U.S. Official Defends Focus Of AIDS Prevention Policy
"The biggest factor in transmission we are spending the least amount of money to address," Jacobson said. "The administration points to the PEPFAR program as a mainstay of its compassionate conservatism agenda, but denying people access to life-saving information and technologies is not compassionate. It is criminal."
Earlier this week, Mabel van Oranje, an analyst with the Open Society Foundation, said at a news conference that "more than half of all HIV cases in southern Africa right now occur among married women. Being faithful is not an option. Abstinence is not at all an option."
Tobias said federal procurement guidelines bar him from discussing grant data until all the awards have been made. But he said he was confident that when the figures are made public, Jacobson's assertion will be proved wrong.
Throughout the conference, abstinence advocates have defended their approach. Simon Peter Onaha, 22, of Uganda said abstinence and monogamy "cut you off entirely from risk" of infection. Though sexually active at 15, he said that he had not had sex for the last three years and would not "until my wedding day."
In his speech, Tobias emphasized U.S.-funded "local ownership" of the programs, which operate in 15 countries in Africa, the Caribbean and Southeast Asia and aim to treat 2 million people with antiretroviral drugs and prevent 7 million new infections.
He said the Bush plan, which critics and some grant recipients have said is too government-driven, would seek to train local doctors and health care providers so that they can run the programs themselves.
Tobias acknowledged that in some countries, such as Vietnam, the most recent country added to the plan, the three-step U.S. program would not be sufficient in fighting AIDS. In Vietnam, as in many Asian countries, epidemiologists are concerned about major AIDS outbreaks in which prostitution and injected drug use are likely sources of infection.
Correct, consistent condom use by prostitutes is a "proven technique," Tobias said, mentioning Thailand as one example of success. As for drug use, he said: "As we develop the programs in Vietnam -- consistent with broad U.S. policy -- in that subject area, we'll be getting the best minds available. And I don't happen to be one of them."
Tobias said the United States was spending nearly twice as much as the rest of the world to fight AIDS. "By its actions," he said, "the United States has challenged the rest of the world to take action."
Staff writer David Brown in Washington contributed to this report.
© 2004 The Washington Post Company