A Misguided Anti-Vice Pledge

Social conservatives in Congress, backed by the Catholic Church and the Christian right, are on a new foray to dictate sexual mores to the rest of the world, at the expense of public health. This time it’s an oath being foisted on U.S. groups working to combat the HIV/AIDS epidemic. They will soon be asked to comply with a 2-year-old law dictating that they have “a policy explicitly opposing prostitution and sex trafficking” before they will be considered for federal grants to provide health services overseas.

The pledge is reminiscent of other Bush administration efforts including the re-imposition of the so-called global gag rule, which bans international family planning groups that receive U.S. funds from performing or even discussing abortion. It is as unproductive as pushing the United Nations to withdraw support for needle-exchange programs. Such policies do little to stem HIV, and contribute to the deaths of women forced to seek illegal and unsafe abortions.

AIDS experts agree almost uniformly that the anti-prostitution pledge could have the opposite of its intended effect, making it tougher for aid groups to reach the women who most need their help -- and who play a major role in the spread of the disease.

The pledge has its origins in a law passed by Congress in 2003 but not used as a litmus test for funding until now. At stake is the entire $3.2 billion the Bush administration has asked Congress to set aside for global efforts to curb AIDS and HIV next year.

It’s absurd to suppose that any of the groups working to combat HIV in the Third World -- like Save the Children, Doctors Without Borders and Oxfam -- are in favor of prostitution. But a big part of fighting HIV/AIDS necessarily involves working with prostitutes and building trust so that they’re willing to seek treatment and counseling.

The pledge will not prevent groups from giving condoms or antiretroviral drugs to prostitutes. But it might stand in the way in other cases, with highly damaging effects.

For instance, aid workers in Bangladesh sometimes pass out shoes to brothel workers who are forced by local custom to go barefoot. That might not seem like a way to stem AIDS, but it helps gain their trust and gives them a measure of self-respect -- without which they are unlikely to change their behavior. Would these handouts, or counseling sessions for sex workers on personal hygiene, be considered a violation of the anti-prostitution pledge? Its vague wording leaves that unclear. What is apparent is that it could easily be used to deny funding to groups that legislators don’t like.

Last year, Senate Majority Leader Bill Frist (R-Tenn.) helped delay efforts to apply the 2003 law to U.S. groups working overseas. This year he has stood on the sidelines. Frist -- who regularly travels to Africa to do pro bono work as a physician -- knows the situation on the ground far better than most of his colleagues. He should stand up to his fellow conservatives and speak out against the pledge. U.S. groups working overseas should also refuse to sign it. These groups fully understand why prostitution is a public health disaster in the developing world. They are working hard to give women better options, not through coercion or moralizing, but through venereal disease counseling, domestic violence prevention, literacy programs, job training and other social support. They shouldn’t be forced to prove their sincerity by signing a pledge that could be used cavalierly against them.

If conservatives want to go after prostitution in the Third World, they can fund religious groups to proselytize against it. Interfering in the fight against HIV is a misguided policy that could cost lives.