Governing Sexuality: Bush Pushes Abstinence in HIV Education  

For more than a decade STOP AIDS had effectively spread safe-sex messages to gay men in San Francisco. Recognized by public health officials and community advocates, the nonprofit group received generous funding from the Centers for Disease Control for its cutting-edge HIV-prevention workshops. Then George W. Bush was elected president in 2000.

Over the next two years the CDC audited STOP AIDS three times, twice for alleged obscenity and once for improper accounting. On each occasion a team of investigators trekked across country to STOP AIDS's headquarters, a modest Edwardian on a quiet street in San Francisco's Castro district, to sort through stacks of paperwork, normally filed, color-coded, and stored in a meticulously organized closet. On each occasion the organization was cleared of wrongdoing, and was even rewarded with a "gold standard" for their accounting system.

"Conservatives tried to use us as the boogeyman of HIV prevention, but we were in full compliance with federal and local guidelines," says STOP AIDS spokesperson Jason Riggs.

Since then the Bush Administration has found other means to cut funding to organizations that it disagrees with, while promoting its own ideology: that abstaining from sex is preferable to using condoms. With the advent of Bush's faith-based initiative, abstinence-only programs, many of them run by Christian groups, receive more than thirty percent of money dedicated to HIV education. ( California is the only state that has refused matching dollars to teach abstinence-only.)

The effectiveness of these programs is now being examined more fully. A recent report by Rep. Henry Waxman of California found of the thirteen federally-funded abstinence-only curricula studied, eleven gave out misleading information. One claimed that half of gay male teenagers in the United States are HIV positive, when in reality that statistic is unknown. Another asserted that the success rate of condoms in preventing HIV transmission during heterosexual sex was as low as 69 percent. Most researchers agree the success rate is at 97 percent.

"The Bush administration is trumping science with ideology," Riggs says. "When the United States' approach to HIV prevention is the same as the Vatican's, you have to ask what's going on.

"Condoms are still the best HIV-prevention tool for the sexually-active population. The message that you might as well not use a condom is criminal. It's like saying, "Seat belts don't work all the time, so why bother, or don't drive."

Since gaining office, the Bush Administration has edited the CDC website, deleting information on how to correctly use a condom, and adding a passage on abstinence: "The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected."

The administration also appointed two controversial conservatives to the Presidential Advisory Council on HIV/AIDS. Tom Coburn, who successfully ran for the senate last November, has promised to redirect the focus of HIV prevention from condoms to abstinence. In 1997 as a member of Congress, he authored a bill to end anonymous testing for HIV; he also sponsored legislation to provide more than $1 billion annually for AIDS prevention and treatment. More recently he was quoted as saying, "Why do you think we see the rationalization for abortion and multiple sex partners. That's a gay agenda."

The other Bush-appointed member of the advisory council, Joe McIlhaney, heads the Medical Institute for Sexual Health, which disseminates information that refutes the effectiveness of condoms. In a press release, his organization states, "Condoms must be used 100 percent of the time and used correctly during all the years an unmarried individual is engaged in sexual activity to provide any reasonable hope of avoiding STD infection. One hundred percent use of condoms for many years is so uncommon that it is almost a purely theoretical concept"

Two Faces of Activism

During the Reagan presidency the AIDS epidemic was spreading, but people rarely talked about what was then thought of as a "gay disease," Riggs says. Then Surgeon General C. Everett Koop criticized the administration for being complacent. Community activists were there to pick up the pieces, building institutions and providing services to help deal with the health crisis.

Today, there are so-called AIDS activists, like Coburn and McIlhaney, on the other side of the issue, Riggs says. "It's a lot scarier. They believe in abstinence. They believe condoms don't work. It's not complacency. It's actually strategically dismantling AIDS prevention in this country."

Riggs doesn't downplay STOP AIDS' honest and blunt approach to sexuality, which clearly offends conservatives. In particular, its "Great Sex Workshop" came under attack when the organization was being audited.

"The packaging was sexy so people would come," he says. "We were targeting people at high-risk for HIV on how to use a condom, how to negotiate safe sex, being honest about status, what the risks are with oral and anal sex, what to do in an anonymous situation. Programs for Mormons living in Utah are not going to work for the population we serve."

Even though the Materials Review Panel, which determines what is obscene according to local standards, had approved all of STOP AIDS programs, the Department of Health and Human Services released a report in 2001 condemning the organization's workshops for "encouraging sexual activity." Soon after, appropriations bill HR3061 passed, which contained a provision allowing the HHS inspector general to conduct an audit of all federally-funded HIV prevention programs.

At present, sexual education content must tout the benefits of abstaining from sex and the ineffectiveness of condoms in preventing HIV infection one-hundred percent of the time, as stipulations for funding. Pamphlets, audiovisual materials, advertising, and websites are censored for "obscene" content.

In addition, local Material Review Panels are being infiltrated by more conservative voices. Previously, HIV-prevention groups named members to such panels. Now, panel members are appointed by state and local health departments and the CDC is proposing that public officials sit on the committees.

"For San Francisco that wouldn't be a problem because the gay community has a strong voice," Riggs says. "But programs in more conservative areas will have to get watered down to get approval from local public officials, who are concerned about being re-elected.

"The politicization of public health decisions in approving local materials targeting often politically unpopular groups such as IDU-users, gays, and others, is troubling."

STOP AIDS lost its federal funding but continues to operate at full capacity thanks to local and state grants and individual contributions. With 22 employees, annually, the group serves 10,000 people through community outreach and 5,000 people through its workshops. STOP AIDS' most recent social marketing campaign, "Are You Up to Speed," warns about the risks involved in using the drug. "Speed puts you in a hyper-sexualized state," Riggs explains. "Men who use speed are much more likely to get HIV than those who don't. They represent 30 percent of the population becoming infected."

Riggs believes such messages are vital to San Francisco's gay male population, one-third of whom are HIV-positive.

Riggs first started working at STOP AIDS in 1994 as a volunteer. Moving from Los Angeles, he found the organization a good place to meet other people and build a community of friends. Resembling a young Tom Hanks, Riggs, 31, says, "Because of my age, HIV has always been a part of my identity as a gay person." He expects the repercussions of Bush's policies will soon be apparent in San Francisco. STOP AIDS' work will be even more crucial.

"In five years, a whole generation of young gay and bisexual men reared on abstinence-only education will be moving here without even basic understanding of HIV-prevention."

He adds: "It's a recipe for disaster."