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.
"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.