Sex and the State Dept.

LAURIE GARRETT is a senior fellow for global health at the Council on Foreign Relations and the author of "Betrayal of Trust: The Collapse of Global Public Health."

FRIDAY’S HASTY resignation of Deputy Secretary of State Randall L. Tobias, prompted by revelations that he was a regular customer of services provided by the “D.C. Madam,” is a lesson in the perils of mixing moralizing with foreign policy.

It is easy to judge the Tobias case as an example of being hoisted on one’s own petard. He endorsed -- indeed, designed -- foreign policy positions that blended so-called Judeo-Christian sexual morals with U.S. foreign aid.

Tobias, a former pharmaceutical industry chief executive, gave up considerable wealth and private-sector options in 2003 to take on leadership of the Bush administration’s Presidential Emergency Plan for AIDS Relief, a.k.a. PEPFAR, a five-year, $15-billion program to provide treatment and HIV prevention to millions of Africans, Vietnamese, Haitians and Guyanese. PEPFAR is the most ambitious and best-funded global health campaign ever attempted by the U.S., and it has served as a beacon for similarly ambitious efforts by other wealthy countries.


But, from the outset, PEPFAR was controversial because of key moral principles underlying its grants to needy nations. In order to receive funding, countries and aid organizations had to officially denounce or oppose prostitution, which, when it equates with unsafe sex, is a vector for the spread of HIV. However, this denunciation had no caveats, such as “except where legally practiced under supervision, as in Amsterdam.” Nor did it have a caveat covering the use of “escort services and massage,” as offered by “D.C. Madam” Deborah Jeane Palfrey’s company.

In comments to ABC News after the release of his terse resignation letter, Tobias, who is married, said that he liked “to have gals come over to the condo to give me a massage.” He insisted the massages were not sexual. But the State Department’s call for abolition of prostitution is an absolutist moral declaration, which, in principle at least, Tobias appears to have violated. Tobias also spearheaded efforts to prevent AIDS primarily through other faith-based values programs that seek to delay first sexual experiences in teenagers, encourage sexual abstinence except for married couples and encourage faithfulness within marriage.

Last month, the prestigious Institute of Medicine in Washington released its audit of PEPFAR, finding that 33% of the $311 million spent by the program for HIV prevention in 2006 funded abstinence education. Far less funding has been devoted to encouraging condom use, and no funding has been devoted to providing sterile syringes for IV drug users -- strategies proven effective in Australia, the Netherlands and Thailand but attacked, for moral reasons, in the U.S. (So far, according to the Institute of Medicine report, little data is available on the efficacy of the abstinence campaigns. PEPFAR is spending more than $4 million to evaluate them; it’s spending only $275,000 to evaluate its condom distribution efforts.)

Last year, Tobias was elevated to the position of deputy secretary of State in a move that consolidated all U.S. foreign aid programs under a single “strategic framework.” That framework, defined in the administration’s fiscal year 2008 budget request to Congress, requires that poor nations receive American largesse based not on need but on their strategic value for the U.S. You don’t have to look too closely to see that sexual morality also plays a role. For 2008, the administration is asking for $70 million less in international family planning funding than it did for 2007. Aid for family planning -- which may include abortion services and sex education -- has been cut every year since President Bush took office.

Critics of such administration policies at home and abroad are no doubt gloating over Tobias’ disgrace -- and especially the apparent element of poetic justice in his downfall. And yet those who would like to see puritanical morals removed from foreign aid decisions would do well to lower their eyebrows and stay focused on the issues.

Tobias’ inferred sin is sexual and personal -- as was President Clinton’s Monica Lewinsky episode. Like it or not, sexual relations occur outside of marriage. Engaging in such activities doesn’t make a person unfit to be a public servant, just as, in broader terms, legalizing prostitution, or even being unwilling to formally denounce it, doesn’t make a nation unfit to receive money to help prevent the spread of AIDS.

Designing foreign policy to stamp out sexual activity among consenting adults is a fool’s errand and a waste of taxpayers’ money. When it comes to AIDS policy, we should stop pushing a moral idea about the circumstances in which sex should occur and instead push what works: condoms, clean needles, sex education and making sure that women have equal power to say no, or yes, to sex.

After all, we know we can slow the spread of HIV and maybe even stop it. We’ll never end extramarital sex, prostitution or even “escort services.” Just ask the “D.C. Madam” and her clients.