How Ideology Trumped Science: Why PEPFAR has Failed to Meet its Potential

Next week, the Center for American Progress will publish a scathing critique of how PEPFAR – the Bush Administration’s signature initiative to combat the spread and impact of HIV and AIDS in Africa – ignored by design the HIV prevention needs of LGBT communities.

“How Ideology Trumped Science: Why PEPFAR has Failed to Meet its Potential” is written by Scott Evertz, a Bush Administration appointee. The Council for Global Equality sponsored Evertz’ refreshingly honest research, the thrust of which is to advocate a more inclusive, science-based program that ultimately will make more effective use of taxpayer dollars.

PEPFAR is rightly praised for having provided anti-retroviral medicines to some 2.1 million people who otherwise may have lacked recourse to them. It has made HIV testing and counseling available to millions more, while providing care to orphans and others with little means to provide for themselves. But PEPFAR’s assistance pipelines largely have bypassed LGBT communities, leaving gaping holes in the logic of efforts to stem the disease.

At a pre-holiday preview of his report, Evertz demurred on whether PEPFAR’s exclusion of LGBT needs was a deliberate reflection of anti-gay bias. But PEPFAR’s emphasis of abstinence until marriage amounts to a built-in exclusion of gays and lesbians, for whom marriage isn’t presently an option. Indeed, only negligible funding has been targeted at prevention outreach to men who have sex with men – a population that remains, at least partly of consequence, highly vulnerable to HIV infection.

Dogma-over-science has undermined PEPFAR’s effectiveness in other ways as well. PEPFAR grantees must explicitly oppose prostitution – thereby undercutting outreach to commercial sex workers, a major avenue of HIV infection. Averting needle exchange programs for injecting drug users has torn another hole in PEPFAR’s impact. And by giving overriding primacy to “abstinence” and “be faithful” messages, with little attention to correct condom usage, PEPFAR programs have reduced sex education to an asterisk.

The most detailed and disturbing portions of Evertz’ report relate to how PEPFAR may have contributed inadvertently to the unraveling of Uganda’s previously successful fight against HIV/AIDS. The Ugandan Government readily adopted PEPFAR’s de-emphasis of condoms and related sex education as effective means of HIV prevention. Evertz also reveals tell-tale signs that some faith-based PEPFAR sub-grantees may have helped nurture the anti-gay climate in Uganda that has spawned a horribly homophobic draft law that may be put to a vote in the coming days. Those of us of the Christian faith should be first to speak out against this subversion of religion to justify state-sponsored homophobic hate, imprisonment, and even death.

Larger questions fleetingly emerge, without answer, from Evertz’ work. For example, how could the UN Security Council not have recognized until the year 2000 – almost 20 years into this health crisis – the global security repercussions of the spread of HIV/AIDS? But the most disturbing question is this: how were those who ran PEPFAR allowed to break the wall of public policy separation our Founding Fathers rightly erected between church and state – thereby infusing a ground-breaking public health program, and indeed America’s national foreign policy interests, with sectarian dogma?

This is less a question for historians to dissect, or even for the previous Administration to defend, than one that public policy experts must ensure can never rightly be asked again.

View the panel discussion about this report held on December 15, 2009 at the Center for American Progress:

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