Science, ideology clash on AIDS prevention

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Science, ideology clash on AIDS prevention

By Steve Sternberg, USA TODAY

These questions are at the heart of the controversy over the government's HIV-prevention policy:

1) Can teenagers be persuaded to abstain from sex until marriage?

2) Do condoms effectively prevent sexually transmitted diseases?

3) Has the right balance been struck in the funding of abstinence and condom-based programs?

Researchers say the science is clear. "Are condoms effective? Give me a break," says James Curran, dean of Emory University's Rollins School of Public Health and a pioneering AIDS researcher. "They've been effective for 50 years. They're not perfect, but they work."

But effectiveness isn't the only issue. AIDS prevention, because it necessarily involves sexual behavior, carries profound moral and ideological import, especially where adolescents are concerned.

The tension between science and ideology has emerged as one of the central issues of the 2004 presidential campaign. President Bush and Democratic challenger John Kerry have sparred in particular over the integrity of White House representations of the science involved in stem cell research and verification of Iraqi weapons of mass destruction. Some of the nation's most prominent scientists became activists this year.

The debate over the best approach to AIDS prevention has taken a back seat to these highly publicized questions. But behind the scenes, the debate rages on.

Research shows that teenagers who pledge to stay abstinent until marriage typically don't. Although they do hold off longer than many of their peers, they're less likely to use condoms and as likely to get sexually transmitted infections.

When used consistently, studies show, condoms are 98% effective for preventing pregnancies, nearly 90% effective for preventing HIV and highly effective for stopping the spread of syphilis and gonorrhea. They also can block chlamydia and human papillomavirus.

The Bush administration interprets the scientific findings differently from public health experts, asserting that condoms cannot eliminate all risk from sex with multiple partners. Bush and his supporters in Congress stand on the virtues of abstinence.

Federal regulations now require that government-funded organizations providing AIDS prevention services point out condom-failure rates to their clients.

"The problem on issue after issue is that the Bush administration puts ideology ahead of science," Kerry says. He has been a vocal proponent of programs that support condom use, along with abstinence and faithfulness within marriage.

Last year, President Bush pledged to become the nation's leading AIDS advocate by promising to supply $15 billion over five years for treatment and prevention in the 15 hardest-hit countries.

Some government health experts initially expressed frustration at the slow pace of the administration's fulfillment of that promise.

Eve Slater, former assistant secretary for Health and Human Services, is one of them. "With each passing day, we're losing some very important battles," says Slater, a Republican who resigned in February 2003.

Unhappy AIDS experts found that the legislation required that one-third of AIDS prevention money go to abstinence-only programs, many of them faith-based.

Abstinence funding has flooded the coffers of some struggling organizations. For example, IRS records show that a group called Teen-AID in Spokane, Wash., got $784,868 in federal money in 2002, up from zero in 1998.

Bush believes condoms aren't always the best solution for the prevention of sexually transmitted diseases. "We were buying condoms for STD prevention, and we haven't succeeded," says Megan Hauck, deputy policy director for the Bush-Cheney campaign.

The administration has paid for a study on the effectiveness of abstinence-only programs, Hauck says. "There isn't any evidence comparing abstinence programs with comprehensive sexual education," she says. "We feel that teaching kids an abstinence message is the only foolproof way to keep them from pregnancy and disease."

Julie Gerberding, director of the Centers for Disease Control and Prevention, maintains that charges of bias against science are overblown. "We are absolutely committed to making decisions on HIV-prevention policy on the basis of science," she says. Yet she made headlines last year when she handed a poster-size check for $363,935 to abstinence-only Metro Atlanta Youth for Christ.

This fight is just part of a larger war, many scientists say.

The Union of Concerned Scientists obtained the signatures of more than 5,000 scientists across the political spectrum, including 48 Nobel Prize winners, on a letter accusing the administration of twisting science to achieve ideological goals.

Ronald Numbers, medical historian at the University of Wisconsin-Madison and the grandson of two fundamentalist preachers, says science has been steadily losing its gravitas in the political arena over the past decade or so.

"Science is portrayed as just another ideology," he says. "If you look at what critics of science say — academic and religious critics alike — they converge on the same notion: Science is just one more way of looking at the world, and it shouldn't have the cultural authority it has been granted."

Says the Bush campaign's Hauck: "There's an issue of effectiveness and an issue of what we should be teaching our kids. When you take people's money and make decisions on what to fund with it, you have to consider morals and ethics in addition to science. It's a combined equation."

Can the two factions find common ground?

"Personally," Numbers says, "I think it would be very difficult."

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AIDS-prevention policy has provoked stormy political debate in every administration, almost from the moment the disease emerged in the early 1980s

" I used to say that we're like the body of a bird that's being beaten up by the right and left wings," says Jim Curran, who led the Centers for Disease Control and Prevention's AIDS research during the Reagan, Bush and Clinton administrations.

During the Reagan years, vigorous opposition from conservatives in Congress almost scuttled an $18 billion survey of teenage sexual behavior involving 24,000 students in grades 7 to 11.

Bernadine Healy, then director of the National Institutes of Health and now a columnist for U.S. News & World Report, says the survey has since become a darling of conservatives, because it helps NIH and other organizations track teen sexual behavior.

"You want health agencies to have some independence from the political process," Healy says.

President Clinton refused to pay for programs that would allow drug addicts to exchange used hypodermic syringes for sterile ones. This was even after the head of every federal science agency signed off on a memo stating that he or she had reviewed all relevant research and concluded that the programs would prevent AIDS without encouraging drug use.

"The (opposition to) needle-exchange was straight politics," says Donna Shalala, former secretary of Health and Human Services and now head of the University of Miami.

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this is the sort of shit that happens when a born-again christian that claims he "talks to God" is fucking president.