Of all the world leaders discussing sex last week, George W. Bush was the least stimulating. Hot on the heels of the United Nations Special Session on AIDS -- at which even Libya and Pakistan pledged to expand access to condoms and "youth-friendly information and sexual health education" to slow the spread of the disease -- Bush spent the last few days disparaging those same policies at home.
The target of Bush's attacks was a modest 30-page report on sexual health in the U.S. prepared by Surgeon General David Satcher. The paper, in carefully chosen words, criticized the national "conspiracy of silence when it comes to sexuality," calling on government to renew its commitment to sex education, and increased tolerance for sexual diversity. But despite its moderate approach, the report met with resistance from the president. Especially irritating to Bush was Satcher's dismissal of abstinence-only sex education programs -- a White House favorite already slated for increased funding this year. Under the watchful gaze of the religious right, Bush took pains to distance himself from the report: He suggested that as a Clinton appointee, Satcher does not represent the administration's views, and again reiterated his support for abstinence-only initiatives.
That Bush, a self-described social conservative, maintains these regressive positions should no longer surprise us; like other Ashcroftian "men of integrity," he believes in his programs not because they are practical and effective but, as with the death penalty, because they should work, even if a flood of evidence suggests otherwise.
But Bush's moral rectitude loses credibility in the context of last week's United Nations AIDS conference, where the U.S., along with 188 other countries, signed the Declaration of Commitment on HIV/AIDS. This 20-page document has its flaws: Sections that dealt explicitly with homosexuality, intravenous drug use and commercial sex work were toned down to placate several Islamic countries and the Vatican. But, inevitable compromises aside, it remains an impressive example of international cooperation. It isn't every day that Iran acknowledges "gender equality and the empowerment of women" as a key element in the battle against AIDS. And despite what U.N. Secretary General Kofi Annan called "painful differences" between nations over the original draft of the agreement, the final version emerged with most of its goals intact -- including proposals for the very kind of sex education advocated in Surgeon General Satcher's report.
Bush himself did not attend the conference -- preferring instead to talk shop with another no-show, South Africa's notorious AIDS skeptic Thabo Mbeki. Secretary of State Colin Powell went in his place, and gave an impassioned speech in which he insisted that "prevention, prevention, prevention," should be the foundation of the global response to AIDS. One has to wonder what exactly prevention means to the Bush administration, and if anyone besides the Traditional Values Coalition will benefit from it.
It's no secret that the AIDS crisis -- particularly the one raging in Africa -- is low on the president's priority list. In the relatively short time since he took office, Bush has avoided tackling the issue of drug treatment for those most devastated by the disease. But some telling events have exposed the vast indifference at the heart of U.S. policy. Take, for example, Agency for International Development head Andrew Natsios' comment last month that Africans would not benefit from anti-retroviral treatment for AIDS, in part because they have no concept of "western time" -- presumably a necessity for complying with the complicated dosage instructions.
Chastised by scientists and activists -- turns out you don't need a watch to take the drugs after all -- the administration set out to raise its profile at the United Nations. The U.S. committed $200 million to Kofi Annan's new Global AIDS and Health Fund with another $1.3 billion working its way through Congress -- and said to have Bush's approval as well. Meanwhile, Powell restated U.S. dedication to eradicating AIDS in Africa, acknowledging for the first time that treatment is an integral part of the package.
But leadership calls for more than money and rhetoric; consistency is essential. If the U.S. effort to fight AIDS globally is to be taken seriously, it must be implemented at home as well. Surgeon General Satcher has defended his report, saying that he is acting in the interest of public health. Bush's condemnation of Satcher will only undermine our efforts to fight AIDS, at home and abroad.
