Boy was I wrong. Little did I realize that this was in fact a "back" story....Tobias's had been inviting some "gals" over to his condo for personal massages. Problem is those "gals" were employed by Pamela Martin and Associates, described in court papers by owner Deborah Palfrey as a "high-end adult fantasy firm offering legal sexual and erotic services across the spectrum of adult sexual behavior." Palfrey, now dubbed the DC Madam, is under investigation for running a "prostitution ring," a no-no last time I understood Administration policy. Tobias's personal cell phone number was found among thousands of other customers, many of them reportedly high-level Washington officials, on a list kept by Palfrey now being used in her defense.
Tobias, of course, claims he "did not have sex with those women" (let's call them "les gals"), and just invited them over for a bunch of friendly massages. Let's put aside whether Tobias simply lusted in his heart while receiving massages from women employed by a firm offering "legal sexual and erotic services," and ask: If tight muscles were the only problem, why didn't he open the yellow pages and hire a certified massage therapist? Is the concierge at his condo on vacation? And does the fact that some of the women were from Central America—immigration status unknown—hint at a new kind of guest worker program supported by the Administration?
Let me be clear: I personally do not care about, nor is it my business to know about, the sexual habits, practices or relationships of consenting adults, and in any case sex between mature, consenting individuals is normal and healthy. But religious fundamentalist self-righteousness and hypocrisy both send me up the wall. And as you may know, Bush and his supporters are really big on abstinence. From sex. Always. In the far-rights anti-science, always fiction world, you should never have sex, unless you are a married heterosexual willing to do so only at risk of getting pregnant. Others—sexually active unmarrieds, gay, lesbian and transgender persons, and anyone else outside the "norm"—are subject to reprogramming. So since the Bush Administration wants a video cam in every bedroom and uterus (and I have no idea whether Tobias was taping his masseuses but that is another story), it is fair to ask if these guys are practicing what they preach. Apparently not.
This might in fact just have been one more "thank-god-its-Friday" "what next?" Washington story if it weren't for the irony of Tobias' recent career path, in which he was previously the Global AIDS Coordinator, responsible for overseeing the $15 billion President's Emergency Plan for AIDS Relief and now, as Director of all U.S. Foreign Assistance, ultimately responsible for all foreign assistance including HIV/AIDS, reproductive health and family planning and other areas having to do with sex, reproduction, and women's rights.
Abstinence is big in U.S. global AIDS policy, which one colleague dubbed the "Americans for Stopping Sex in Africa League." Billions of dollars have been spent in a fruitless effort at home and abroad to spread a hyper-moralistic and ideological message to everyone and sundry. Programs teaching people sexual negotiation and safer sex methods have become as scarce as rubbers in Uganda. Even sex workers in Asia and Africa are being told to abstain. (Don't ask me.....it's in the program guides.)
Never mind that unprotected sex is the single greatest factor in the spread of HIV infection worldwide in a global epidemic of unprecedented proportions, and never mind that, as a long list of cell phone numbers from Washington officials indicates, others share my contention that sex is a fundamental part of human life and everyone is trying to get some somewhere.
So enter Tobias who, in both his past and current position, has been and is the ultimate defender and enforcer of some of the most highly controversial policies, including the so-called "ABC" (abstain, be faithful, use-condoms-if-you-are-a-sex-worker-or can't-control yourself) approach to HIV prevention, the prostitution pledge, and the anti-trafficking policies of the Bush Administration. He has repeatedly testified before Congress supporting these policies, regularly using faulty data to support his claims.
Under the "ABC" policy as developed under Tobias' watch, some 11 million people in sub-Saharan Africa have been subject to abstinence-only-until marriage programs, receiving no information, training, or methods to practice safer sex, despite the fact that unprotected sex is responsible for 80 percent of new infections in that region. Condoms have been re-stigmatized and in some programs paid for by your tax dollars teens actually are told they will go to hell for having sex.
Another 30 million have received "abstinence and be faithful messages"—whatever that means. And whatever it means, either it doesn't work in high-literacy settings in Washington or Tobias, a married man, has not been reading his own literature. I mean, even if no "actual sexual activity" was involved (and in some abstinence-only-until-marriage curricula in the United States even touching constitutes an unforgivable act, so unless Les Gals were using retractable devices for those massages, I am suspicious) do you qualify as "being faithful" when you have private exotic dancers prancing through your apartment? Rick Warren please advise.
But the irony does not stop there. Under the "prostitution pledge," U.S. policy forbids organizations from receiving U.S. global AIDS funding if they refuse to sign a pledge stating that they will not in any way promote or support prostitution. Violating this pledge means loss of funding. This policy, vaguely written and defined as is the pattern of the far right, has led to the closure of drop-in centers, classes, and health clinics serving the needs of sex workers in several countries in Asia, and has turned health professionals into snitches for the Administration. As a result, the trust built up over many years between the public health community and disadvantaged and marginalized groups like sex workers has been demolished, the basic human rights of sex workers abrogated, and efforts to stem the spread of HIV infection grossly undermined.
I may be missing something, but does hiring gals from an organization that promotes itself as selling sexual services contradict this policy? Does the fact that this involved women from another country, thereby possibly violating the anti-trafficking policies of the Bush Administration mean that the USAID uber-Administrator himself is in violation of the laws he is supposed to be upholding, however deeply misguided these are? Does this mean that USAID should de-fund the Administrator's office and do we need a State Department Trafficking in Persons report on the activities of individuals within the Administration? And what about the "end-demand" policies of the Administration that wants to put all "johns" in jail? Does Tobias serve time for his gal-pal flings?
In a saner world, U.S. global AIDS policies (and all those having to do with reproductive and sexual health) would be based on the promotion of individual rights, public health, and collective responsibility. In a saner world, the U.S. government would not be known for its fundamentalist "tighty-whities-in-a-twist" approach to sex.
But we don't live in that world. In our world, people with wealth, money, and power get away with "special massages," they make unrealistic rules for other people and set their own for themselves. And those at greatest risk of life-threatening infections and engaged in a fundamental daily life struggle to survive are punished in the interest of moralism. Give me some real science fiction any day.
]]>But at a hearing where the word evidence was used so many times it could give a scientist a headache, the most contentious, confusing and contradictory statements on evidence, ideology and program strategy came from Administration officials.
Some examples:
Sex: Don't have it. According to the Office of the Global AIDS Coordinator, a perfect world is one in which people abstain.....they simply don't have sex...and if they do have sex, it is only after they are married. If they must have sex, if they can't control themselves (note the little stigmatizing factor here....) then please use condoms to protect the innocent.
Never mind the evidence that marriage is not a protective factor for women. Never mind the evidence from country after country, including our own, that the majority of people become sexually active before they are married. Never mind the evidence from throughout the United States that federal programs promoting abstinence-only education are failing miserably at protecting older adolescents and young adults from infection or pregnancy. And never mind the mounting evidence that it is a combination of delaying sexual debut among adolescents and promoting a wide array of changes in behavior geared toward healthy safe, consensual sex--including safer sex practices such as reductions in the number of lifetime sexual partners, and correct and consistent use of condoms-that has contributed to declines in sexually transmitted infections in many countries.
Condoms: "The U.S. relied too heavily on condoms in the past." "The U.S. is de-emphasizing condoms under PEPFAR now because abstinence is a better strategy." "The U.S. sends abroad more condoms than any other country in the world." "The U.S. is sending more condoms abroad under PEPFAR than ever before." "Countries are relieved that the U.S. is not focused on condoms because everyone else is..."
Confused? So was I. But here are the facts: Today, with 5 million new infections each year, the U.S. is sending fewer condoms abroad than in 1990. Claims by OGAC that we've doubled condom procurement and distribution under PEPFAR are not true, as we are basically sending the same amount we did in 2001, before a strike in the main plant from which condoms are procured by the USG cut procurement in half in one year. Moreover, OGAC counts as "distributed by the US" all condoms from other sources that are sold by social marketing organizations supported by US dollars....a little double-counting never hurts, I guess, to make yourself look better. But in the end, it really doesn't matter how many condoms we sent abroad in 1996, because the people having sex now likely didn't stockpile them back then and there's still on average only about 4 condoms per sexually active male in most countries of Africa. And it really doesn't matter how many we are sending abroad today, if half or more of funding for prevention of sexual transmission is going to groups in countries such as Zambia that microwave condoms and then pour milk through them in public demonstrations proving that "condoms don't work." What does count is that U.S.-funded programs are re-stigmatizing condom use and safer sex practices as part of "fear-based" prevention strategies based on ideology, not evidence." And in places where the U.S. did provide the bulk of condom supplies in the past, such as in Tanzania, other donors are not able to make up the difference in the long run because their funds are tied up in other areas. The end result, as testimony by Dr. Lucy Nkya of Tanzania stated, is a shortage of condoms and a proliferation of new infections.
ABC: It's what countries want, stated Dybul, Hill, and Greene, over and over and over again. And our programs are locally led, says OGAC, so we are just doing what the countries themselves want to do. Yet, when asked by Congresswoman Barbara Lee, lead author of the PATHWAY Act of 2006, why, if this is true, we need an earmark to require certain spending patterns, both Dybul and Greene contradicted themselves by
by suggesting if we did not control the way the funds were spent, governments might actually just revert to the condom-crazed promoters of the past. So much for "local leadership" by our "partners." And, despite extolling the virtues of locally led initiatives, Dybul, Hill, and a raft of USAID and State Department staffers simply left the hearing room rather than stay for testimony by either Helene Gayle of CARE or Dr. Lucy Nkya on the ways in which the abstinence earmark is undermining effective prevention programs on the ground.
Evidence: OGAC and its supporters such as Ted Greene are all over the map on the evidence thing. Dybul started out extolling all the evidence that ABC as practiced by the U.S.---that's A, B ....(c...if you can't control yourself...)-and claiming credit for recent declines in prevalence in Kenya, for example, despite the fact that he later claimed that "we don't really know what works," and "behavior change takes a long time..."....so how is it that PEPFAR funding for prevention, which first started rolling out in Kenya only in late 2003, is responsible for declines in prevalence in that country?
What is more, Greene appears to make up his own evidence when it suits him. He claims that the majority of people in Africa are "abstinent" (so how is it that 80 percent of new infections in sub-Saharan Africa are sexually transmitted?) and that condoms are only 80 to 85 percent effective in preventing HIV transmission, when in fact research shows that correct and consistent use of condoms is at least 95 percent effective in reducing transmission of HIV and other sexually transmitted infections.
The only clear thing out of this hearing is that we have a bad law and a bad policy. And it needs to change. That message appears to be gaining ground, because as of today, the PATHWAY Act has the bipartisan support of 80 cosponsors, with more coming on board each week.
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