I’m writing this two weeks before the election hoping to hell that John Kerry saves us from George W. Bush’s domestic AIDS policies. For months, the HIV community has cared about little else. But you’re reading this two weeks after the election. And you’re feeling…what? Even if the White House is liberated, regime change is only a start. Undoing the devastation of Bush’s fundamentalist crusade may prove harder than any of us imagine, especially amid a pack of rabid congressional HIVer-phobes. Indeed, Dr. Margaret Scarlett, a 17-year CDC researcher who quit in 2001 over Bush’s abstinence-only blitzkrieg, predicts that repairing HIV prevention alone may take an entire generation. Given how fast HIV moves, those are lousy odds for high-risk gay guys like me.
I called Dr. Scarlett to discuss the latest rout we’ve suffered in the war on condoms, safe sex and science. In June, the CDC sneakily announced a historic revision of the rules governing all federally funded HIV prevention. (The draft regs were then posted for public comment for two months; they would presumably take effect in a second Bush junta.) Amid Iraq bombings and beheadings, of course, and an exploding election season, the press and public tend to ignore agency drafts. And that’s precisely the goal. As Doug Ireland wrote in the LA Weekly, “It’s all couched in arcane bureaucratese, but this is the Bush administration’s Big Stick.” The CDC soft-pedaled these censorship rules as innovations that keep pace with evolving technology and data. But this Big Stick will knock the agency’s mission from the hands of its fast-diminishing scientists into the laps of the ideologists and opportunists clamoring for civil-service sinecure. All talk about condoms must now mention their “lack of effectiveness”—pure junk-science hysteria. All talk about sex, meanwhile, must clear state health officials, accountable not to the materials’ high-risk audience but to the politicians who appoint them. The Big Stick will also knock the HIV community, especially gay activists, from our hard-won place at the table. Facing the dilemma of doing bad or no prevention with their federal funds, however, few of our 3,800 AIDS service organizations found time for public comment; none protested.
But Dr. Margaret Scarlett did both. In the September 20 Boston Globe, she said, “The battle over the guidelines was viewed within…the CDC as emblematic of a broader struggle for the soul of the agency.” With me, she was even more blunt. “The new initiative is public-health malpractice,” she said. “The most scientifically sound message is that condoms, used consistently and correctly, work—end of story. But the new regulations give priority to abstinence, which is only 87 percent effective against HIV in actual practice. Whereas, the CDC’s own fact sheets before Bush cited four studies proving condoms worked 95 percent or better.” The human cost of Bush’s unprecedented subversion of facts via faith-based politics? Escalating HIV rates in every high-risk group. “By now, very few scientists are left at the CDC who even do prevention,” she said.
Dr. Scarlett described how AIDS had revolutionized the CDC, forcing divisive issues like sex into the open and heightening the inevitable conflicts between science and ideology. Starting in the ’80s, the institution struggled, often heroically, to do the right thing; leaders like conservative Christian Surgeon General C. Everett Koop and staunch Mormon Dr. James Mason spoke out honestly about HIV transmission and homosexuality, promoted condom research and consulted with HIVers, establishing a tradition that prized public health above politics and religion. Under George W. Bush, that tradition, the institution itself, is dead. “It’ll take more than John Kerry to fix this mess,” Dr. Scarlett said. Where to start? “How about some good old-fashioned activism demanding transparency and accountability at the CDC for funding real prevention?”
Whether we get Kerry or Bush, it’s crisis time in AIDS—again. I don’t know about you, but I’m putting my queer shoulder to the wheel—again.