Television footage from President Bush's African trip show his efforts to fit in, to "go native" and find his rhythm, or any rhythm at all, but like his failed abstinence only policies, he keeps missing the beat.

But the crowds cheer, at least on television, and who wouldn't? To cash strapped African leaders, a dollar is a dollar and if they have to teach abstinence to get it, they will, and keep on cheering. That doesn't mean the policies work. As Congressman Tom Lantos pointed out before he died, they don't, and it is time for facts not ideology to drive this debate.

Away from the cheering African crowds, reality continues to rear its ugly head. Today's LA Times editorial, Married to HIV, is in synch with reality, taking on President Bush, his failed abstinence only programs, and the extreme far-right social conservatives on the House Foreign Relations Committee who continue to preach ideology over reality. From the LA Times:

The religious right has begun whipping up the hysteria, calling the Lantos bill the "Pro-Aborts Emergency Plan for Abstinence Reduction." In fact, the bill would do nothing to alter the long-standing ban on U.S. funding for abortion. What it would do is increase the availability of contraception for poor African women -- and that is desperately overdue.

Religious groups are fixated on the need to stop HIV transmission through premarital and extramarital sex, but what's killing African women by the millions is unprotected sex with their husbands. Yet the United States spends more on promoting abstinence and fidelity programs ($198 million in fiscal 2007) than on promoting condom use ($147 million in 2007). Roughly 10 million African girls under the age of 18 are married each year, many to older men who seek HIV-free brides. To those wedded to HIV-positive men [sic], marriage often means a death sentence. They have little power to control their husbands' condom use or extramarital behavior; they are more likely than young men to contract HIV; and those who know they're infected and do not want to bear children often have no access to contraception.

By providing life-saving drugs to HIV-positive pregnant women, the president's program claims to have prevented 157,000 infants from becoming infected. This is a huge accomplishment. What the U.S. funding hasn't done is reduce unwanted pregnancies. In a clinic in Uganda where pregnant HIV-positive women were receiving anti-retroviral treatment, 93% reported that their pregnancies were unintended. It's no surprise that many HIV-positive women do not wish to bear children whom they might infect with the virus or leave orphaned. It's cruel to deny contraception to such poor and sick women should they desire it. And as a public health matter, it's far cheaper to prevent unwanted pregnancies than to prevent mother-child HIV transmission. Yet U.S. funding for family planning has flat-lined.

Of course, the far-right sees it differently. Chuck Colson writes,

The revised bill also undoes rules that prevent money from funding abortions. So out of the 50 billion dollar pot for HIV/AIDS relief, much of it could be diverted from faith-based groups to abortion providers.

While that may inflame the anti-choice donor base and activate their phone lines to Congress, the reality is that since 1973, US law (the Helms Amendment) has prohibited any US foreign assistance from being used to provide abortion services “as a method of family planning or to motivate or coerce any person to practice abortions.” At no time in 35 years has any organization been found to be in violation of this law.

Reproductive health advocates hoping to apply lessons learned from the first five years of PEPFAR argue that the Lantos Bill provides funding to ensure prevention of mother-to-child transmission of HIV. Instead of forcing failed abstinence programs on African agencies that have told us they don't work, the Lantos Bill provides voluntary contraceptive information, counseling and supplies to HIV positive women wishing to plan their families. Such services are recognized by both the World Health Organization and Office of the Global AIDS coordinator as essential. Voluntary contraceptive services reduce unintended pregnancies.

Despite these facts, the far right beat goes on, insisting that 33 cents of every US tax dollar sent to Africa to prevent HIV/AIDS be spent on ideological programs that don't work.

The Institutes of Medicine says,

The [abstinence] earmark has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care, and treatment programs and that target those at greatest risk.

and that they were

unable to find evidence for the position that abstinence can stand alone or that 33 percent is the appropriate allocation for such activities even within integrated programs.

The Government Accounting Office says,

... 17 of 20 PEPFAR teams … reported that the spending requirement presents challenges [in responding] to local epidemiology and cultural and social norms.

Despite these facts, at next week's hearings, the push to compromise with the far-right Congressmen who want to ignore reality will be strong. One would think, based on the strength of the far-right's rhetoric, that people pushing the Lantos Bill were actually trying to eliminate abstinence programs altogether.

They are not. They are simply eliminating the earmark that forces 33 percent of funds to be spent in this specific way. In fact, the Lantos Bill promotes measurable outcomes for increases in abstinence, delay of sexual debut, and behavior change that everyone acknowledges are critical aspects of comprehensive programs.

Let's hope Congress can follow the beat of reality in Africa better than President Bush, by standing firm and passing the Lantos Bill so our efforts to prevent the spread of HIV/AIDS in Africa are in synch with what we've learned from public health experts in the first five years of PEPFAR.