Bush on AIDS: Competing Moral Imperatives

Craig Sterritt


AIDS. 2003;17(18s) 

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Approaches to AIDS prevention and funding in the US have historically been embroiled with issues of reproductive health -- specifically sex education, contraception, and abortion. Thus, when running for president as a religious and socially conservative Republican, it was not surprising that Bush's stance on preventing AIDS, sexually transmitted diseases (STD) and teen pregnancy in the US centered on promoting sexual abstinence. Taking a new turn at an old target, Bush called for 'parity' between what the federal government spent on 'condom-based' programs and what it spent on education programs that exclusively promote abstinence out-side of marriage. It wasn't a matter of ideology per se, Bush reasoned; abstinence-only programs shouldn't be especially favored, but they shouldn't be under-funded in comparison to other programs.

But critics contended that Bush's comparison was invalid and his reckoning fuzzy. An analysis by the Guttmacher Institute, a nonprofit organization focused on sexual and reproductive health research and policy, noted that Bush's $135 million comparator figure comprised dollars directed mainly to services provided under Medicaid and Title X of the Public Health Service Act. These services include Pap smears, breast exams and hypertension screening; the provision of contraceptives was one small part. Further, these were not educational programs and could not be compared to the primarily schools-based, abstinence-only education programs the president was championing. According to Rep. James Greenwood, a Republican from Pennsylvania, "the parity argument is nonsense. Title X funding is not about school-based educational programs. This is not even a case of apples and oranges; it's apples and marmalade."

While a group of conservative Republicans beating the drum for not having sex might not strike some as particularly noteworthy, supporters of comprehensive AIDS education programs have cited Bush's 'parity' plea as merely the opening salvo of what Rep. Henry Waxman (D-CA) termed a "systematic effort by the Administration to replace HIV/AIDS prevention programs that include condom use with ideologically driven 'abstinence-only' initiatives." A second core tactic in this pursuit, critics charge, has been an attempt to undermine public confidence in the effectiveness of condoms in preventing HIV and STD transmission, often by surreptitious means. This tactic has entailed, as phrased by the Washington Post, "a widespread campaign of disinformation and intimidation that is hampering AIDS prevention work across the country."


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