Shelf Life: Bush, the AIDS President?

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Regan Hofmann, editor in chief of POZ, one of the few print magazines on the HIV/AIDS beat, urges the administration to broaden its perspective. “If PEPFAR dollars cannot be used to teach safer sex, or to develop programs to unionize sex workers, or to enforce condom usage . . . perhaps the money could be used to help feed, clothe, and house these women (and men),” she writes (May 2008). Such a broad-minded approach—with added focus on education, poverty reduction, and other locally determined priorities that might not scream “AIDS prevention” on a PEPFAR grant application—would also serve other vulnerable groups, particularly women, girls, and drug addicts.

In her book The Invisible Cure: Africa, the West, and the Fight Against AIDS (Farrar, Straus, and Giroux, 2007), Helen Epstein notes that one program in Uganda—Zero Grazing, which focused on partner reduction—was very successful in the 1990s, showing a decline in HIV infection rates concurrent with a drop in the proportion of people having casual sexual encounters. Unfortunately, though fidelity is one part of the American-export ABC mandate (“Abstain, Be faithful, or use Condoms”), Epstein writes that “PEPFAR-funded programs on the ground in Africa overwhelmingly emphasized abstinence for unmarried youths; very few addressed adults or multiple partnerships directly.” As it turns out, many of the nongovernmental organizations that are carrying out PEPFAR’s work abroad are dead-set on employing the same prevention techniques that have failed in the United States.

The Epidemic at Home 

No one is lauding Bush’s domestic AIDS efforts—he hasn’t put forth any—but no one’s taking him to task on the issue, either; the epidemic is gradually growing quiet. For one thing, advances in antiretroviral drugs have meant that for those who can afford them, a positive test is no longer a death sentence. The cynic in me thinks there’s something else keeping AIDS out of American headlines and off politicians’ agendas: It’s who’s getting infected these days, namely, minorities, particularly in the South. In 2005, 49 percent of new HIV/AIDS diagnoses were among African Americans; among newly infected women in the United States, 60 percent were African American.

The South sees 45 percent of new HIV infections, reports POZ (Nov. 2007), and half of the country’s AIDS deaths. “The South faces unique problems: deep and widespread poverty, a comparative dearth of federal dollars, its intrinsically rural nature, no national media close at hand, and the Bible Belt mentality once so forcefully advocated by former senator Jesse Helms,” writes Steven Petrow for the Independent Weekly (Nov. 28, 2007). To boot, one AIDS services organization hipped Petrow to a disturbing new trend: In North Carolina, large numbers of people are simultaneously testing positive for HIV and being diagnosed with AIDS, an indication that people are waiting far too long to get tested.

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