U.S. Official Defends Focus Of AIDS Prevention Policy

BANGKOK, July 14 -- A Bush administration official on Wednesday defended the $15 billion U.S. AIDS relief plan, which includes policies on abstinence and intravenous drug use that have been attacked during the week-long 15th International AIDS Conference.

Randall L. Tobias, the U.S. global AIDS coordinator, spoke at the conference after about 10 minutes of protest by sign-carrying activists who chanted, "He's lying. People dying."

Tobias said the U.S. promotion of sexual abstinence was part of a balanced approach that could include condom use and other measures. He said the United States has assumed "the leadership role in this fight."

"At this point, perhaps the most critical mistake is to allow this pandemic to divide us," he said. "We are striving toward the same goal -- a world free of HIV/AIDS. When 8,000 lives are lost to AIDS every day, division is a luxury we cannot afford."

In remarks during his speech and in an interview afterward, Tobias, former chairman and chief executive of the drug maker Eli Lilly and Co., responded to accusations that the President's Emergency Plan for AIDS Relief (PEPFAR), which grants funds to health groups in individual countries, is putting ideology before public health.

On the topic of sexual abstinence, which has been strongly debated during the conference, he said the administration's approach was fair and focused on "A-B-C," or "Abstinence" and "Be Faithful" and "Condom Use," in that order.

"Abstinence works. Being faithful works. Condoms work," he said. "Each has its place."

The U.S. global AIDS plan stipulates that by 2006 one-third of the money spent on HIV prevention must be used for "abstinence until marriage" programs, about 7 percent of the $15 billion budget.

An analysis of grants awarded under the plan, conducted by a Maryland-based organization monitoring U.S. international health policy, found that a large amount of the prevention money is being used in programs to prevent infected mothers from passing HIV to their babies. This mode of transmission accounts for only 5 percent of new infections in Africa, the region primarily targeted by the Bush plan.

Jodi L. Jacobson, executive director of the Maryland-based Center for Health and Equity, which conducted the analysis, said that relatively little money is going to prevent HIV transmission through heterosexual intercourse, which accounts for about 80 percent of infections in Africa. When the organization studied grants to programs directed at that risk group, "between 60 and 80 percent of all money is going to abstinence-only programs," she said.