If there’s one thing the current administration has proven during its tumultuous White House tenure—after 9/11, after Hurricane Katrina—it’s the fact that everything—disease, disaster and death included—has a political dimension.

So, it really shouldn’t be surprising that under Bush the U.S. response to the global AIDS epidemic, the largest health crisis the world has ever faced—a disease that took the lives of 2.8 million people in 2005 alone according to a recent UNAIDS report—has become the nexus of a massive morality campaign.

“The Bush administration truly believes that the key to fighting the pandemic is abstinence and fidelity,” said Sandy Krawitz, Communications Manager of ActionAid International USA. “The problem is: You cannot monitor the world’s bedroom habits. It’s impossible: these people are adults.”

A 2003 law authorizing the use of $15 billion over five years to combat AIDS has been held up as a showpiece humanitarian victory for the Bush administration. But that money, which is channeled through a program called The President’s Emergency Plan for AIDS Relief (PEPFAR), is being spent in ways many experts consider counterproductive.

“Scientifically, we know that in order to stop the AIDS pandemic you need to distribute condoms,” Krawitz said. “You need to talk to people in a real-world manner, to be open about sexuality and how HIV is transmitted and how to stop it from being transmitted.”

And PEPFAR ideology does encourage condom use, but only as a last resort.

“The United States is working with our partners to provide treatment and expand prevention efforts that emphasize abstinence, faithfulness in marriage, and the correct use of condoms,” according to a White House press website. “This strategy—pioneered by Africans—has proven its effectiveness, and America stands behind the ABC approach to prevention.”

Former U.S. Global AIDS Coordinator Randall Tobias went even further in 2004 statement to Agence France-Presse, in which he actually questioned the role of condoms in AIDS prevention.

“Statistics show that condoms really have not been very effective," Tobias said. "It's been the principal prevention device for the last 20 years, and I think one needs only to look at what's happening with the infection rates in the world to recognize that has not been working."

Even if the ABC approach, as defined by the U.S., was as effective as the White House claims, PEPFAR’s prevention efforts are proportionately underfunded.

“More than half the total required for the AIDS response each year should go to prevention, due to the many elements that make up comprehensive prevention programs and the large populations they must reach,” according to The UNAIDS 2006 Report on the Global Aids Epidemic. But PEPFAR, which could account for 75 percent of bilateral AIDS assistance by 2007, sets aside just 20 percent of its funding for prevention. And at least, 33 percent of that money must be spent on abstinence-based programs despite limited evidence that such programs work.

“Abstinence programs may have some relevance, but ultimately their effectiveness has not been proven,” said AIDS specialist Dr. Perry Halkitis, Director of Research at the Steinhardt School of New York University. “That approach does not seem particularly directed by the research that I am familiar with.”

On the ground, the PEPFAR’s success is equally questionable. The situation in South Africa, for instance—a centerpiece of the program, which receives more PEPFAR aid than any country except Uganda—continues to get worse.

“South Africa’s AIDS epidemic, one of the worst in the world, shows no evidence of a decline. Based on its extensive antenatal clinic surveillance system, as well as national surveys with HIV testing and mortality data from its civil registration system, an estimated 5.5 million people were living with HIV in 2005,” according to the UNAIDS report. “An estimated 18.8 percent of adults were living with HIV in 2005. Almost one in three pregnant women attending public antenatal clinics were living with HIV in 2004 and trends over time show a gradual increase in HIV prevalence.”

In a possible jab at the U.S., the UNAIDS report points out four pages prior to the section dealing specifically with PEPFAR that “over the last few years, many countries have developed national AIDS plans to guide their responses but, in many cases, the plans have not been sufficiently strategic, evidence-based and targeted.”

The Bush administration’s ideologically charged approach to AIDS prevention has implications reaching far beyond PEPFAR.

Between May 31 and June 2, a series of “high-level meetings” on the global AIDS response took place at the United Nations in New York. They culminated in a “political declaration” that disappointed most AIDS activists.

“Clearly, the declaration was a battleground document,” said Julie Davids, Executive Director of the Community HIV/AIDS Mobilization Project (CHAMP). “I think it shows that there are leaders of countries around the world who are prepared to put their ideological interests ahead of public health.”

The declaration has been criticized both for lacking concrete targets and failing to explicitly mention high-risk groups such as sex workers, “men who have sex with men” (including those who don’t identify themselves as gay) and injecting drug users.

“It basically says, here’s some things you can consider that probably should happen for fighting AIDS, but if it makes you uncomfortable, don’t worry about it,” Davids said. “That’s not a very strong declaration.”

And, while the meetings leading up to the declaration were complex and involved representatives of many countries, there is little question the U.S. delegation played a decisive role in their final outcome.

“No one underestimated how difficult it would be to have a good declaration come out of those meetings,” Davids said. “However, it was made distinctly harder by having our own country lead the charge to divide nations, to promote dangerous and ideologically based approaches and to be a force of disruption in this process.”

The inclusion of language explicitly referring to high-risk groups such as prostitutes in the declaration might have been perceived by the U.S. delegation as inconsistent with PEPFAR ideology: the program requires all countries receiving aid to adopt a “policy explicitly opposing prostitution and sex trafficking.”

This seemingly innocuous caveat has proven highly controversial; in 2005, Brazil turned down $40 million in PEPFAR funding because of it.

“Prostitution is illegal in Brazil,” Krawitz said. “But working with prostitutes is also a mainstay of their prevention program: they had to work with prostitutes in order to make sure this pandemic is halted in its tracks. So they turned down that money, and I tend to think they did the right thing.”

Domestic groups are also feeling the sting of this hard-line stance on organizations that help prostitutes. Robyn Pew, Executive Director of the Sex Workers Outreach Project—who said her organization has lost all federal funding in recent years—was not in the least surprised by the omissions in the UN political declaration.

“These groups are completely leaving out words like prostitution because of the Bush administration. They don’t even put them in the declaration because they are afraid of losing money, losing funding from this powerful country.”

Political influence is increasingly noticeable in academic spheres as well.

“Under the Clinton administration, we saw the proliferation of programs around HIV that were very progressive in their thinking,” Halkitis said. “In that last several years, the grant applications and programs that have been pushed have been mostly based on these faith-based ideologies that are clearly a representation of the political thinking in Washington.”

While these disputes over morality and language continue, with no end in sight, AIDS continues to ravage the planet, with no end in sight.

“[Promoting abstinence] is a nice ideological approach,” Krawitz said. “In a perfect world, yes, it’s good, people should be faithful to one another. That’s what marriage is all about. But we’re in a crisis here: people are dying. Eighty-five hundred people are dying a day; we don’t have time to play with mere ideology when lives are on the line. We have to approach this in a scientific way or else there’s just going to be more death, more disease and more pain.”