American Foundation for AIDS Research, February 2002
Dave Gilden

When Secretary of State Colin Powell remarked to an international MTV audience on Valentine's Day, "I believe condoms is [sic] part of the solution to the HIV/AIDS crisis," he was not whistling in the wind. Rather, his remarks were a notable straw in the wind. They reflect a rift within the Bush administration between pragmatists and religious fundamentalists on AIDS prevention strategy.

Most significantly, Powell concluded by saying, "It is important that the whole international community come together, speak candidly about it [AIDS], forget about taboos, forget about conservative ideas with respect to what you should tell young people about it."

The Secretary was immediately denounced by spokespersons for such conservative ideas – people like Ken Connor, president of the Family Research Council. These moral conservatives have been stalwart supporters of George Bush as candidate and president. Yet the President's press spokesperson explicitly rejected even the suggestion that Powell and Bush disagreed.

The divisions on AIDS prevention are reflected in Bush's new nominees for the Presidential Advisory Council on HIV/AIDS (PACHA). As announced two weeks before Powell's MTV appearance, the new commission is a mixed bag. One of its chairs is former congressional representative Tom Coburn, who consistently attacks safe-sex education. Besides abstinence, Coburn emphasizes such restrictions on people with HIV as tracing of sexual contacts and criminal penalties for transmitting the virus.

Little noticed in the hubbub over Coburn was the other PACHA co-chair, Louis Sullivan. Sullivan is an African American and was Secretary of Health and Human Services in the Bush, Sr. administration. After his nomination in 1989, Sullivan was skewered by conservatives because of his pro-abortion statements.

Including the nine carryovers from the last Council, the 35-member body has 14 African Americans. Among these are Memphis Pastor Edwin Sanders, who reportedly was rejected as chair because of his support of clean syringe programs for intravenous drug users.

Pat Ware, another African American, is now PACHA's executive director. Ware is an abstinence absolutist who used to work for the pro-Coburn Americans for Sound AIDS Policy.

The Council is set up to have acrimonious debates over abstinence, needle exchanges and other aspects of HIV prevention. It lacks a clear majority on any of these questions and probably will not provide decisive leadership.

At the Department of Health and Human Services, moral conservatives decisively hold the reins of power. HHS Inspector General Janet Rehnquist (daughter of the Supreme Court chief justice) is now auditing AIDS prevention programs around the country to see if they promote sexual activity and therefore violate federal guidelines. And abstinence-only sex education is slated to increase by one-third under Bush's proposed 2003 budget. Outside of medical research, AIDS programs are flat-funded.

As Cornelius Baker, director of Washington's Whitman Walker AIDS clinic warned, "AIDS advocacy groups have not asserted leadership in the new situation. We lack key organizing strategies." There is more at stake than just abstinence versus condoms. As the October Treatment Insider described, medical science makes possible a broad range of population- and individual-based HIV prevention strategies. Public pressure will be decisive in making sure that this promise is fulfilled.

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