If there was any remaining doubt that George W. Bush is the AIDS community’s new No. 1 enemy, it was erased by an avalanche of recent actions.

1. After a year’s delay, Bush finally named a surgeon general: Richard Carmona, MD, a gun-toting, anti-abortion Bush campaign contributor and former Green Beret who, as a deputy sheriff in Arizona, was named one of the nation’s “10 Top Cops” by a police lobby. Carmona was trained as a trauma surgeon, but his only significant public health experience was heading bioterrorism planning for the southern half of his state. In announcing his choice, calculated to help win the Latino vote in 2004, Bush emphasized Carmona’s priority mission as fighting bioterrorism; AIDS was never mentioned. It’s hard to see this appointment as anything other than the conscription of the public health service in Bush’s failing war on terrorism -- disastrous for efforts to make HIV treatment and prevention a priority. Since his appointment in March, Carmona has been as silent on AIDS as a grave. But he’s just following his boss’s lead: When Bush proclaimed National Disease Prevention Month in May, AIDS was bizarrely absent from his concerns.

2. At the same time, Bush at long last named a new head for the National Institutes of Health, replacing a distinguished Nobel Prize-winning researcher with Elias Zerhouni, MD, a radiologist who assisted with Ronald Reagan’s colon surgery. As the head of Johns Hopkins’ medical research division, Zerhouni turned it into “a very business-driven operation,” as his former boss at the university told The Washington Post, while running a for-profit company on the side. The nation’s greedy drug companies were doubtless thrilled by this appointment, but introducing a profit-motivated entrepreneur into our premier public-health research entity likely means more sweetheart deals with Big Pharma -- not good news for the fight against AIDS.

3. Bush’s Health and Human Services (HHS) Department is about to shred protections of your medical privacy: Under new rules to be promulgated in October (barring a congressional outcry), doctors and hospitals will be required to open medical records to government agencies any time they ask, without so much as a court order. The new regs mandate creating a patient database for every possible ailment, coded down to individual visits, to make it easier for profit-making concerns to access this info under existing data-sharing agreements. With no meaningful federal protection against HIV discrimination in insurance or employment, this is frightening stuff indeed.

4. HHS head Tommy Thompson has also installed a team at the Centers for Disease Control and Prevention (CDC) to audit the way it makes funding decisions -- in part, a witch hunt for any sex-education efforts that the censorial Bush crowd finds “obscene.” In fact, safe-sex materials have all but disappeared from the CDC’s catalog (with a malevolent trickle-down effect, since municipal health departments follow the CDC’s lead). AIDS prevention groups that offer explicit, easy-to-understand instruction on how to avoid HIV through condoms and clean needles are even seeing their website links purged from the CDC’s computer offerings. This ongoing audit threatens organizations that offer comprehensive sex-ed programs with loss of federal funds, creating a reign of terror that could cripple already-inadequate HIV prevention.

Most execs of AIDS agencies, which are typically dependent on federal funds, are fearful of speaking out. But Lora Branch, director of lesbian and gay health for the Chicago Department of Public Health, says, “It’s a scary time. We are experiencing something I’ve never seen before, this rigid approach to prevention and treatment. The kind of auditing [the CDC] is proposing is troubling -- they’re trying to evaluate using measures that are inaccurate. Prevention experts are the ones who should make decisions.”

5. Bush is not content with imposing an ostrich-like policy of abstinence-only on the U.S. -- he’s made his crusade global. At the UN Special Session on Children in May, Bush formed an unholy alliance with “axis of evil” countries Iran and Iraq to eliminate from the official declaration any references to the right of the world’s children to “reproductive health services and education,” including condoms for HIV prevention. Adrienne Germaine, head of the International Women’s Health Coalition, says the U.S. “behaved like a big bully,” threatening countries with trade and aid reprisals if they didn’t toe the no-condoms, abstinence-only, anti-abortion line.

Democrats may have mustered little opposition to Bush’s war on condoms, but if the Republicans gain control of the Senate, it will certainly get worse. It’s up to you to say no to Bush’s paleolithic obscurantism on election day in November.