Ending the Compromise Era on AIDS / Michelle Goldberg

[Demeter]

http://www.prospect.org/cs/articles?article=ending_the_compromise_era_on_aids


The removal of Mark Dybul as head of the federal AIDS program shows that under Secretary of State Hillary Clinton, the era of compromising with the religious right on global HIV prevention is over.

When Mark Dybul, erstwhile head of the President's Emergency Plan for AIDS Relief, or PEPFAR, was asked to clean out his desk late last month, it was a stark manifestation of the different styles that Barack Obama and Hillary Clinton bring to governing.

Initially, the Obama transition team had asked Dybul to stay on, and it's easy to see why it might have liked him. A gay man who had, in the past, donated to Democrats, Dybul seemed to pride himself on his ability to make common cause with conservatives. As global AIDS coordinator in the Bush White House, he often sided with allies like Rick Warren rather than with women's-health advocates on issues ranging from abstinence to sex-worker outreach to family-planning funding. This earned him feminist enmity, but others respected his ability to neutralize the right-wing opposition that had long hindered AIDS relief. As his defenders point out, he was able to build what the medical journalThe Lancet called "the largest and most successful bilateral HIV/AIDS programme worldwide" while working under a Republican administration.

Yet if Obama admires this sort of ideology-straddling bipartisanship, Clinton, who became Dybul's boss in the State Department, is more of a political pugilist. She has a long, close history with the international reproductive-rights movement that battled Dybul for years. Hearing that he had been asked to stick around, the international reproductive rights movement made its objections known to those close to Clinton, and shortly after inauguration, Dybul was axed. It's not clear whether Clinton directly ordered his firing, but people in the field believe that either she or someone who works for her was behind it.

Now a fierce debate is underway about whether Dybul was unfairly treated. What's at stake is more than just the reputation of one man, because the argument is really about America's AIDS policies and the future of PEPFAR, Bush's lone but in many ways impressive humanitarian achievement. Since Bush created it in 2003, PEPFAR has spent tens of billions of dollars fighting AIDS in the developing world, providing life-saving anti-retroviral drugs for more than 2 million people infected with the disease, and caring for millions of AIDS orphans. With Bush gone, though, the program's future direction is unclear. Will it proceed Obama-style, with lots of continuing outreach to religious conservatives, a focus on treatment and a sidelining of inflammatory gender issues? Or will it, under Clinton's leadership, work to address the sexual realities that drive the epidemic, even at the cost of bipartisan support?

... some who worked closely on the legislative process surrounding PEPFAR say that, whatever Dybul's politics were before he joined the administration, once there, he was eager to forge alliances with the religious right. "The way he built his power base was to be seen as this ultimate sensible arbiter of bipartisan approaches, which meant, in the Bush era, having the far-right religious groups behind you and participating in the marginalization of women's-rights and reproductive-rights advocates," says Jodi Jacobson, a longtime AIDS activist currently working as a senior political adviser at RH RealityCheck, a reproductive health Web site.

Heather Boonstra, a senior public-policy associate at the sexual and reproductive health-focused Guttmacher Institute, adds, "He really came out in many ways as very hostile to promoting greater linkages between HIV services and sexual and reproductive health services...

In the end, the abstinence earmark, though shaved a bit, remained. And Dybul went further than he had to, issuing a regulation banning clinics that work to prevent mother-to-child transmission from purchasing contraceptives for their clients. Most surprisingly, even after Obama was elected, Dybul continued to push the religious right's agenda. According to Jacobson, Dybul lobbied on the Hill against any attempts to force PEPFAR grantees to provide referrals for services, like condom distribution, that they were not willing to provide themselves. Indeed, Jacobson says, that was part of the reason for his firing.




Michelle Goldberg is an author and journalist based in New York. Her new book, The Means of Reproduction: Sex, Power and the Future of the World, will be published by Penguin Press in April.