MB Civic

President Bush deserves much credit for sharply increasing United States financing for AIDS prevention programs overseas. But along with Congress, he must also shoulder the blame for letting ideology rather than sound public health policy drive how the money is spent.

The elevation of ideology over both science and local needs is deadly in this case. A new report by the Government Accountability Office, an investigative arm of Congress, finds that efforts to stem the AIDS pandemic are being undermined by the insistence of Republican Congressional leaders and the administration that an unduly large portion of the funds be used to emphasize sexual abstinence and fidelity.

Based on candid and confidential in-depth interviews with American officials carrying out AIDS prevention programs financed by the United States in 15 countries, the G.A.O.’s assessment should weigh heavily on the president’s conscience, and inspire a change of policy.

Because of a very bad amendment tagged onto the law financing global AIDS efforts, fully 33 percent of prevention funds must be used for abstinence-until-marriage and fidelity programs. That drastically limits the money and flexibility for broader, proven strategies to combat AIDS, including the condom part of the so-called ABC approach: abstain, be faithful or use condoms.

Apart from ignoring human nature, the stress on abstinence largely ignores the situation in countries like India or Russia, which have exploding H.I.V. and AIDS problems stemming largely from the intravenous use of illegal drugs and prostitution. The administration has added rules that effectively raise the spending for abstinence-only programs in some countries to well in excess of 33 percent.

The result, according to the G.A.O. review, is abstinence overkill, with some countries having to cut spending on effective prevention strategies, including programs to prevent the transmission of H.I.V. from infected mothers to their newborn infants. That is indefensible.

With no intervention, a pregnant woman with H.I.V. stands a large chance of infecting her infant at birth or during breast-feeding — a possible death sentence because, without treatment, some 60 percent of infected children die by their third birthdays. The experience in developing countries is that inexpensive treatment with antiretroviral drugs can reduce the risk of transmission by up to half.

While promoting abstinence and faithfulness is important, de-emphasizing effective programs that involve condoms, as the administration has been doing, is a dangerous strategy.