Could You Repeat the Question, Please?

During Tuesday night's vice presidential debate in Cleveland, moderator Gwen Ifill threw the candidates a curve ball. The problem was that while neither candidate caught the ball, Cheney was running in the wrong direction altogether.

Turning to Vice President Dick Cheney, Ifill told him that she wanted to hear about AIDS – "and not about AIDS in China or Africa," she made clear. "[B]ut AIDS right here in this country, where black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their counterparts."

"What," she asked pointedly, "should the government's role be in helping to end the growth of this epidemic?"

Cheney seemed at a loss. For a few seconds, he talked about the HIV pandemic in the rest of the world. But then he actually had to admit he didn't know anything about what she was talking about.

"I had not heard those numbers, with respect to African American women," Cheney said. "I was not aware that it was that severe an epidemic there, because we have made progress in terms of the overall rate of AIDS infection."

How the vice president managed to miss one of the most significant turns in the national HIV epidemic in the last several years is a mystery. With 40,000 new infections per year in the U.S., the virus hasn't gone away. It's just been busy making its home in the heart of the African American community.

In fact, African Americans, who make up 12 percent of the U.S. population, now represent 42 percent of all people living with AIDS and more than half of all new infections. That's hardly news; the Centers for Disease Control and Prevention (CDC) has been sounding this alarm for many years. AIDS is already the leading cause of death among 24- to 44-year-old African Americans. Nearly two-thirds of new HIV cases among the 25-and-under demographic are occurring among young African Americans.

Nowhere are these trends more dramatic than among African American women, which is why Ifill smartly asked the question that she did. Analysis from the Kaiser Family Foundation showed that 70 percent of HIV cases among black women in 2001 were traced solely to heterosexual sex.

President Bush frequently touts his announcement of an additional $20 million to state-run AIDS drug assistance programs. Bush has also highlighted his efforts to help fight the AIDS pandemic in Africa and Asia. (The amounts, as presidential candidate John Kerry has correctly said, are nowhere near where they need to be in order to begin making a dent.)

But the sprinkling of dollars obscures the real issue: the White House has not only ignored public health issues facing black communities (and communities of color more broadly), but has also forced the abstinence-or-else mantra down the throats of funding recipients. In June, the CDC itself proposed guidelines to ensure that "appropriate prevention messages" of abstinence and condom failure rates would be going out to their target populations. Say what? In the face of overwhelming evidence supporting the success of safe sex messages in preventing the spread of HIV in the U.S. and abroad, why would our national public health center even be considering this kind of regression?

With a bit of background, it all begins to make sense.

Abstinence-über-alles has always been Bush's not-so-hidden agenda, but he's quietly slipped Republican Tom Coburn in to do a lot of the dirty work on behalf of the Christian right. A former Congressman now running for a U.S. Senate seat in Oklahoma, Coburn is an unabashed right-to-lifer, an opponent of gay rights and a proponent of abstinence until marriage. Back in the late '90s, he even went so far as to try to eliminate anonymous HIV testing, and he prides himself on battling the "gay agenda."

The kicker is that Dr. Coburn is currently the co-chair of the President's Advisory Council on HIV/AIDS. President Bush has been busy stacking that council with abstinence-only advocates who serve out four-year terms. That's just enough time to do an awful lot of damage. While Coburn and cronies spin fanciful tales of HIV reduction through abstinence, infection rates in African American communities grow unabated.