Improving PEPFAR Means Ignoring Tony Perkins


Tony Perkins of the Family Research Council says if the President's Emergency Plan for AIDS Relief (PEPFAR) isn't broken, we shouldn't fix it. Perkins wants Congress to ignore mountains of evidence that suggest the program should be improved. He's also hiding the far-right's anti-contraception agenda behind yet another trumped up fight over abortion.

On Wednesday, the House Foreign Affairs Committee starts to debate how best to apply the lessons learned from the first five years of PEPFAR so that,

  • more African women and girls will have easier access to HIV/AIDS education, prevention and contraception,
  • more HIV positive Africans have necessary nutrition to support the strong medications PEPFAR has made available,
  • more people can avoid HIV or if they have it, live full lives with it.

Most people think these are laudable goals representing the very mission of the proposed $50 billion five-year reauthorization, and the reason Congress is doing this hard work right now. But to Mr. Perkins and his colleagues on the extreme right, such goals are nothing short of genocide. In an email to his donor base last week he said,

[Democrats] are plotting to turn the program into something that would help eliminate Africa's next generation. Under [Chairman Howard] Berman's proposal, PEPFAR could permit abortion services at taxpayer expense, as well as the removal of the Prostitution Pledge, which would give a U.S. stamp of approval on global sex trafficking and prostitution!

Perkins reduces the cultural and public health complexities of AIDS on the entire continent of Africa to boilerplate social conservative hyperbole that suggests people trying to improve the bill are potentially racist, genocidal pimps.

PEPFAR reauthorization as proposed by the Democratic Majority in the Lantos-Berman Bill would:

  • NOT provide funding for abortions under any circumstance as PEPFAR and all US Foreign AID is prohibited from doing under the Helms Amendment;
  • NOT change the current eligibility guidelines for any family planning or faith based organization;
  • Provide contraceptive services to women and girls through established reproductive health clinics to better reach them with education and prevention messages and methods, as suggested in numerous studies. For countries with severely compromised transportation infrastructure and limited access to medical facilities, consolidating reproductive health and HIV-related services into one clinic is of vital importance;
  • Repeal the prohibition on using prevention funds to reach sex workers. Public health experts agree that to prevent spread of the disease, you must target the most vulnerable groups.

By ignoring sex workers, Perkins and his social-con minions on the House Foreign Affairs Committee, jeopardize the health and life of the African women and girls who are doing the right thing, according to Perkins, by being married. But their husbands, often much older, holding all the power in the relationship, may not be faithful, and thus contract HIV and spread it to their wives. By funding the "A is for Abstinence" part of PEPFAR with a 33 percent earmark, and paying cash strapped people to preach the "B is for Be Faithful" part, Perkins and company make the "C is for Condoms" part, a "little c" deemphasizing contraception. They would eliminate it altogether if they could. Voluntary contraception is the one hope innocent young wives and girls have to protect themselves from their husbands, a fact social cons refuse to acknowledge.

Fortunately, most people aren't buying into Perkins' hysteria, and objective observers see through the ideological spin to the truth. Adam Graham-Silverman writes in the scrupulously unbiased Congressional Quarterly an article entitled Cracks in a Fragile AIDS Consensus (PDF):

Over time, however, government agencies such as the Government Accountability Office and the Institute of Medicine issued reports that bore out the complaints of many activist critics, as did independent good-government groups, such as the Center for Public Integrity. The set-aside of funds for abstinence education tied the hands of many public health workers on the ground, the studies found, while the faith-based funding initiative sometimes directed money to groups with little scientific backing. And (Rep. Chris) Smith's no-prostitution pledge scared off experienced groups that said that, since sex work was a prime pathway for HIV, they had to work with those trying to help transactional sex workers.

As is often the case in Congress, once the far-right screams abortion, even the very best of intentions, as PEPFAR has always had, get muddled by the misinformation and ideological zealotry of social conservatives. But as Jennie Quick of Population Services International said in the CQ piece, "The fact that the American people put the Democrats in the majority in Congress is a sign that they want Democrats to move forward with their agenda."

As suggested here on RH Reality Check before, if PEPFAR cannot be improved based on sound science and the reality of public health data from the past five years the cause of HIV prevention and treatment in Africa is better served by letting this bill go. Take the case to American voters where social conservatives can defend why they did not want to learn from PEPFAR experience and improve the program to help more people, using U.S. tax dollars more wisely.

While it is not the best way to govern, many billions of tax dollars are appropriated each year without being reauthorized. Title X domestic family planning funds have not been reauthorized in decades but continue to flow; similarly Foreign Assistance dollars continue to flow without Congressional reauthorization. No one is endanger of losing one dollar of PEPFAR money if it doesn't get reauthorized this year. We risk wasting many more tax dollars if Congress doesn't use this opportunity to stand on the solid ground of science and public health over the whims of right-wing ideology.

The reason for doing the hard work of reauthorizing PEPFAR now is precisely because we know it can and should be improved, and that there is a Democratic majority that can make that happen. This is a moment for all people concerned about HIV/AIDS in Africa, or anywhere, to insist Congress stand firm and improve the bill based on reality.

When PEPFAR was authorized in 2003, the final vote in the House was an overwhelming 375-41, because the mission of the bill, to move billions of dollars quickly to Africa to turn the tide against the spread of HIV and AIDS was so important. Democrats, then in the minority, had many objections to the 33 percent abstinence-only earmark and other ideological provisions in the bill, but a consensus of what could be achieved through compromise was reached and the bill won easy approval, reflecting the GOP majority opinion.

The vote on the 33 percent abstinence-only earmark was more along party lines, a closer 220-197 with the GOP majority winning, a handful of crossover D's and R's canceling each other out.

Sure, there will be close even controversial votes again in 2008 as the Democratic majority does the hard work of applying the lessons learned from the first five years of PEPFAR, over the objections of the radically charged, quickly shrinking, far-right wing of the GOP. Elections matter and voters in 2006 spoke loud and clear. If the primary season, early polling, and avalanche of GOP retirements are any indication of the 2008 election, voters will be speaking louder and clearer than ever before looking for programs that work, not inflammatory rhetoric from the far right.

Everyone should see through the far-right's efforts to turn this into a battle over abortion, when it really is about contraception and preventing HIV. The distorted rhetoric of Perkins and others once again demonstrates the lengths they will go to misinform, distort and confuse issues just to score political points.

Democrats in Congress and global AIDS activists need to have the strength of their convictions and finish the hard work of improving PEPFAR based on reality, confident that in the end, the final vote will be an overwhelming win in the House reflecting the Democratic majority elected by voters demanding change.

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