Lee Fights For Better AIDS Policy


At the International AIDS Conference in Thailand, Rep. Barbara Lee, a Democrat from California, bolstered her reputation as one of the most vocal opponents of the Bush administration's international policies.

In September 2001, Lee became famous for being the lone member of Congress to vote against giving the president authority to use "all necessary and appropriate force" against perpetrators of the Sept. 11 attacks.

Last month, at the AIDS meeting in Bangkok, she made her mark again. Not only was she the only congressional representative at the meeting, she presented a bill – the New U.S. Global HIV Prevention Strategy to Address the Needs of Women and Girls Act – that seeks to eradicate the U.S. administration's abstinence-only approach to AIDS.

"Once again, I believe we have isolated ourselves from the global community," Lee said, in a phone interview from Bangkok, referring to the maverick championing of abstinence-only programs by the United States at a time when the country is also fighting a war in Iraq for which there is little international support.

When Congress approved the first $2.4 billion of the president's $15 billion five-year pledge for AIDS relief worldwide earlier this year, it included an amendment dedicating 33 percent of prevention funds for abstinence-only programs.

Lee's bill would reverse that requirement and instead steer funds toward comprehensive sex education, domestic-violence prevention and economic empowerment. The bill also pushes access to condoms as a key way of helping women and girls protect themselves from HIV.

"We recognize that condoms are the only [preventive] technology available right now to deal with the pandemic," Lee said. "The Bush administration doesn't seem to understand this."

Women's Vulnerability

According to the text of the bill, "women and girls are often powerless to abstain from sex, endure their partner's faithfulness or to insist on condom use even within marriage, especially in the case of early or child marriages."

More women are becoming infected with HIV in the United States and worldwide. In Sub-Saharan Africa, which accounts for 25 million of the 38 million infections worldwide, women and girls make up 60 percent of those with HIV.

"The face of HIV/AIDS is now that of a woman, and a young woman at that," said Terri Bartlett, vice president of public policy for the Washington, D.C.-based Population Action International. "Barbara Lee understands that we're not going to win this without more condoms."

Lee, co-chair of the Congressional Black Caucus Global AIDS Task Force, is an author of many bills on the pandemic. Her district of Oakland is one of the hardest-hit in the country and most of those afflicted are African Americans. In 1998, the same year Lee was elected to the House, Oakland's Alameda County was the first in the nation to declare a state of emergency on HIV/AIDS among African Americans.

Health officials estimate that at least 7,000 people may be infected in the county, most in Oakland. African-American women are the fastest-growing group being infected in Oakland, with half of transmissions occurring through heterosexual sex.

State of Emergency

Lee secured $5 million for HIV/AIDS prevention and treatment in Alameda County shortly after the state of emergency was declared. Still, local health officials say current resources are not enough to deal with the crisis.

Lee proposes the United States provide more female and male condoms. In 2002, donor countries only gave 12 million female condoms – a polyurethane sheath that lines the entire vagina and protects from sexually transmitted diseases – to countries in need. And only one-quarter of male condoms needed worldwide are being supplied, according to Population Action International. The group estimates that 12 billion male condoms are needed.

"We need to assist women to be able to negotiate their own lives so they can be less at risk," Lee said. "We need a comprehensive approach to deal with every aspect – treatment, education, violence against women and access to female condoms and other contraceptives."

Lee's anti-war vote almost two years ago endeared her to her largely liberal urban constituency across the bay from San Francisco – where Barbara Lee Speaks For Me bumper stickers are often seen – and earned her an armful of awards from human rights and peace groups. But it also resulted in death threats and temporary 24-hour protective guard.

Another Fray

Now this new bill and her outspokenness at the AIDS conference put Lee in the middle of a fray over abstinence-only AIDS prevention programs that raged all week in Bangkok. The debate pitted the United States and leadership in Uganda against advocates, policymakers and scientists from around the world over the most effective course of action to prevent new AIDS infections.

"The administration's strategy is more about politics and ideology than public health," said Bill Smith, public policy director for the D.C.-based Sexuality Information and Education Council of the United States (SIECUS).

Speaking in Philadelphia last month, Bush defended abstinence-only until marriage programs, calling them a "practical, balanced and moral approach" to AIDS prevention. He notably included a reference to condoms "where appropriate" without elaborating. The administration's support is based on a successful Ugandan program of "ABC": abstinence, be faithful and condom use. The administration seeks to replicate ABC in the United States and elsewhere.

Uganda's infection rate is now about 6 percent, down from 30 percent in the early 1990s. Ugandan President Yoweri Museveni has said the country's success is a direct result of teaching abstinence.

Randall Tobias, head of the U.S. State Department's Office of the Global AIDS Coordinator, said at the Bangkok conference that people are misinformed about the administration's policy.

"Our strategy is A and B and C; abstinence works, being faithful works, condoms work," Tobias told Kaiser Family Foundation senior fellow Jackie Judd. "They all have a role but it's not a multiple-choice test where there's one right answer; all of the things have a place and they have a place in the president's emergency plan."

The Maryland-based Center for Health and Gender Equity, however, in March analyzed grants awarded by the United States and found that up to 80 percent of funding to prevent unsafe sex went to programs that teach only abstinence. The study also concluded that the administration "misrepresented" the Ugandan approach.

"Exhaustive evidence shows that Uganda's HIV prevention program emphasized abstinence, fidelity, partner reduction and correct and consistent condom use, along with messages aimed at catalyzing frank discussions about sex and sexuality," the report states.

While it's very unlikely the president will sign a bill eliminating dedicated funds for abstinence-only programs overseas, Lee isn't deterred.

"Yes, it's going to be difficult, but all these fights have been difficult," she said. She referred to AIDS orphan legislation she authored that unanimously passed the House in June. The bill would coordinate assistance to AIDS orphans, such as health care, school food programs and inheritance rights. Democratic Sen. Barbara Boxer of California is proposing the same bill in the Senate. Worldwide, 15 million children have lost one or both parents to AIDS, according to the UNICEF report released this week.

Lee said she will continue to fight for a comprehensive AIDS policy and added a plug for her party. She said her battle would be a lot easier with a Democrat in the White House.

"Senator Kerry has a good position on this," she said. "We're going to fight to make sure we have an administration in November that will support comprehensive AIDS prevention."

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