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New Limits On AIDS Funding Abroad

U.S. nongovernmental organizations fighting AIDS abroad have an ultimatum from the Bush administration: Pledge active opposition to sex trafficking and prostitution, or operate without federal money.

The new rule has created confusion among health groups, wondering how it will affect them, and has drawn criticism from others who say it infringes on free speech rights and could do more harm than good.

It will affect about $2.2 billion in AIDS grants and contracts this year, said Kent Hill, acting administrator for global health at the U.S. Agency for International Development, which issued a policy directive outlining the regulation.

Hill said the pledge is a way for the United States to take a stand against a life he called degrading and debilitating.

"Prostitution is not a positive for the people who are involved in it," Hill said. "The vast majority of people, globally, do not find themselves there by choice."

One of those troubled by free speech issues the pledge requirement raises is Terri Bartlett, vice president for public policy at Population Action International, a health advocacy group for women's issues.

"There's a litmus test of issues and organizations' positions on those issues, and regardless of their ability, they will be judged by that position," Bartlett said.

Bartlett said while she agreed with the pledge requirement's premise that prostitution is a harmful occupation, it may have the unintended effect of deterring prostitutes from seeking help by unnecessarily singling them out.

"We want to build trust and reduce stigma," Bartlett said, speaking of people in the high-risk world of prostitution. "This policy flies in the face of what we know works."

Congress ordered the pledge requirement in 2003. It was immediately applied to foreign aid recipients, but the Justice Department questioned the constitutionality of applying it to domestic organizations. Last fall, the department gave the all-clear for the government to implement the requirement here as well.

The rule now affects private U.S. groups in their conduct of AIDS programs overseas. If a group seeks a federal grant or contract, it first must adopt a statement that it explicitly opposes prostitution and sex trafficking. Then it must sign a government form that it has the policy. Only then is the organization eligible to receive money under President George W. Bush's showcase program to fight HIV-AIDS abroad.

Michael Wiest, vice president of Catholic Relief Services, a recipient of USAID funds, said it would take a lot of time and money to make sure his organization wasn't working with foreign partner groups that might violate the pledge. That would be wasted energy, he said, because "the idea that one of our partners would be pro-prostitution is ... off the charts."

Although the bill that contained the funding restrictions passed with broad bipartisan support, David Olson, a spokesman for Population Services International, said he worries that the rules will be used against groups that use methods unacceptable to conservatives.

"This administration has made no secret that they want new partners for AIDS work," Olson said.

He said conservatives favor AIDS prevention programs that focus on abstinence and monogamy, rather than ones that endorse condom use and safe sex.

Sen. Tom Coburn, a conservative Republican from Oklahoma, made statements to that effect in a letter he wrote Bush regarding AIDS programs last month. He specifically criticized USAID for financing Olson's group, which has programs aimed at educating prostitutes and their clients in nightclubs and at bingo-type games where the two groups traditionally mix.

"There is something seriously askew at USAID when the agency's response to a dehumanizing and abusive practice that exploits women and young girls is parties and games," Coburn's letter said.

The anti-prostitution pledge rule is a continuation of conservative policy shifts the Bush administration has implemented for nongovernmental organizations.

On Bush's first day in office in 2001, he reinstated the "Mexico City policy," which prohibits private, foreign groups that receive federal family planning money from advising or even discussing the possibility of abortions for clients.

The policy, called the "global gag rule" by critics, originated during President Reagan's era but was dropped during President Clinton's.

Besides the pledge, the new rules require AIDS groups to inform clients of condom failure rates. Another requirement is that the federal government must now provide equal opportunity to receiving money to applicants with "a religious or moral objection" to a particular AIDS prevention method or treatment program, such as condoms or needle exchanges.

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