Media's glowing reports on Bush's AIDS-relief program ignore criticism by the officials responsible for implementing it

In their coverage of World AIDS Day, several media outlets, including CNN, The Washington Post, The Indianapolis Star, and The Wall Street Journal, praised or uncritically reported praise of the President's Emergency Plan for AIDS Relief (PEPFAR). However, none of those outlets noted criticism of PEPFAR's requirement that starting in fiscal year 2006, 33 percent of funds set aside for prevention under the act that created PEPFAR be spent on abstinence-until-marriage education -- a provision the Bush administration reportedly lobbied Congress to add. According to many of the government officials responsible for managing PEPFAR abroad, as well as the Institute of Medicine (IOM), this requirement hindered PEPFAR's effectiveness in preventing the spread of AIDS. Congress removed the requirement when it reauthorized PEPFAR in 2008.

The following media outlets praised or uncritically reported praise of Bush's AIDS relief efforts:

• On the December 1 edition of CNN Newsroom, CNN correspondent Kathleen Koch stated that Bush's AIDS policy is "something that the president is quite proud of" and that "[t]he strides that the U.S. has helped make globally in the fight against HIV/AIDS" are "a really important part of his legacy."
• A December 2 Washington Post article reported that "Bush called his program to combat HIV/AIDS 'one of the most important initiatives of my administration' and praised it as a resounding success." The Post added: "The administration's HIV/AIDS initiative is a particular point of pride for Bush, who has received praise at home and abroad for his leadership on the issue."
• In a December 2 article, The Indianapolis Star uncritically reported that U.S. global AIDS coordinator Randall Tobias said that under Bush, the "U.S. has led the global fight against AIDS with the President's Emergency Plan for AIDS Relief."
• A December 1 post on The Wall Street Journal's Washington Wire blog reported that "[t]he White House is expected to roll out a series of retrospectives on President George W. Bush's achievements throughout the month of December" in order to "burnish" his "record." The post went on to report that "in remarks at the White House, Bush started with a recap of his substantial accomplishments on AIDS relief" and also uncritically reported Rev. Rick Warren's assertion that "[n]o man in history, no world leader has ever done more for global health than President George W. Bush, and I think we need to recognize that and I thank you for that."

None of these reports mentioned criticism of PEPFAR's abstinence-until-marriage requirement. According to a 2007 IOM report, "the abstinence-until-marriage budget allocation ... hampers ... PEPFAR's ability to meet the [prevention] target":

PEPFAR's approach to achieving the prevention target involves planning and implementing prevention programs and activities that are evidence-based, harmonized with country plans and priorities, and appropriate to each country's unique epidemiologic and cultural context. However, the abstinence-until-marriage budget allocation in the Leadership Act hampers these efforts and thus PEPFAR's ability to meet the target. Despite the efforts of the Office of the U.S. Global AIDS Coordinator to administer the allocation judiciously, it has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care, and treatment programs and that target those populations at greatest risk.

IOM further found that "the Committee has been unable to find evidence for the position that abstinence can stand alone or that 33 percent is the appropriate allocation for such activities even within integrated programs."

Moreover, in a 2006 report, the Government Accountability Office (GAO) noted the assessments of the "focus country teams" made up of the "U.S. agency officials responsible for managing PEPFAR in the focus countries." According to the GAO, "about half of the focus country teams told us that meeting the [abstinence] spending requirement can undermine the integration of prevention programs":

Satisfying the Leadership Act's abstinence-until-marriage spending requirement presents challenges to most country teams. Several focus country teams indicated that they value the ABC model [Abstain, Be faithful, or use Condoms] as an HIV/AIDS prevention tool and noted the importance of AB [abstinence/faithfulness] messages, particularly for certain populations. However, about half of the focus country teams told us that meeting the spending requirement can undermine the integration of prevention programs by forcing them to isolate funding for AB activities. Further, 17 of the 20 PEPFAR teams required to meet the spending requirement unless they obtain exemptions from it reported that the spending requirement presents challenges to their ability to respond to local epidemiology and cultural and social norms.

Additionally, in a November 2006 report titled "Bush's AIDS Initiative: Too Little Choice, Too Much Ideology," the Center for Public Integrity stated that Bush's AIDS relief policy "has enabled his administration to funnel tens of millions of dollars to Christian faith-based organizations that support his ideology and form his political base." The report quoted Dr. Paul Zeitz, executive director of the Global AIDS Alliance, asserting that PEPFAR "is failing to stop the global spread of AIDS and failing to help lead the world to stop this deadly disease. ... We have a flawed framework with flawed policies that have kept us from being where we should be by now."

According to a May 2, 2003, New York Times article, the abstinence-spending provision, added to the United States Leadership Against Global HIV/AIDS, Tuberculosis, and Malaria Act of 2003 as an amendment in the House, "was endorsed by the White House. Lawmakers said Vice President Dick Cheney called House members today to lobby for it."

A February 21 New York Times article reported that amid Democratic efforts to remove the abstinence spending requirement from PEPFAR, Bush "defended the requirement":

[F]or the first time on the trip, Mr. Bush faced tough questioning from an African reporter about his administration's requirement that one-third of the AIDS initiative's prevention funds be spent on programs promoting abstinence.

The independent Institute of Medicine has said the abstinence requirement is hindering prevention efforts. Democrats in Congress, debating reauthorization of the initiative, want it dropped.

Mr. Bush's questioner on Wednesday told the president that the requirement was not realistic, because "multiple sexual relationships or partner relationships is the reality" in African societies, "though it's not spoken of in public."

As he has in the past, Mr. Bush defended the requirement, but he then went a step further.

"I monitor the results," he said. "And if it looks like it's not working, then we'll change. But thus far I can report, at least to our citizens, that the program has been unbelievably effective. And we're going to stay at it."

Additionally, a February 18 article on the San Francisco Chronicle's website reported:

"It is a balanced program. It is an ABC program: abstinence, be faithful and condoms. It's a program that's been proven effective," he [Bush] said, speaking at a news conference with Tanzanian President Jakaya Mrisho Kikwete, an enthusiastic supporter of the effort.

"I understand there's voices on both ends of the political spectrum trying to alter the program," Bush said. "I would ask Congress to listen to leaders on the continent of Africa ... analyze what works, stop the squabbling and get the program reauthorized."

Congress subsequently passed the reauthorization bill, and Bush signed it on July 30. According to a 2008 GAO report, the bill "removes the abstinence-until-marriage spending requirement and calls for the Global AIDS Coordinator to ensure that abstinence and fidelity programs are evidence-based and country-based."

From the 11 a.m. ET hour of the December 1 edition of CNN Newsroom:

HARRIS: Today, World AIDS Day. Take a look at this. That means four people will be infected while I'm on your television screen. Today is the 20th World AIDS Day. Globally, 33 million people are believed to be infected with HIV. CNN's Kathleen Koch is at the White House, where a gigantic red ribbon decorates the North Portico. Kathleen, good morning to you. Quite a sight.

KOCH: Yes indeed, Tony. This very same ribbon actually graced the North Portico, if you'll remember, last year on World AIDS Day. And it's important to point out that this is a really -- something that the president is quite proud of, the strides that the U.S. has helped make globally in the fight against HIV/AIDS, a really important part of his legacy. And he and the first lady came out on the North Lawn about an hour and a half ago underneath this great, huge ribbon that's gracing the North Portico.

And the president talked about how his President's Emergency Plan for AIDS Relief, known in the shorthand version as PEPFAR most of the time -- how it finally has reached the goal that it set back in 2003, when it started, of increasing the number of people who are receiving anti-retroviral treatment for HIV/AIDS from 50,000 -- that was the number in 2003 -- to 2 million within just five years.

BUSH [video clip]: When PEPFAR began, only 50,000 people living with HIV in all of sub-Sahara Africa were receiving anti-retroviral treatment. Around the world, we've also supported care for more than 10 million people affected by HIV, including more than 4 million orphans and vulnerable children. More than 237,000 babies had been born HIV-free thanks to the support of the American people for programs to prevent mothers from passing the virus on to their children.

KOCH: Now, for the last hour or so, the president has been participating across town in a civil forum in global health here in Washington. And the president receiving a touching video tribute, not only from U.N. -- the head of the U.N., Ban Ki-moon, but from Bono, from Bill Gates. The president also reflected on how he got involved in fighting this global pandemic of AIDS, and he talked about, if he'd done nothing about it, how he would have, quote, "disgraced the office of the presidency." And he also discussed how he was surrounded by people who felt this was just such an important cause for the United States to take up, people including Secretary of State Condoleezza Rice.

Now, looking at the program, the president did just in July sign legislation that will authorize another $48 billion, Tony, to expand the program.

HARRIS: All right, Kathleen Koch. Wow, that's quite a figure right there.

KOCH: Quite a lot.

HARRIS: Yeah. At the White House for us, Kathleen, thank you.