeeded in reducing HIV prevalence in large part by promoting abstinence among the young and fidelity among the sexually active.

"It just so happens in this case the morally right thing is also the efficacious approach," says Stephen Colecchi, director of the office of international justice and peace at the pro-abstinence U.S. Conference of Catholic Bishops.

Supporters of the mandate say that without it, programs advocating sexual abstinence until marriage and sexual fidelity after marriage would get shortchanged. "Over time, we probably won't need [the provision], but for now we still do," says Dr. Mark Dybul, head of the Bush AIDS program.

The opponents of the provision, however, point to new scientific evidence to back up their claim that the abstinence provision instead inhibits progress against HIV. A new study by the U.S.'s Institute of Medicine concludes that congressional provisions dictating how the administration must spend AIDS money -- whether for abstinence or treatment -- tie the hands of health professionals on the ground.

"Contrary to basic principles of good management and accountability, the budget allocations have made spending money in a particular way an end in itself rather than a means to an end -- in this instance, the vitally important end of saving lives today and in the future," the study concluded.

Another study, commissioned by the Department of Health and Human Services, found that abstinence-only programs in the U.S. have had no impact on the sexual behavior of young people.

James Wagoner, president of Advocates for Youth, a Washington-based nonprofit that presses for sex education that includes abstinence and condom use for HIV protection, says that if the Democrats fail to delete the abstinence provision, "they'd leave themselves open to the charge of being public-health frauds."

The liberal advocacy groups have some well-placed allies. Sen. Dianne Feinstein, a California Democrat and a member of the Appropriations Committee, argues that the abstinence requirement is "squeezing out available funding for other key HIV-prevention programs, such as mother-to-child transmission and maintaining a healthy blood supply." Rep. Barbara Lee, a California Democrat on the House Appropriations Committee, has introduced legislation that would strike the abstinence provision, which sets aside 33% of AIDS prevention money, or about $300 million this year, for overseas abstinence programs.

Rep. Nita Lowey, a New York Democrat and chairman of the House subcommittee that funds international AIDS programs, says the pandemic "is unyielding, and we cannot afford to use anything less than the best and most effective tools at our disposal in this fight."

Nonetheless, Mr. Obey appears reluctant to risk slowing progress on spending bills by taking on such a controversial measure. Before winning control of Congress, Democrats attacked the majority Republicans for failing to complete spending measures on time.

A White House spokesman declined to say whether President Bush would veto legislation that deletes the abstinence mandate. But, in an email, he added, "We'll certainly fight to maintain a balanced approach" in HIV-prevention grants -- in other words, to support abstinence and fidelity programs in addition to condom promotion.

Already this month, Mr. Bush sent pre-emptive letters to Democratic leaders vowing to veto any bill that weakened antiabortion provisions in U.S. aid law. The issue is peripheral to the abstinence provision, but both draw support from the same socially conservative constituency.

Health activists also are pressing for repeal of another controversial measure, which requires grant recipients to have written policies opposing prostitution. Socially conservative lawmakers and advocates argue the provision is a common-sense approach because HIV can spread through prostitution. Their opponents, including AIDS groups in Brazil and India, argue that condemning prostitution stigmatizes sex workers and makes it harder to win their trust.

AIDS advocates thought their efforts to repeal the prostitution-pledge requirement might get a boost from the departure of Bush foreign-aid czar Randall Tobias, who resigned after admitting he summoned call girls to his home for massages. But Congress shows even less appetite for taking on the prostitution issue than it does the abstinence issue. The Democrats realize the issue is a public-relations trap; removing the provision opens them up to attacks accusing them of being pro-prostitution.

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