The Politics of AIDS: Engaging Conservative Activists

Holly Burkhalter

From Foreign Affairs, January/February 2004

Summary:  American evangelicals have put the fight against AIDS on Washington's map, even while clashing with other activists over strategy. Now all must unite behind a comprehensive approach stressing effective practices in prevention and treatment.

Holly Burkhalter is Director of U.S. Policy and of the Health Action AIDS campaign at Physicians for Human Rights.

In 2001, accordingly, UN Secretary-General Kofi Annan announced the creation of the Global Fund to fight AIDS and other infectious diseases and asked wealthy donor nations for $7 billion to $10 billion a year. In June that year the UN General Assembly met in special session and endorsed a comprehensive approach to disease management, including integrated prevention, care, and treatment. President Bush pledged $200 million to Annan's fund and boosted bilateral assistance efforts, but U.S. funding for foreign AIDS programs still hovered at less than a fifth of what activists considered an appropriate share of the global burden. After that, support for treatment for people with AIDS in the world's poorest countries gradually increased in Congress and among nongovernmental organizations. But the real turning point in American AIDS policy came when conservative Christians made the cause their own.

ENTER THE EVANGELISTS

In February 2002, Franklin Graham, son of Billy Graham and founder of Samaritan's Purse, an evangelical charity based in South Carolina, convened the first "international Christian conference on HIV/AIDS." More than 800 evangelical Protestant and Catholic leaders and overseas missionaries from AIDS-stricken countries gathered in Washington, D.C., for the meeting, titled "Prescription for Hope," and demanded treatment for the sick and the dying. Graham's superstar status among evangelicals and the conference's state-of-the-art visuals, gospel choruses, and heartbreaking testimony from African ministers and health workers convinced American religious conservatives that it was their moral duty to do something about the pandemic.

The highlight of the conference came when 81-year-old Senator Jesse Helms (R-N.C.) stated, "I'm so ashamed that I have done so little" to help the victims of AIDS in Africa. Within days, the senator published an op-ed in The Washington Post promising to secure $500 million to prevent mother-to-child transmission of the disease. By focusing on the "innocent victims" of AIDS, Helms publicized the fact that in Africa the disease was usually transmitted heterosexually, reaching audiences who had previously disregarded its spread among homosexuals or considered it a God-sent punishment.

President Bush went on to make a dramatic commitment to tackling the pandemic in his 2003 State of the Union address. In a speech designed to prepare the world for war in Iraq, the president announced an "Emergency Plan for AIDS Relief" and committed $15 billion over five years to the cause. The plan promised to provide treatment for two million people and enough support to prevent seven million new HIV transmissions in Africa and the Caribbean. Although scale-up of this program has been slow, the conservatives' endorsement of the president's intention to put millions of people on anti-retroviral therapy has settled the controversy over treatment once and for all.

TRANSMISSION PROBLEMS

Conservatives have also provided welcome leadership in helping reduce the transmission of HIV/AIDS through unsafe needles and blood transfusions. According to the WHO, unsafe health care accounts for at least 500,000 new AIDS transmissions every year and possibly many more. Yet reducing this number has not been a priority for the international health establishment, which considers such numbers trivial compared to the number of people infected through heterosexual intercourse. But a leading Senate conservative, Republican Jeff Sessions of Alabama, has taken this issue to heart.

When a new study was published in early 2003 suggesting that transmissions from unsafe health care could represent far more than seven to ten percent of new cases, as the WHO estimates, The Washington Times covered the story, conservative groups picked it up, and Sessions held two Senate hearings on it. Some AIDS activists feared that religious conservatives would use the issue to discredit and undermine prevention efforts and justify diverting funds from condom distribution and reproductive health programs. But Sessions' safe health care initiative proved them wrong. While calling for new studies to clarify the source of AIDS transmission, Sessions neither refuted the role of sexual transmission in the pandemic nor criticized safe-sex programs. By the end of 2003 he had built bipartisan support for mainstreaming the issue of injection and blood safety into U.S.-funded prevention strategies, reversing decades of neglect and offering considerable support for building proper health infrastructure in the poorest countries in Africa.