Bush insider recounts how ideology trumped science on US AIDS policy

BMJ 2009; 339 doi: (Published 21 December 2009) Cite this as: BMJ 2009;339:b5525
  1. Bob Roehr
  1. 1Washington DC

    Ideology not science drove the prevention side of PEPFAR, the US international HIV/AIDS programme, during the Bush administration, an insider with personal knowledge of the situation said last week. The charge is not new but the source and the details are. They came at a forum at the liberal think tank The Center for American Progress.

    They are contained in a new report and recommendations, “How Ideology Trumped Science: Why PEPFAR has failed to meet its potential,” written by Scott Evertz, which is to be published shortly. He was the domestic “AIDS Czar” appointed by President George Bush in 2001. He lasted only 15 months before being shifted to a position in the department of health dealing with AIDS internationally.

    Speaking at the forum, Mr Evertz called PEPFAR (President’s Emergency Program for AIDS Relief ) “a heroic programme of monumental consequences” in terms of testing, treatment, prevention of mother to child transmission, and care for orphans. “However, from the very early discussions about the PEPFAR programme it became patently clear to me that we weren’t going to discuss certain harm reduction strategies in relation to either our domestic or international programming.”

    Bush “did indicate to me rather strongly that needle exchange and condom …

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