Bush on AIDS: Competing Moral Imperatives

Craig Sterritt

Disclosures

AIDS. 2003;17(18s) 

In This Article

The War on Condoms: Evidence-Based Versus Principle-Driven Medicine

Most academic studies and reports on the subject, including those conducted by NIH, CDC, former US Surgeon General David Satcher, and the Institute of Medicine, have concluded that the only proven approach to preventing the transmission of HIV and other STD is a comprehensive one that combines abstinence counseling with education about risk reduction practices, including the correct and consistent use of condoms. The Bush administration and the US Department of Health of Human Services (HHS), however, has been widely criticized for attempting to distort public health information in order to promote abstinence-only AIDS prevention programs and to 'manufacture uncertainty' about prevention models that include condom use and other, sex-related risk reduction practices. (The administration has likewise been accused of distorting breast cancer-related information in order to advance its antiabortion agenda.)

Most notably, the CDC's veteran fact sheet, "Condoms and Their Use in Preventing HIV Infection and Other STDs," was removed from that agency's website. HHS Secretary Tommy Thompson explained that, in response to a series of letters from Rep. Waxman and as many as 29 other members of Congress, scientific data in the fact sheet had become outdated. A new document, entitled "Male Latex Condoms and Sexually Transmitted Diseases," was posted to the CDC website in December 2002.

The original advised the public that "correct and consistent use of latex condoms during sexual intercourse -- vaginal, anal, or oral -- can greatly reduce a person's risk of acquiring or transmitting most STD, including HIV... " The reposted version includes similar language, on page 2, but begins with a 'blackbox' type warning that abstinence is the "surest way to avoid transmission of sexually transmitted diseases." And whereas the former iteration detailed the scientific evidence supporting the efficacy of condoms in preventing HIV infection, the latter one emphasizes that "observed rates of condom effectiveness may be inaccurate" due to methodologic flaws of epidemiologic studies (page 3). Further, information regarding proper use of condoms and product options has been entirely omitted from the revised fact sheet.

In a second instance, the CDC's "Programs that Work" (PTW) website was taken off line. This resource provided educators with information about a range of scientifically vetted HIV prevention models and programs aimed at reducing at-risk behaviors among teenagers, including those that incorporate condom distribution and franks discussions of sexuality.

These changes in HHS website content and emphasis have been widely impugned as serving the anti-contraception ideology of the administration's conservative Christian supporters, rather than interests of the public health.

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