I recently excerpted the HIV/AIDS-related items from the State Department's Country Reports on Human Rights Practices for 2008. The grim survey ranges from Russia, where Moscow officials undermine prevention efforts by accusing foreign HIV/AIDS organizations of encouraging pedophilia, prostitution and drug use; to Burma and Cambodia, where sex trafficking victims are at risk for HIV/AIDS as well as physical and mental abuse. In Africa, AIDS orphans from Kenya to Swaziland resort to prostitution for survival, while adults from Burundi to Malawi rape children out of a belief that sex with virgins will cleanse them of HIV. These heartbreaking practices occur even in South Africa despite its modern economy.
One program to combat the global AIDS pandemic is the President's Emergency Plan for AIDS Relief (PEPFAR). It was reauthorized last year at $48 billion, which pays for a lot of effective prevention and treatment -- at least to the extent that the funds are not being channeled to anti-science and anti-gay religious zealots.
James Kirchick of The New Republic wrote on March 10, ''The problems with PEPFAR were inherent in the 2003 legislation establishing the program.'' For example, a third of PEPFAR prevention funds were reserved for pushing abstinence until marriage. Kirchick writes, ''Many organizations combating HIV -- whether groups that worked with prostitutes, gays, or intravenous drug users -- have been either neglected or explicitly prohibited from receiving U.S. money, while evangelical Christian organizations have had little problem accessing funds. In this way, while PEPFAR distributed drugs to millions of people living with the disease, the program undermined the global fight against HIV transmission.''
Charles Francis, a disillusioned former Bush appointee to the Presidential Advisory Council on HIV/AIDS, seeks a course correction from the new president and Congress. He wrote to me last week about the need to reverse the Bush legacy that includes alliances with violent homophobes like Ugandan pastor Martin Ssempa and born-again Burundian President Pierre Nkurunziza. The latter's ruling party organized a March 6 demonstration in Bujumbura in which thousands of people demanded the criminalization of homosexuality.
''Today,'' Francis writes, ''we see this wave growing dangerously across the continent, from Senegal, where AIDS activists are now imprisoned, to Nigeria, where lawmakers want to jail gay people merely for living together, to Uganda, where three Americans recently held a public seminar on the 'Homosexual Agenda.' It is time to put a 'hold' on PEPFAR until Congress can demand the transparency and the necessary reform for this program.''
African despots regularly charge their foreign critics with neocolonialism, and accuse dissidents at home of collaborating with them. In truth, Western nations have been known to use their economic strength to re-colonize by other means. But past abuses by others do not justify these rulers' present abuses, and there can hardly be a more incoherent basis for policymaking than using post-colonial guilt to justify subsidizing oppressive regimes. Instead, we should heed brave activists like Christian Rumu, vice chairman of the Burundian gay rights group ARDHO (Association for the Respect and Rights of Homosexuals), who called the March 6 demonstration ''pure propaganda crafted for the 2010 elections.''
I know a nurse who was born in Burundi and who lectured there last year on HIV prevention. He also has family in the Democratic Republic of the Congo, where he nearly lost a nephew a few years ago when his family took the sick child to a traditional healer instead of a doctor. After tentatively diagnosing a form of meningitis over the phone, my friend angrily ordered his family to take the boy to a hospital immediately. He called ahead and discussed treatment with the doctor, as a result of which the boy soon returned to health.
Alas, many similar children have no relative with medical training to look out for them. American foreign aid can help remedy this, but not if it is funneled through religious fanatics who exploit underdeveloped populations' resistance to modern science for the purpose of spreading their own willful ignorance and prejudice.
We cannot prevent American fundamentalists from promoting their dogma overseas; and we have to deal with the reality that religious-affiliated groups provide a large portion of overall health services in many countries. But our government must stand squarely on the side of science; direct funds to underserved high-risk populations, especially men who have sex with men; and resist bankrolling ideologically driven misinformation that makes things worse.