Married to HIV

President Bush returns from Africa, where he justifiably touted the success of his AIDS relief initiative, to face a battle with Congress over that laudable program. Bush wants to nearly double funding, to $30 billion over the next five years, for the President’s Emergency Plan for AIDS Relief; the House wants to spend $50 billion and expand the program to fight malaria and tuberculosis. But that $20-billion dispute probably won’t generate as much heat as the provision in the bill, written by the late Rep. Tom Lantos (D-Burlingame), killing the requirement that one-third of all funds spent on AIDS prevention go to programs that promote abstinence until marriage. The State Department and some House Republicans oppose the bill, which is now spearheaded by Rep. Howard L. Berman (D-Valley Village) and is slated to be considered by a House committee next week.

The religious right has begun whipping up the hysteria, calling the Lantos bill the “Pro-Aborts Emergency Plan for Abstinence Reduction.” In fact, the bill would do nothing to alter the long-standing ban on U.S. funding for abortion. What it would do is increase the availability of contraception for poor African women -- and that is desperately overdue.

Religious groups are fixated on the need to stop HIV transmission through premarital and extramarital sex, but what’s killing African women by the millions is https:///unprotected sex with their husbands. Yet the United States spends more on promoting abstinence and fidelity programs ($198 million in fiscal 2007) than on promoting condom use ($147 million in 2007). Roughly 10 million African girls under the age of 18 are married each year, many to older men who seek HIV-free brides. To those wedded to HIV-positive men, marriage often means a death sentence. They have little power to control their husbands’ condom use or extramarital behavior; they are more likely than young men to contract HIV; and those who know they’re infected and do not want to bear children often have no access to contraception.

By providing life-saving drugs to HIV-positive pregnant women, the president’s program claims to have prevented 157,000 infants from becoming infected. This is a huge accomplishment. What the U.S. funding hasn’t done is reduce unwanted pregnancies. In a clinic in Uganda where pregnant HIV-positive women were receiving anti-retroviral treatment, 93% reported that their pregnancies were unintended. It’s no surprise that many HIV-positive women do not wish to bear children whom they might infect with the virus or leave orphaned. It’s cruel to deny contraception to such poor and sick women should they desire it. And as a public health matter, it’s far cheaper to prevent unwanted pregnancies than to prevent mother-child HIV transmission. Yet U.S. funding for family planning has flat-lined.

Although some U.S. religious conservatives find contraception objectionable, most Americans do not. Congress should take note and expand funding for family-planning programs to help the HIV-positive girls and women.